the law will retain CHIP and Medicaid as a primary source of coverage for low-income children and families.
State policy makers, advocates, and child coverage experts have learned a great deal about the use of data in evaluating CHIP over time. Using Virginia as a primary example, this paper discusses the some of these lessons in using uninsured and administrative data in running and evaluating CHIP at the state level. First, I discuss the role that data have played in CHIP policy making and program management and also how state analysts and advocates use, promote, and disseminate national survey data at the state level. I then describe how more accessible local uninsured and enrollment data would add useful information to aid in evaluating CHIP and the unmet needs of uninsured children.
Virginia, like most states, had high levels of uninsurance among children before CHIP was created in 1997. The percentage of employer-sponsored health insurance (ESI) for children was in decline, and there were few public insurance options for children whose families had too much income to qualify for Medicaid coverage. Nationally, over 22 percent of low-income children with family incomes below 200 percent of the federal poverty line (FPL) were without health insurance in 1997 (Georgetown University Center for Children and Families, 2006).
The Balanced Budget Act allocated $40 billion over 10 years in federal funding to allow states to create CHIP programs. Unlike Medicaid, CHIP was created as a block grant program, so states would receive an allotment based on a funding formula, not on the number of eligible applicants. States were given significant flexibility in program design and management in determining eligibility levels, enrollment, and program design. To further entice states, the federal match rate was set at 30 percent above the match rate for Medicaid. A state with a 50 percent federal match rate in Medicaid would receive 65 percent federal reimbursement for CHIP.2 States broadly embraced CHIP, and, by 2000, every state had a program up and running.
However, the effort was not the same in all states. Despite the substantial uninsured low-income child population, Virginia did not fully embrace CHIP initially. The state program, the Children’s Medical Security Insurance Plan (CMSIP), was created as a Medicaid expansion program, covering children from the Medicaid eligibility endpoint3 up to 185