CHILDREN’S HEALTH 

INSURANCE

Cost, Coverage, and 

Access Considerations for 

Extending Federal Funding

Statement of Carolyn L. Yocom

Director, Health Care

Testimony

Before the Subcommittee on Health, 

Committee on Energy and Commerce, 

House of Representatives

For Release on Delivery 

Expected at 10:15 a.m. ET

December 3, 2014

GAO-15-268T

United States Government Accountability Office
United States Government Accountability Office

Highlights of GAO-15-268T, a testimony 

before the Subcommittee on Health,

Committee on Energy and Commerce, House 

of Representatives

December 3, 2014

CHILDREN’S HEALTH INSURANCE

Cost, Coverage, and Access Considerations for 

Extending Federal Funding

Why GAO Did This Study

Without health insurance coverage, 

children are less likely to obtain routine 

medical or dental care, establish a 

relationship with a primary care 

physician, and receive immunizations 

or treatment for injuries and chronic 

illnesses. As such, Congress faces 

important decisions about the future of 

CHIP. PPACA extended federal 

funding for CHIP through fiscal year 

2015, and Congress will be deciding 

whether to act to extend that funding.

States can operate CHIP as a separate 

program, include CHIP-eligible children 

in their Medicaid programs, or use a 

combination of the two approaches. If 

funding for CHIP runs out after 2015, 

children in CHIP-funded Medicaid 

programs will remain in Medicaid. For 

the 5.3 million children in separate 

CHIP programs, beginning in October 

2015, PPACA requires that if a state’s 

CHIP funding is insufficient to cover all 

CHIP-eligible children, the state must 

establish procedures to ensure that 

they are screened for Medicaid 

eligibility, and, if not eligible, enroll 

them in QHPs certified as comparable 

to CHIP.

This testimony is based on prior work 

conducted from February 2011 through 

November 2013, and highlights 

relevant GAO findings on cost, 

coverage, and access in CHIP.

What GAO Found

Over the last 17 years, the State Children’s Health Insurance Program (CHIP)—a 

federal-state program that provides coverage to about 8 million low-income 

children—has played an important role in providing health insurance coverage for 

children who would otherwise be uninsured. The Patient Protection and 

Affordable Care Act (PPACA) created alternative coverage options with the 

establishment of subsidized coverage—through a premium tax credit and costsharing subsidies—offered through health insurance exchanges, however, there 

remain important considerations related to cost, coverage, and access when 

determining the ongoing need for the CHIP program.

• Cost. In 2013, GAO found that consumer costs in CHIP plans were lower 

than under the benchmark plans selected by states as models for the 

benefits that would be offered by qualified health plans (QHP) through 

exchanges in 2014. For example, when comparing CHIP plans in five states 

with separate CHIP programs to state benchmark plans, GAO found that the 

CHIP plan in the states typically did not require the payment of deductibles, 

while all five states’ benchmark plans did. Similarly, the amount of any 

applicable cost-sharing was almost always less for CHIP plans and the 

difference was particularly pronounced for physician visits, prescription 

drugs, and outpatient therapies. PPACA provisions, which seek to 

standardize QHP costs and reduce cost-sharing for certain individuals, could 

narrow the cost gap. GAO’s work also suggests that some children 

transitioning out of CHIP would not be eligible for the premium tax credit 

because they have a parent with employer-sponsored health coverage that is 

considered affordable under Internal Revenue Service regulations.

• Coverage. GAO’s prior work from 2013 found that coverage was generally 

similar in separate CHIP and benchmark plans, though some variation exists. 

GAO also found that in contrast to CHIP plans where dental benefits are 

included, in some states, dental coverage is optional through exchanges and 

may be offered as a stand-alone dental plan. GAO found that families 

choosing such coverage could face higher costs. Further, in the current 

landscape of coverage options, many children eligible for CHIP, Medicaid, or 

the premium tax credit will have different eligibility than their parents, which 

can create complex scenarios of coverage for families. In 2012, GAO 

estimated that 21 percent of children eligible for CHIP, Medicaid, or the 

premium tax credit under PPACA would have different eligibility than their 

parents.

• Access. GAO’s prior work found that CHIP enrollees generally reported 

having access to health care at rates comparable to children with private 

insurance, with some exceptions. In 2013, GAO’s analysis of national survey 

data indicated that CHIP enrollees reported positive responses regarding 

their ability to obtain care, and the proportion of positive responses was 

generally comparable to those with Medicaid or with private insurance.

View GAO-15-268T. For more information, 

contact Carolyn L. Yocom at (202) 512-7114 

or yocomc@gao.gov.
 

