The Balanced Budget Act of 1997 (BBA 97; P.L. 105-33 ) established the State Children's Health Insurance Program (CHIP) under a new Title XXI of the Social Security Act and provided annual appropriations for CHIP through FY2007. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA, H.R. 2 , P.L. 111-3 ), which was signed into law on February 4, 2009, provided CHIP appropriations through FY2013 and made other changes. Groups may be covered under the CHIP state plan or via special waiver authority. CHIPRA added a new state option to cover pregnant women under CHIP through a state plan amendment. The highest state-reported upper income eligibility limit for children in CHIP is 350% of the FPL, in New Jersey. The latest official numbers show that CHIP enrollment reached nearly 7.4 million children in FY2008. Twelve states reported enrollment of about 335,000 adults in CHIP in FY2008 (see Table 1 ). Benefits

As noted above, when designing their CHIP programs, states may cover targeted low-income children under their Medicaid program, create a new separate CHIP program, or devise a combination of both approaches. All 50 states, the District of Columbia, and five territories have CHIP programs. The territories, the District of Columbia, and 6 states use Medicaid expansions; 18 states use separate state programs; and 26 states use a combination approach. In other words, they must provide "wrap-around" benefit coverage. Cost-sharing may include monthly premiums, enrollment fees, deductibles, copayments, coinsurance and other similar charges. States that cover targeted low-income children under Medicaid must follow the nominal cost-sharing rules of the Medicaid program. DRA provided states with a new option for premiums and service-related cost-sharing that may be applied to targeted low-income children under CHIP Medicaid-expansion programs. For all families with incomes under 150% FPL and enrolled in separate state programs, premiums may not exceed the amounts set forth in federal Medicaid regulations. Preventive services are exempt from cost-sharing for all CHIP families regardless of income. The rules vary by fiscal year.
The Balanced Budget Act of 1997 (BBA 97; P.L. 105-33) established the State Children's Health Insurance Program (CHIP) under a new Title XXI of the Social Security Act and provided annual appropriations for CHIP through FY2007. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA, H.R. 2, P.L. 111-3), which was signed into law on February 4, 2009, provided CHIP appropriations through FY2013 and made other changes.
In general, CHIP allows states to cover targeted low-income children with no health insurance in families with income above Medicaid eligibility levels. States may also extend CHIP coverage to pregnant women when certain conditions are met. The highest state-reported upper income eligibility limit for children in CHIP is 350% of the federal poverty level, in New Jersey.
Under CHIP, states may enroll targeted low-income children in a CHIP-financed expansion of Medicaid, create a new separate state CHIP program, or devise a combination of both approaches. States choosing the Medicaid option must provide all Medicaid mandatory benefits and all optional services covered under the state plan. In addition, they must follow the nominal Medicaid cost-sharing rules or apply the new state plan option for premiums and service-related cost-sharing as allowed under the Deficit Reduction Act of 2005 (DRA). In general, separate state programs must follow certain coverage and benefit options outlined in CHIP law. While some cost-sharing provisions vary by family income, the total annual aggregate cost-sharing (including premiums, copayments, and other similar charges) for a family may not exceed 5% of total income in a year. Preventive services are exempt from cost-sharing.
All states, the District of Columbia, and the five territories have CHIP programs. The territories, the District of Columbia, and six states use Medicaid expansions; 18 states use separate state programs; and 26 states use a combination approach. At the national level, nearly 7.4 million children were enrolled in CHIP during FY2008. In addition, 12 states reported enrolling about 335,000 adults in CHIP through program waivers in FY2008.