Leveraging CHIP to Improve Children’s Health: An Overview of State Health Services Initiatives

Updated September 2021

Through the Children’s Health Insurance Program (CHIP), states can develop Health Services Initiatives (HSIs) to improve the health of low-income children and youth. While HSIs can serve children of all incomes, they must be designed to directly improve the health of children under age 19 who are eligible for CHIP and/or Medicaid. HSIs are funded using a portion of a state’s existing CHIP administrative dollars — CHIP administrative expenditures are limited to no more than 10 percent of a state’s total CHIP spending. After covering regular CHIP program administrative costs, states can use any remaining funds — within the 10 percent cap — for an HSI project. The federal share of the HSI project cost is funded at the state’s CHIP match rate upon approval by the Centers for Medicare & Medicaid Services (CMS) of a state plan amendment (SPA).

HSIs can include direct services and public health initiatives. States have used HSIs to support poison control centers, school health services, lead abatement efforts, and other unique prevention and intervention projects. The chart below provides information about states’ HSIs by topic. For more HSI information, see the CMS January 2017 FAQs. To submit information about a state’s HSI that is not included in this chart, contact acardwell@oldsite.nashp.org.

Note: Information about states’ HSIs comes from CHIP SPAs and from CHIP Annual Report Template System (CARTS) reports. Data from CARTS reports are from 2019 reports unless otherwise noted. This chart may not include all CMS-approved SPAs for HSIs, nor does it capture HSIs that are awaiting CMS approval, but it includes most states’ approved initiatives as of September 2021.