State CHIP program directors are concerned that there be adequate planning and protections for maintaining coverage, access and quality of care for the 14.1 million children and pregnant women expected to be covered by CHIP during 2013 and who may be moved either to exchange plans or to Medicaid. We want to learn from rather than repeat mistakes of the past, such as those that occurred when we tried to abruptly move millions of low-income seniors and people with disabilities from Medicaid drug coverage into new Medicare Part D plans. While the move from CHIP to exchange plans which do not yet exist is of strong concern, state directors also are concerned about the many children who would move from CHIP to Medicaid. Twenty-one states currently cover children and adolescents from six to 18 with family income between 100 percent and 133 percent of the FPL in separate CHIP programs, and their coverage would switch from CHIP to Medicaid in proposals currently under consideration in Congress. 28 Effecting such a large change even from one public program to another will necessitate substantial administrative planning and systems change to assure continuity of coverage and adequacy of provider networks. Revisiting another major shift within public coverage for children is instructive here. An estimated 926,000 to 1.37 million fewer children were enrolled in Medicaid between 1995 and 1998 in the wake of welfare reform, which broke the program linkages between welfare and children’s Medicaid coverage.

Full report: Building on Success to Effectively Integrate Current Children’s Coverage with National Health Reform: Ideas from State CHIP Programs (html)

The National Academy for State Health Policy. (2009). Building on success to effectively integrate current children’s coverage with national health reform: ideas from state CHIP programs. Hess, Catherine & Hensley-Quinn, Maureen.