Children's Health Insurance Program Overview



The Balanced Budget Act of 1997 created the Children’s Health Insurance Program (CHIP) and enacted Title XXI of the Social Security Act. CHIP is a state-federal partnership that provides health insurance to low-income children. In February 2009, President Obama signed the Children Health Insurance Program Reauthorization Act of 2009, extending CHIP through 2013. The Affordable Care Act (ACA) extended CHIP an additional two years through 2015. In 2015, Congress reauthorized the law. Among many provisions, the laws extend the authorization of the federal CHIP program for an additional 2 years, through September 30, 2017. States are prohibited from implementing eligibility standards, methodologies or procedures that are more restrictive than those in place as of March 23, 2010, with the exception of waiting lists for enrolling children in CHIP. In January of 2018, Congress passed a 6-year extension. Congress then extended the program another 4 years after the Congressional Budget Office released a report stating a 10-year extension would save $6 billion.

States receive an enhanced federal match for CHIP that exceeds the federal match for state Medicaid funding. From 2017-2018, CHIP allocated over $28 billion to help states insure low income children who are ineligible for Medicaid but cannot afford private insurance.

Given the link between maternal health and infant health, states have the option to cover pregnant women at various stages of pregnancy through the CHIP program. There is a high level of variation in CHIP coverage for pregnant women. By covering prenatal checkups and other services, CHIP encourages maternal health while establishing access to care until the child is born.

CHIP programs look different state to state. Federal law allows states to choose from three different program designs for their CHIP programs:

  1. The separate CHIP program model allows states to design their programs within the statutes of the CHIP program.
  2. The Medicaid expansion model allows states to cover CHIP-eligible children through the Medicaid program.
  3. The combination CHIP program model allows states to use elements of the separate CHIP and Medicaid expansion models.


Additional Resources

Federal Legislative Milestones in Medicaid and CHIP | Medicaid and CHIP Payment Advisory Commission

State Medicaid and CHIP Profiles |

Medicaid and CHIP Managed Care Rules | Centers for Medicare & Medicaid Services, April 2016

Preventing Infant and Maternal Mortality: State Policy Options – NCSL Issue Brief, 2019

CHIP Quality and Performance |


This project is supported by the Maternal and Child Health Bureau (MCHB), Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U1XMC31659-02-00, Supporting State Maternal and Child Health Policy Innovation Program. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.