Medicaid and the Children’s Health Insurance Program: Technical Report

This technical report on Medicaid and the Children’s Health Insurance Program (CHIP), the cornerstones of the entire children’s health care delivery system, complements the 2023 American Academy of Pediatrics policy statement “Medicaid and the Children’s Health Insurance Program: Optimization to Promote Equity in Child and Young Adult Health.” The origin and intent of both the Medicaid and CHIP programs are outlined, and a current summary of issues related to enrollment, eligibility, funding, benefits, payments, quality assurance, and reporting in these programs that pertain to all children, including children with special health care needs (CYSHCN), is provided. Opportunities and drawbacks associated with states contracting with Medicaid managed care organizations are highlighted. This report also details mechanisms by which Medicaid can be modified through executive and legislative actions and summarizes past proposals (many recently resurrected) that would have degraded Medicaid’s ability to provide quality care for children. Special issues of interest for specific populations are explored, including children with special health care needs, adolescents, immigrant children, children in foster care, and adopted children, and the role of Medicaid and CHIP in addressing specific health care needs in the arenas of mental and behavioral health and dental care are discussed. Finally, the following 3 themes are emphasized: (1) the criticality of these programs to the current needs of children and the necessity to resolve operational factors that cause inequities; (2) the strategic importance of these programs to the well-being of the country’s future; and (3) the crisis with attracting, training, and retaining pediatric generalists and subspecialty physicians to lead the care of children in future generations.