Children's Health Insurance Program Overview



The Children’s Health Insurance Program (CHIP) was created by the Balanced Budget Act of 1997 and enacted Title XXI of the Social Security Act. CHIP is a joint 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, the law was reauthorized again. Among many provisions, the laws extend the authorization of the federal CHIP program for an additional two 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. 

States receive an enhanced federal match that exceeds the federal match for state Medicaid funding.  From 2015-2016, CHIP allocated over $25.5 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. When states finance CHIP pregnancy care, eligibility is determined by income as a proportion of the Federal Poverty Line. By covering prenatal checkups and other services, CHIP encourages maternal health while establishing access to care for the unborn child.

Federal and state policymakers are currently balancing the need to address competing priorities and the need to provide program stability. In December, 2016, the Medicaid and CHIP Payment Advisory Commission recommended a (five year) extension, citing reductions in children’s uninsurance rates and CHIP’s recognition of states’ role as laboratories for innovation. CHIP is due to expire in September 2017, although services are financed until September, 2019. Congressional action is required for CHIP to continue.

Additional Federal and State CHIP policy is summarized in the following resources:

State Examples:

Resources will be posted soon


NCSL CHIP Resources

CMS Final Rule Governing Medicaid and CHIP Programs Delivered in Managed Care - NCSL Federal Report, Rachel Morgan, July 2016

NCSL Report on Medicaid/CHIP Managed Care Final Rule NCSL Fact Sheet, Rachel Morgan, July 2016

NCSL Health Reform: Medicaid and CHIP - NCSL Resource, 2015

NCSL Health Reform Database NCSL Database, 2016


Additional CHIP Resources

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

State Medicaid and CHIP Profiles -

Health Reform Implementation Resource - Centers for Medicare and Medicaid Services

Helping Pregnant Women Navigate the New Coverage Landscape American Congress of Obstetricians and Gynecologists, NCSL Learning Collaborative, June 2016


NOTE: NCSL provides links to other websites for information purposes only. Providing these links does not necessarily indicate NCSL's support or endorsement of the site.

This site is made possible by project, UC4MC21528, from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, U.S. Department of Health and Human Services.