The Children’s Health Insurance Program (CHIP)

Published: 10/19/2022

ACP has been a staunch supporter of the Children’s House Insurance Program (CHIP) and has advocated for a long-term extension of funding for the program and for enhanced eligibility for children in Medicaid and CHIP.  ACP also joined forces with a coalition of five other front line physician organizations to advocate for continued funding for CHIP and other key federal workforce programs that support primary care and has called for CHIP’s permanent extension.


The Children’s Health Insurance Program (CHIP) is a federal-state financed program that provides health insurance to about 9 million children in families who are ineligible for Medicaid and unable to purchase private coverage.  Since its inception in 1997, CHIP, together with Medicaid, has helped to reduce the number of uninsured children by a remarkable 68 percent. CHIP has a proven track record of providing high-quality, cost-effective coverage for low-income children and pregnant women in working families.

CHIP is funded jointly by the federal government and states through a formula based on the Medicaid Federal Medical Assistance Percentage (FMAP).  See FMAP rates for Medicaid by state. As an incentive for states to expand their coverage programs for children, Congress created an “enhanced” federal matching rate for CHIP that is generally about 15 percentage points higher than the Medicaid rate — averaging 71 percent nationally. For example, if a state has a 50 percent match rate for Medicaid, they may have a 65 percent match rate for CHIP. See FMAP rates for CHIP by state.

Federal Activity

On March 18, 2020, the Families First Coronavirus Response Act (FFCRA) was enacted to respond to the COVID-19 public health emergency (PHE). The FFCRA provides states with a temporary 6.2 percent payment increase in FMAP funding. States qualify for this enhanced funding by adhering to the Maintenance of Effort requirement, which ensures eligible people enrolled in Medicaid stay enrolled and covered during the PHE. This requirement increased retention in Medicaid and potentially reduced churn in and out of the program. The additional funds are available to states from January 1, 2020 through the quarter in which the public health emergency period ends.

Federal funding for CHIP expired for a period of months back in 2017 because Congress did not intervene and pass legislation to extend funding for the program.  This caused great instability for states administering the program and for families who relied on CHIP coverage and, in some instances, states began taking measures to shutter their CHIP programs due to lack of funds.  Fortunately, as part of a continuing resolution to fund the federal government, legislation was enacted on Jan. 22, 2018 to reinstate funding for CHIP for five years until 2023. Legislation was later enacted in February 2018, the Bipartisan Budget Act of 2018, that provided an additional four years of funding for CHIP giving the program a 10-year combined reauthorization.  ACP has called for CHIP to be extended permanently.

In August 2022, President Biden signed into law the Inflation Reduction Act (H.R. 5376).  Beginning in October 2023, the Act expands coverage of ACIP-recommended adult vaccines without enrollee cost sharing under Medicaid and CHIP by mandating such coverage for (1) enrollees who receive coverage under traditional Medicaid; (2) nearly all Medicaid Medically Needy enrollees in specified states; and (3) CHIP enrollees 19 years of age or older.

State Activity

Approximately two-thirds of states have implemented continuous coverage for children in Medicaid and/or CHIP, which allows enrolled children to maintain coverage for a year-long period despite monthly fluctuations in family income which may otherwise cause gaps in coverage.  In September 2022, Oregon became the first state to provide multi-year continuous coverage for children under age 6 after being approved for a waiver under Section 1115 of the Social Security Act by the Centers for Medicare and Medicaid Services (CMS).  Section 1115 demonstrations allow states to waive certain requirements and have been used to expand eligibility, test delivery systems reforms, and establish managed care organizations, and ACP’s position paper Medicaid Expansion: Premium Assistance and Other Options includes a number of recommendations on how waivers should be constructed. For initial 1115 waiver submissions and extensions of existing waivers, states are mandated to have a public notice and comment period of at least 30 days.  Once the state has submitted the application to the federal government and it has been deemed to be complete, a 30-day federal public comment period begins. States are mandated to have a public notice and comment period of at least 30 days.  Once the state has submitted the application to the federal government and it has been deemed to be complete, a 30-day federal public comment period begins. California, New Mexico, and Washington have also submitted Section 1115 waivers to CMS to implement similar policies as the Oregon waiver. If you have questions regarding a waiver in your state, please contact ACP National through the Advocacy Assistance Request Form.