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Children's Health Insurance Program: A Case Study

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Primary Stakeholders in the CHIPs Program
The Children's Health Insurance Program (CHIP) is funded jointly by the federal government and states through a formula based on the Medicaid Federal Medical Assistance Percentage (FMAP). 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% nationally.
CHIPs is a capped program, in which each state is provided an annual CHIP allotment. Every fiscal year, the Centers for Medicare & Medicaid Services (CMS) determines the share of program funding they will pay that year. States must provide matching funds to get their federal funding
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CMCS’s efforts are guided by the overarching aims of the CMS Quality Strategy: better health, better care, lower cost policies The CMS Quality Strategy is built on the foundation of the CMS Strategy and the HHS National Quality Strategy. Working with states and other partners to eliminate disparities and improve patient safety are key aspects of achieving these aims.
Medicaid and the Children’s Health Insurance Program (CHIP) provide critical health coverage for millions of people. Through these programs, CMS supports access to care in several ways. First and foremost, providing health coverage allows individuals to access health care services that may not be affordable without Medicaid or CHIP. Additionally, some programs and benefits under Medicaid and CHIP include special protections to ensure services are accessible, such as provider network standards, payment methodologies, and other protections. CMS acknowledges the importance of using services, including preventative care, to help people stay healthy and avoid more costly care and has developed resources and materials to help Medicaid and CHIP beneficiaries understand the importance of these services and learn how to access them. To understand and ensure progress, CMS supports a variety of efforts to
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