Children's Enrollment in Children's Health Insurance Program (CHIP) Coverage During the Medicaid Unwinding

To examine changes in children's Medicaid and CHIP enrollment during the Families First Coronavirus Response Act unwinding and assess whether CHIP enrollment offsets Medicaid declines.

We used linear probability models with monthly indicators to estimate changes in enrollment from April 2023 to September 2024 overall and by CHIP structure type.

We used monthly children's enrollment data from the U.S. Centers for Medicare & Medicaid Services for 32 states and the District of Columbia.

During the unwinding, Medicaid enrollment declined from 48.1% to 41.2% of children, while CHIP enrollment remained stable (8.7% to 8.6%). We found average declines of 62,032 (95% confidence interval [CI]: -108,018 to -16,045) Medicaid-enrolled children per state (6.5 percentage points [pp], 95% CI: -8.1 to -5.0). Medicaid declines were larger in states with combination CHIP (-8.7 pp, 95% CI: -10.3 to -7.2) than Medicaid expansion CHIP (-4.5 pp, 95% CI: -6.0 to -3.1). We found no evidence of significant changes in CHIP enrollment overall or by CHIP structure.

Children's Medicaid enrollment fell sharply without offsetting CHIP gains during the unwinding, underscoring the need for policies that prevent administrative disenrollment and ensure seamless coverage transitions.