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The Incredible Shrinking CHIP Program
By Chris Hobson, Consultant, Dragon Tree Communications, LLC
Posted on May 7, 2025
We're back in action, folks! Well, at least when it comes to analyzing the State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Data. This dataset went dark for a few months earlier this year, but I'm happy to report that, as of March, it's back!
I've written about the CHIP enrollment numbers in a few states in previous blog posts here and here. Many observers are watching what happens to Medicaid closely due to factors I'll discuss below, but suffice it to say that if the Medicaid budget is reduced over the coming year, I have no doubt that CHIP enrollment will also be affected.
As a reminder, in past posts I've chosen five states to highlight – Maine, Arizona, North Dakota, Kansas, and Colorado. I've done so because, to some degree, they represent the U.S. political spectrum: one of these states is reliably liberal (Maine), one is a swing state (Arizona), and two are reliably conservative states (North Dakota and Kansas). I also included Colorado because it's been in the news lately because a large number of people there have recently lost their Medicaid coverage.
We'll come to this in a minute, but Kansas is an interesting state because although the population tends to vote conservative in national elections, they have been known to vote more liberal on things like state constitutional amendments.
As I've mentioned before, examining these states' approach to expanding Medicaid (or not, as with Kansas) should give us a good sense of the varieties of options on offer as they relate to children, and to what degree they're proving successful.
CHIP Expansion and Obamacare
This post can be thought of as an adjunct to my last post about enhanced premium tax credits related to Obamacare. What once seemed a foregone conclusion to extend the tax credits beyond 2025 (given that most people who benefit from these tax credits live in conservative states) has now become a hotly-debated question given how focused Congress has become on trimming the Medicaid budget by around $880 billion.
As part of this effort, lawmakers are considering a reduction in the federal government’s share of Medicaid expansion; doing so would shift more of the financial responsibility for expansion to the states. Also on the chopping block could be the Affordable Care Act expansion group, many of whom benefit from the enhanced premium tax credits. So the fate of Obamacare and the CHIP program are loosely related insofar as they're both largely dependent on federal government funds.
Quick note: with respect to the State Medicaid and CHIP Applications, Eligibility Determinations, and Enrollment Data, i.e. the data set from which I've pulled the numbers you'll see below, there was already a big lag between reporting dates and the actual dates when the reports come available. Now, because there weren't any updates provided for several months in early 2025, that time lag has only increased. So today we'll be looking at how CHIP enrollment changed in November of 2024, and see if the trend lines have changed.
The Uncertain Future of Medicaid
Since these numbers are tied up in states' decision whether or not to expand Medicaid, it's worth noting that the federal insurance program may undergo some major changes in the coming months. As I alluded to above, right now the U.S. Congress is considering cutting around $880 billion from the program over the next 10 years, which would undoubtedly affect CHIP enrollment numbers (or, indeed, the very existence of the program).
Depending on who you ask, Medicaid has either been a major success, or it's too wasteful and needs to be constrained. It should also be said that for two years now, nationwide CHIP enrollment has declined. Here is a report from the official Medicaid website:
"Since March 2023, total enrollment across Medicaid, CHIP, BHP, and the Marketplace has declined by 7.8 million individuals (7 percent). This is a 14.6 million individual decrease for Medicaid and CHIP and a 6.4 million individual increase for the Marketplace."
With that in mind, let's see how CHIP enrollment numbers were doing as of November of 2024 in five U.S. states which, again, is the latest date for which we have data.
CHIP Enrollment in Arizona
To get us started, let's look at enrollment numbers in Arizona. As a reminder, I discussed the circumstances surrounding Arizona's CHIP expansion in an earlier post. As I mentioned in that post, as part of the state budget approval process in 2023, Governor Katie Hobbs and the state legislature agreed on an expansion of KidsCare, which is the name of Arizona's CHIP program. The decision allowed KidsCare to expand eligibility to cover more children by increasing family income limits.
Since the expansion took effect on March 1, 2024 and data started being collected in May, we'll look at enrollment rates between May and November of 2024.
Data courtesy of Data.Medicaid.gov
As will become a common refrain in this post, enrollment numbers have been on a more or less constant descent ever since the program expanded. This trend stands in stark contrast to Obamacare enrollment rates overall, which shows that Medicaid expansion has achieved uneven results for different cohorts of people in different states. But maybe the fact that Arizona is a Republican-leaning state has something to do with this? Let's now look at a more liberal state to test that theory.