Page 1 GAO-15-268T

Chairman Pitts, Ranking Member Pallone, and Members of the 

Subcommittee:

I am pleased to be here today to discuss the extension of federal funding 

for the State Children’s Health Insurance Program (CHIP). Established in 

1997, CHIP finances health insurance for over 8 million children whose 

household incomes are above the threshold for Medicaid eligibility.1 Since 

the inception of this joint federal-state program, the percentage of 

uninsured children nationwide has fallen by half, although the uninsured 

rate for children varies considerably among states.2

Congress faces important decisions about the future of CHIP. Congress 

has appropriated federal CHIP funding at various times since the creation 

of the program. Most recently, the Patient Protection and Affordable Care 

Act (PPACA) appropriated federal CHIP funding through federal fiscal 

year 2015.

Without health 

insurance coverage, children are less likely to obtain routine medical or 

dental care, establish a relationship with a primary care physician, and 

receive immunizations or treatment for injuries and chronic illnesses. The 

Centers for Medicare & Medicaid Services (CMS) within the Department 

of Health and Human Services (HHS) oversees CHIP, while states 

design, manage, and administer the operations of their individual CHIP 

programs. States administer CHIP under broad federal requirements, and 

the programs vary, for example, in the services covered, costs to 

individuals and families, and eligibility requirements.

3

 

1

Medicaid is a joint federal-state program that finances health insurance coverage for 

certain categories of lower-income individuals, including children. Most states’ CHIP 

eligibility levels are between 200 and 300 percent of the federal poverty level (FPL), with 

the highest eligibility level being 400 percent of the FPL.

Congress will decide whether to act to extend funding in the 

future. In the near term, PPACA requires that, if CHIP funding for a state 

is insufficient to cover all CHIP-eligible children, beginning in October 

2015—the month after which federal funding for CHIP is scheduled to 

2

The percent of uninsured children was 13.9 in 1997 and 6.6 percent in the first three 

months of 2014. See Cohen, R.A, Martinez, M.E. Health Insurance Coverage: Early 

Release of Estimates from the National Health Interview Survey, January-March 2014. 

National Center for Health Statistics. (September 2014). Available from: 

http://www.cdc.gov/nchs/nhis/releases.htm. 

3

Pub. L. No. 111-148, § 10203, 124 Stat. 119, 927 (2010). In this testimony, references to 

PPACA include any amendments made by the Health Care and Education Reconciliation 

Act of 2010, Pub. L. No. 111-152, 124 Stat. 1029 (2010), unless otherwise indicated.
 

Page 2 GAO-15-268T

end—the state must establish procedures to ensure that the children who 

are not covered by CHIP are screened for Medicaid eligibility.4 If ineligible 

for Medicaid, children are to be enrolled in a qualified health plan (QHP), 

which are plans offered by private issuers through health insurance 

exchanges established as required by PPACA.5 While all QHPs must 

meet certain requirements related to what services are covered and the 

value of coverage, the QHPs for children transitioning out of CHIP must 

be certified by the Secretary of HHS as offering benefits and imposing 

cost-sharing for children in a manner that is at least comparable to the 

covered services and cost-sharing protections provided under the state’s 

CHIP plan. If the Secretary finds that no exchange plans are comparable 

to CHIP, states are not required to seamlessly transition children from 

CHIP to exchange coverage, though families may obtain such coverage 

on their own. Children transitioning from CHIP to exchange coverage may 

be eligible for the advance health insurance premium tax credit (referred 

to as the premium tax credit) and for cost-sharing subsidies established 

through PPACA to offset the cost of insurance purchased through state 

exchanges by eligible families.6

My statement today will draw from past GAO work examining the 

Medicaid and CHIP programs to identify important issues regarding 

Over the longer term, PPACA also 

requires states to maintain eligibility levels for children in CHIP and 

Medicaid. That requirement ends after fiscal year 2019, which means that 

under current law, in fiscal year 2020, some states could choose to 

eliminate their programs even if federal funds were available.

 

4

Although federal appropriations for the program will end on September 30, 2015, any 

unexpended amounts allotted to the states in fiscal year 2015 will be available for 

expenditure through September 30, 2016. 

5

PPACA requires the establishment of health insurance exchanges (referred to as 

exchanges) in each state—marketplaces where eligible individuals can compare and 

select among QHPs offered by participating private issuers of health coverage. QHPs 

provide a package of essential health benefits—including coverage for specific service 

categories, such as ambulatory care, prescription drugs, and hospitalization.

6

Eligibility for the premium tax credit is limited to individuals with household incomes 

between 100 and 400 percent FPL. In addition, to be eligible for the premium tax credit, an 

individual cannot have access to public insurance such as Medicaid or CHIP (except for a 

child in a state with insufficient CHIP funds for eligible children) or to affordable employersponsored health insurance that provides a minimum value. Eligibility for the cost-sharing 

subsidies, which aim to reduce out-of-pocket costs for deductibles, co-payments, and 

other costs, is for individuals and families with household incomes of up through 

250 percent FPL.
 

