By Chris Hobson, Consultant, Dragon Tree Communications, LLC
Posted on August 1, 2026
*Author's note: To see the SQL and R coding behind the visualizations in this blog post please visit my GitHub account.
It's time again for my semi-regular look at enrollment rates in Medicaid and the Children's Health Insurance Program (CHIP). Focusing on enrollment as a measure of program effectiveness has become even more important, in my opinion, since last year's passage of the Budget Reconciliation Act, also known as the One Big Beautiful Bill (BBB) Act. I wrote about that legislation previously here and here.
In the past I've examined these rates as a combined number: Medicaid and CHIP enrollment. But I now want to split them off and only look at the CHIP enrollment rates; more specifically, I will examine how the cohorts covered under that program are being affected by the significant changes occurring as a result of the BBB.
It should be noted that, while the CHIP enrollment rate is often seen as a proxy for acquiring insurance for children, that's not entirely a correct assumption. That's because. for instance, pregnant women can qualify for coverage under the program. That being said, it's the best measure I've found so far for gaining a solid understanding of how children are being affected by this legislation.
Also worthy of note: as with past blog posts where I looked at combined Medicaid and CHIP rates, I got the data from a Data.gov data set called the State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Data. The data I used was published in June of 2026 with new numbers through March of 2026, but wouldn't you know it? Right as I was getting ready to publish this blog post, new data was published at the end of July for April. I'll plan to examine that data in a future post.
Falling Enrollment Numbers
Although not all U.S. states have experienced falling numbers with respect to CHIP enrollment, the five states we usually focus on – Maine, Arizona, North Dakota, Kansas, and Colorado – have all experienced varying degrees of change in their enrollment numbers between 2025 and 2026, with North Dakota being the only one to experience positive growth.
Of note, Wisconsin, which I haven't been highlighting up until now, experienced the biggest positive growth in CHIP enrollment at 7.1% since last year. This may be a deceptive number, however, when it comes to how Wisconsin is covering its underinsured population. That is because, according to the Kaiser Family Foundation Medicaid/CHIP Monthly Enrollment Tracker, when looked at as a combined number, Medicaid and CHIP enrollment declined by 5% over the past year in the state.
The Georgetown University McCourt School of Public Policy Center for Children and Families website confirms that the insured rate for children under CHIP is falling:
"The latest federal CMS data confirms that child enrollment in these programs dropped by 1.5 million since…January 2025. The CMS enrollment data covers January 2025 to January 2026. State data we’re tracking suggests that number could be 1.8 million as of this writing and will soon reach 2 million."
The author states that "when the number of children enrolled in Medicaid goes down the uninsured rate tends to go up." The reason for this is that "most children who lose Medicaid and/or CHIP remain eligible and/or don’t have other sources of affordable coverage available to them."
Who We're Talking About
When it comes to the children who qualify for CHIP and who are most likely already being affected by both the BBB and the general mood of the country, it's important to get a handle on to whom we're specifically referring. In that same piece on the Georgetown University website, the author noted the following:
"One reason though that is likely to account for some of this child enrollment decline – as we’ve discussed before – is the 'chilling effect' whereby parents of citizen children living in mixed status families are too fearful of deportation and other negative consequences if they share contact information."
In other words, downward pressure is being exerted on so-called "mixed-status" families. This term usually refers to families where one parent does not have legal immigration status to remain in the U.S.
How many people fall into this category? Past estimates on the number of U.S.-born children, i.e. American citizens, under the age of 18 that are living with an unauthorized immigrant parent have varied from 4.4 million in 2024 to 1 million in 2025 (in the latter case, the author states that 6.3 million children overall -- U.S. citizens and not – were living with at least one unauthorized immigrant parent at the time of publication).
There is widespread speculation that parents are more reluctant now to enroll their children in the CHIP program for fear that they or their families will show up "in the system" and subsequently be deported. This trend has been in place for many years, but may be accelerating due to the BBB.
I will keep my eye on this and see if rates of enrollment continue to break in a negative direction. It's pure speculation on my part, but this chilling effect could extend beyond this specific group to those who are legally permitted to reside in the U.S., but who are not yet full citizens.
Why Trendlines are Mostly Downward
By my count, 34 states have experienced a decline in enrollment in the CHIP program since 2025. As I mentioned before, 2025 is a good cutoff for tracking approximately how many children (and pregnant women who qualify for CHIP) are losing or gaining insurance through the CHIP program because the BBB passed about halfway through the year.
Before then, I was using March of 2023 as the cutoff (I'm still using that year as a jumping off point when it comes to the graphs you'll see a little further down). That year is an important benchmark because that's when the so-called "Medicaid unwinding" began after the federal COVID public health emergency ended. At that point, people were no longer automatically continuously enrolled in the program, and periodic coverage determinations resumed.
There is quite a bit of speculation that, at least in part, the mostly downward numbers we're seeing have to do with a so-called "chilling effect" brought about by the BBB. While work requirements stipulated in the bill will undoubtedly affect rates of adults in the ACA Medicaid expansion group who are continuously covered by Medicaid, it's not evident that this is having any affect on children.
And anyway, states aren't required to initiate these work requirements until Jan. 1, 2027 (although a few states have already started experimenting with these requirements). On June 1st CMS released their Interim Final Rule on the work requirements, including who is exempt from them, which I will probably write about soon.
CHIP Enrollment By the Numbers
As promised, here are a few charts that track the recently downward trends in CHIP enrollment among the five states we usually look at: Maine, Arizona, Colorado, Kansas, and North Dakota. My rationale for examining these states can be found in this blog post. I figured I'd leave the overall benchmark for the charts at the year 2023 to show the uneven enrollment rates after the Medicaid unwinding, followed by a mostly downward trend since January of 2025. I will continue to track this information and report back what I find.
Focusing on CHIP Rates in the BBB Era