Maine's CHIP Rollercoaster
Calling Maine a liberal state is a little but like calling an SUV a truck: it is, and it isn't.
Maine is in some ways the inverse of Kansas, another state we'll be looking at. This is true in the sense that in national politics the state generally votes for the Democrats and they currently have a Democrat as a governor, whereas the state's Senate and important state-level seats are often held by Republicans.
As noted in my previous blog post, the CHIP expansion didn't take effect until August of 2024. Oddly, it just so happens that in that same month, enrollment numbers started to take a nosedive, matching the national trend. It's not apparent to me why an expansion of CHIP would be met with a near collapse in the numbers of those receiving the benefit, and this warrants further investigation.
Data courtesy of Data.Medicaid.gov
Colorado's Encouraging CHIP Trendline
Like a few of the cases we'll be discussing, CHIP enrollment numbers in Colorado started to decline after the Consolidated Appropriations Act of 2023 decoupled the Medicaid continuous enrollment provision from the Covid-19 public health emergency (PHE) on March 31, 2023. This allowed the government to resume Medicaid disenrollments. ((Read more about the disenrollments here.)
But the news isn't all bad in Colorado. Ever since around June of 2024, CHIP enrollment numbers have leveled out and, in some months, even slightly improved. It's nothing to shout from the rooftops, but at least state lawmakers have a steady base from which to work.
I'm not sure why numbers in Colorado have stabilized, but as I noted in the above-referenced blog post, to combat the state's declining numbers, Colorado's Department of Health Care Policy & Financing (HCPF) announced a policy that will "support continuous coverage for children from birth to age three who are eligible for Health First Colorado (Colorado’s Medicaid program) or Children’s Health Insurance program (CHP+)."
Although the program doesn't go into operation until January 1, 2026, it's possible that this announcement has instilled confidence in the people of Colorado that this program will be around for some time to come. Maybe this is why the enrollment numbers are slowly climbing? I'm not sure, but I'll keep watching.
Data courtesy of Data.Medicaid.gov
North Dakota on a Steady Slide
Medicaid expansion was first enacted in North Dakota in 2014 as a result of the Affordable Care Act, and then was expanded again on April 1, 2024. This makes it one of the earlier states in our field to expand Medicaid. But despite being on the vanguard of expansion, ever since early 2023 (around the time when the Consolidated Appropriations Act of 2023 went into effect), North Dakotans have mostly kept pace with the national downward trend of enrolling their children in the CHIP program.
Data courtesy of Data.Medicaid.gov
Kansas in a Holding Pattern
Kansas is an interesting case. Like Maine, the state is run by a Democratic governor, but unlike Maine, national-level politics in the state lean more Republican. The state's governor, Laura Kelly, has been trying to expand Medicaid to her constituents and, as a consequence, open up access for more children to be enrolled in the CHIP program.
But in a story published a few days ago on a local news website, it was revealed that state leaders, including Kelly, are fighting hard to help her state avoid cuts to Medicaid. Kansas is potentially facing around $1 billion in cuts, which would probably affect CHIP enrollees. We likely won't know for several months whether this news will have a destabilizing effect on enrollment numbers.
What we can say with confidence is that through November of 2024, numbers of enrollees had steadied after a drop starting in early 2023 (the likely cause being, again, the Consolidated Appropriations Act of 2023 going into effect in March of 2023). While there are now fewer enrollees than in early 2023, the fact that the numbers have stabilized could be seen as a positive sign.
Data courtesy of Data.Medicaid.gov
Obamacare Up, CHIP Down
It's not totally clear why, at a time when Obamacare enrollment numbers are up (check out this post for more on Obamacare), CHIP enrollment is down. It's possible that, due to the availability of premium tax credits, parents who would otherwise have enrolled their children in CHIP have found it more advantageous to enroll as a family in the insurance exchange.
It's also possible that some states are doing a better job of messaging about CHIP than others. This helpful article from the Georgetown University McCourt School of Public Policy discusses the statutory obligations states have to conduct outreach to eligible families regarding CHIP enrollment. The article also discusses the relative efforts made by different states to do this. I'm not finding any definitive reasons why CHIP isn't meeting expectations at this point, so I'll stay on the case and update you as new information comes available.