Page 3 GAO-15-268T

whether to extend federal funding for CHIP beyond fiscal year 2015. In 

particular, my remarks will address considerations related to cost, 

coverage, and access in CHIP.

My statement is based on reports we issued from February 2011 through 

November 2013.7 For this work, to compare costs and coverage for

consumers in separate CHIP plans and the benchmark plans that serve 

as models for QHP benefits,8 we reviewed Evidence of Coverage 

documents from separate CHIP plans and benchmark plans from five 

states. To describe access to care for children in CHIP compared to 

others with Medicaid, private insurance, or without insurance, we 

analyzed nationwide data from HHS’s Medical Expenditure Panel Survey 

(MEPs) from 2007 through 2010. The reports cited in this statement each 

provide detailed information on our scope and methodology. The work 

upon which this statement is based was conducted in accordance with 

generally accepted government auditing standards. Those standards 

require that we plan and perform the audit to obtain sufficient, appropriate 

evidence to provide a reasonable basis for our findings and conclusions 

based on our audit objectives. We believe that the evidence obtained 

provides a reasonable basis for our findings and conclusions based on 

our audit objectives.

With CHIP programs, states cover children in families whose household 

incomes are too high to qualify for Medicaid. Most states’ CHIP eligibility 

levels are between 200 and 300 percent of the federal poverty level 

(FPL). States typically cover a broad array of services in their CHIP 

 

7

See GAO, Medicaid and CHIP: Given the Association between Parent and Child 

Insurance Status, New Expansions May Benefit Families, GAO-11-264 (Washington, 

D.C.: Feb. 4, 2011); Medicaid and CHIP: Most Physicians Serve Covered Children but 

Have Difficulty Referring Them for Specialty Care, GAO-11-624 (Washington, D.C.: 

June 30, 2011); Children’s Health Insurance: Opportunities Exist for Improved Access to 

Affordable Insurance, GAO-12-648 (Washington, D.C.: June 22, 2012); and Children’s 

Health Insurance: Information on Coverage of Services, Costs to Consumers, and Access 

to Care in CHIP and Other Sources of Insurance, GAO-14-40 (Washington, D.C.: Nov. 21, 

2013).

8

To prepare for the offering of QHPs through exchanges in 2014, HHS asked states to 

select benchmark health plans—plans intended as models for the benefits that would be 

offered through QHPs—by December 26, 2012. To offer coverage starting in 2014, 

individual market and small group market insurance plan issuers were required to offer 

QHPs that were substantially equal to their state’s benchmark plan. We compared 

coverage under CHIP and benchmark plans to establish baseline information.

Background
 

Page 4 GAO-15-268T

programs, for example, routine check-ups, immunizations, emergency 

services, and certain dental services. With respect to costs to consumers, 

CHIP premiums and cost-sharing may not exceed minimum amounts as 

defined by law. States may vary CHIP premiums and cost-sharing based 

on income and family size, as long as cost-sharing for higher-income 

children is not lower than for lower-income children. Federal laws and 

regulations also impose additional limits on premiums and cost-sharing 

for children in families with incomes at or below 150 percent FPL. In all 

cases, no cost-sharing can be required for preventive services—defined 

as well-baby and well-child care, including age-appropriate immunizations 

and pregnancy-related services. In addition, states may not impose 

premiums and cost-sharing, in the aggregate, that exceeds 5 percent of a 

family’s total income for the length of the child’s eligibility period in CHIP.9

States can operate CHIP as a separate program, include CHIP-eligible 

children in their Medicaid programs (referred to as a CHIP-funded 

Medicaid expansion), or use a combination of the two approaches. 

Eligible children in a CHIP-funded Medicaid expansion are entitled to 

coverage because Medicaid is an entitlement. There is no individual 

entitlement to coverage under separate CHIP programs. If funding for 

CHIP runs out after fiscal year 2015, those children enrolled in CHIPfunded Medicaid expansions—2.5 million children across 32 states and 

the District of Columbia in fiscal year 2013—will remain in Medicaid.10 For 

the 5.3 million children across 39 states in separate CHIP programs, 

PPACA requires that the state must establish procedures to ensure that 

the children who are not covered by CHIP are screened for Medicaid 

eligibility and, if determined ineligible for Medicaid, are enrolled into a 

QHP in an exchange in that state that has been certified by the Secretary 

of HHS as comparable to CHIP.

 

9

This annual cumulative cost-sharing maximum applies to all services with cost-sharing 

requirements, irrespective of the number of children in the family that are enrolled in CHIP.

