The Impact of the Children’s Health Insurance Program (CHIP): What Does the Research Tell Us?

The Children’s Health Insurance Program (CHIP) was established in 1997 to provide coverage for uninsured children who are low-income but above the cut-off for Medicaid eligibility. In 2009, Congress reauthorized and extended federal funding for CHIP, and the Affordable Care Act (ACA) extended CHIP funding further, through FY 2015. If Congress does not act, federal funding for CHIP will expire a little over a year from now. Decisions about CHIP’s future will be consequential as more than 8 million low-income children were covered by CHIP at some point during 2012. CHIP and Medicaid combined cover more than 1 in every 3 children in the U.S. To help inform the debate about CHIP’s future, this brief reviews data and a large body of research about the impact of Medicaid and CHIP on low-income children. The evidence can be summarized as follows:

• Coverage: Medicaid and CHIP have significantly expanded health coverage among U.S. children and provided a coverage safety-net for children in working families during economic downturns. From 1997, when CHIP was enacted, to 2012, the uninsured rate for children fell by half, from 14% to 7%. Medicaid and CHIP have helped to reduce disparities in coverage that affect low-income children and children of color.

• Benefits and out-of pocket protection: Medicaid and CHIP cover expansive benefits for children, including dental care, which is often excluded from private health insurance. Of key importance for children with special health care needs, all CHIP programs cover physical, occupational, and speech and language therapies, often without limits. Both Medicaid and CHIP provide strong financial protection for low-income children and families. Out-of-pocket exposure is greater in subsidized Marketplace coverage.

• Access to care: Children with Medicaid and CHIP have much better access to primary and preventive care and fewer unmet health needs than uninsured children. They also have much better access to specialist and dental care. Further, children covered by Medicaid and CHIP fare as well as privately insured children on measures of primary and preventive care access. However, some research finds disparities between publicly and privately insured children in their access to specialist and dental care. Also, Medicaid and CHIP children visit the emergency department more than other children, which may be due, in part, to barriers to access to timely primary care, such as lack of available after-hours care. Most physicians who care for children participate in Medicaid and CHIP, but dentist participation is low.

• Outcomes: Evidence from some studies shows that Medicaid and CHIP expansions have a positive impact on health outcomes, including reductions in avoidable hospitalizations and child mortality, while other studies show no impact on health. In addition, there is evidence that improved health among children with Medicaid and CHIP translates into educational gains, with potentially positive implications for both individual economic well-being and overall economic productivity.

• Parents’ views:  Most low-income parents have positive impressions of Medicaid and CHIP. The parents of children enrolled in Medicaid or CHIP are more likely than low-income parents of children with job-based coverage to say they are very satisfied with the quality of care, the scope of benefits, and affordability.

Taken together, the evidence is strong that improving coverage through CHIP and Medicaid has contributed to meaningful gains in access to care and the quality of care for low-income children. Further, studies that find an impact of CHIP and Medicaid on children’s health show a positive impact, suggesting that the programs advance the end goal of coverage, better health.