Both Medicaid and the Children’s Health Insurance Program (CHIP) offer health insurance coverage to children in low- and moderate-income families. Enrollment has increased over the past few years—particularly during the recent economic recession—with 40 million children insured by Medicaid or CHIP in 2009. However, an estimated 7.3 million children remained uninsured in 2008, with nearly two-thirds of them eligible for, but not enrolled in Medicaid or CHIP. In early 2010, U.S. Secretary of Health and Human Services Kathleen Sebelius issued a nationwide challenge to find and enroll approximately 5 million uninsured children eligible for Medicaid or CHIP.

This policy brief from Health Affairs and the Robert Wood Johnson Foundation (RWJF) examines recent efforts to increase enrollment in these programs and how they may inform enrollment efforts under the planned expansion of Medicaid in 2014. The Congressional Budget Office estimates that by 2019, 16 million more children and adults will be enrolled in Medicaid because of the expansion. All 50 states and the District of Columbia offer both Medicaid and CHIP programs, but the structure and eligibility criteria differ from state to state. Medicaid offers a comprehensive benefits package to the lowest income children, while CHIP covers children at moderate income levels, but generally with a less comprehensive benefits package. With states being challenged to increase enrollment in the years ahead – even as most state budgets are severely stretched—it’s more important than ever that state leaders learn from what’s been working elsewhere.