Children’s Health Insurance Program (CHIP) advocacy

Doctor examining child patient.

The Children’s Health Insurance Program (CHIP) has improved health care coverage for millions of patients and ensured their access to primary care.

Family physicians benefit when CHIP has stable funding and robust federal support.

Why CHIP matters for children’s health

Seventy-four percent of family physicians care for infants and children. Nationwide, Medicaid and CHIP together serve some 77 million people, including about half of the nation’s children. Since its 1997 inception, CHIP has considerably improved children’s health. Among other impacts, the program has:

  • Reduced the number of uninsured children

  • Strengthened the continuity of health coverage for children

  • Helped ensure children’s health care during economic downturns and public health crises such as the COVID-19 pandemic

Beyond covering children directly, CHIP has led to more eligible children receiving Medicaid.

7.2M

Number of children enrolled in CHIP as of July 2025

Medicaid & CHIP Enrollment Data Highlights

Research has linked CHIP and Medicaid coverage of pregnant and postpartum patients and children with long-term benefits continuing into adulthood, including:

  • Better overall health

  • Reduced disability

  • Greater educational attainment

  • Better financial outcomes

AAFP advocacy to maintain and strengthen CHIP

Because nearly 65% of family physicians participate in Medicaid and provide care for children, the Academy advocates for a strong CHIP with the fewest possible barriers to coverage.

Unlike Medicaid, CHIP is a block-grant program that congress must regularly reauthorize and fund. It is funded through 2027. CHIP's most recent reauthorization, via the Bipartisan Budget Act of 2018, extended the program through 2027. The Academy was significantly involved in passing that legislation and continues to call for CHIP’s ongoing authorization as well as enhancements to increase access to comprehensive, equitable and high-quality health care for minors.

Key issues in CHIP advocacy

  • Medicaid expansion

    The Academy’s CHIP advocacy is part of efforts to expand the Medicaid program in all 50 states, increasing care access for low-income individuals and families.

  • Enrollment barriers

    Like Medicaid, CHIP is a federal-state partnership, granting states considerable flexibility in program design and operation, within federal guardrails. Because states largely set CHIP policy, the AAFP supports chapter advocacy in Medicaid and CHIP access policies. Chapter advocates are instrumental in urging policy that lowers barriers to CHIP coverage rather than introducing limitations such as income or work requirements.

  • Enrollment churn

    Income and employment changes among Medicaid enrollees and parents whose children are enrolled in CHIP can lead to patterns of disenrollment and reenrollment, which disrupt longitudinal care.

The AAFP supports rulemaking to reduce this so-called coverage churn and called for policies that:

  • Improve integration of CHIP and Medicaid

  • Allow flexibility, support, technical assistance and oversight to state Medicaid agencies to minimize coverage disruptions

  • Ensure adequately funded primary care payment that positions family physicians to provide the care that all patients deserve through achieving payment equity between Medicaid and Medicare.

This advocacy is helped by the broad support CHIP enjoys among nonpartisan groups, including the National Governors Association and the Medicaid and CHIP Payment and Access Commission.

Frequently asked questions about CHIP

What is CHIP?

Since its creation in 1997, the Children’s Health Insurance Program (CHIP) has provided health insurance to millions of children and reduced the percentage of uninsured children. In its first nine years, CHIP lowered that number from 15% in 1997 to 4.5% in 2016. Within federal guidelines, CHIP is administered by states, which have broad flexibility and variation in program design.

Who is eligible for CHIP?

All CHIP programs, regardless of state, provide health insurance coverage to children through age 19 in families with incomes too high to qualify for Medicaid. State program flexibility allows eligibility to be expanded beyond that guideline.

States and the District of Columbia cover children in families with incomes of up to a percentage (often 200% to 300%) of the federal poverty level (FPL).

Between 2020 and 2024, half of states had taken steps or were planning to expand Medicaid and CHIP coverage or reduce enrollment barriers for children.

Are there caps or waiting lists for CHIP?

Unlike Medicaid, states are authorized to impose caps and waiting lists for their CHIP programs, up to 90 days. As of 2024, nine states had a waiting period.

How is CHIP funded?

CHIP is jointly funded by federal and state governments, with the federal share determined by an enhanced federal matching rate approximately 15% to 20% above the Medicaid federal medical assistance percentage (FMAP). This enhanced rate varies by state and is generally tied to per capita income, with wealthier states generally receiving lower FMAPs. Overall, insurance provided by CHIP costs, on average, 40 percent less per child compared to private insurance or Medicaid. States that operate separate CHIP programs independent of Medicaid restrictions are allowed to charge enrollees premiums and other forms of cost-sharing.

Recent AAFP communications

Joint communications with other organizations

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