10For children that remain in Medicaid, the state is to receive reimbursement based on the 

federal matching rate for the state’s Medicaid program rather than the CHIP rate, which 

under PPACA is to increase by 23 percentage points to nearly 100 percent from fiscal 

years 2016 through 2019. The federal government matches state Medicaid service 

expenditures based on a statutory formula known as the Federal Medical Assistance 

Percentage (FMAP). The FMAP depends on each state’s per capita income and may 

range from 50 to 83 percent.
 

Page 5 GAO-15-268T

Over the last 17 years, CHIP has played an important role in providing 

health insurance coverage for low-income children who would otherwise 

be uninsured. While the introduction of the premium tax credit and costsharing subsidies for coverage through health insurance exchanges could 

provide an alternative coverage option for some of these children, there 

are important considerations related to cost, coverage, and access when 

determining the ongoing need for the CHIP program.

Our prior work suggests that consumer costs under state benchmark 

plans, which were used as models for QHP benefits, would be higher 

than in CHIP, due to higher cost sharing and premiums. For example, in 

2013, when comparing CHIP plans in five states with separate CHIP 

programs to state benchmark plans, we found that the CHIP plan in the 

states we reviewed typically did not include deductibles, while all five 

states’ benchmark plans did.11 Similarly, when cost-sharing applied, the 

amount was almost always less for CHIP plans, and the cost difference 

was particularly pronounced for physician visits, prescription drugs, and 

outpatient therapies.12 For example, depending on income, the 

copayment for primary care and specialist physician visits ranged from $2 

to $10 per visit for one state’s CHIP enrollees, but was $30 and $50 per 

visit, respectively, for benchmark plan enrollees. PPACA provisions, 

which seek to standardize QHP costs and reduce cost-sharing for certain 

individuals, could narrow the cost gap we identified, but will vary by 

consumers’ income level and plan selection.13

 

11The five states were Colorado, Illinois, Kansas, New York, and Utah. See 

Our analysis of premium 

data also suggested that CHIP premiums were likely lower than 

benchmark plans, with some enrollees in three states paying no 

premiums and most enrollees across all five states paying less than $200 

a year. For families that qualify for a premium tax credit, premium 

contributions for those covered under the QHP will be limited to anywhere 

from 2 percent to 9.5 percent of the family’s annual income; we estimated 

GAO-14-40. 

12We have work underway that is examining a comparison of costs and coverage in 

separate CHIP plans and QHPs in selected states.

13Effective January 1, 2014, PPACA provides for cost-sharing subsidies for individuals 

and families with household incomes up through 250 percent of FPL to reduce out-ofpocket costs for deductibles, co-payments, and other costs.

Cost, Coverage, and 

Access Are Important 

to Consider in 

Deciding whether to 

Extend Federal CHIP 

Funding

Cost considerations
 

Page 6 GAO-15-268T

that in 2014 those premium contributions would range from $471 to 

$8,949 for a family of four.

Further, our work suggests that some children transitioning out of CHIP 

would not be eligible for the premium tax credit because they have a 

parent with employer-sponsored health coverage that is considered 

affordable under Internal Revenue Service (IRS) regulations. With regard 

to affordability, IRS standards consider the cost of self-only coverage 

offered by the employer rather than the cost of family coverage. In 2012, 

we estimated that about a half million uninsured low-income children 

would be ineligible for the premium tax credit under these IRS standards, 

because they had access to affordable employer-sponsored coverage.14

Further, we estimated that without CHIP-funded Medicaid expansion or 

separate CHIP programs, an additional 1.9 million children who would 

otherwise be eligible for CHIP would be considered to have access to 

affordable insurance under the IRS standards for affordability.15

Our prior work suggests that coverage was generally similar in CHIP and 

benchmark plans, though some variation exists. In 2013, we found that 

the separate CHIP and benchmark plans we reviewed in five states were 

generally similar in terms of the services on which they imposed day, visit, 

or dollar limits.16 For example, the plans we reviewed were similar in that 

they typically did not impose any such limits on ambulatory patient 

services, emergency care, preventive care, or prescription drugs, but 

commonly did impose limits on outpatient therapies and pediatric dental, 

vision, and hearing services.17

 

14See

One notable difference between CHIP and 

benchmark plans we reviewed was the frequency by which they limited 

home- and community-based health care services. While the benchmark 

plans in four states imposed day or visit limits on these services, only one 

state’s CHIP plan did so.

GAO-12-648. 

15Our analysis did not identify the percentage of these children estimated to be in CHIPfunded Medicaid expansions and separate CHIP programs.

16See GAO-14-40. 

17One state’s CHIP plan specified limits on rehabilitative services received in an inpatient 

setting, but not the number of days allowed for an inpatient admission.

Coverage considerations
 

Page 7 GAO-15-268T

Another consideration around coverage in CHIP and through exchanges 

is in coverage of dental services. CHIP covers dental services, but such 

coverage is optional for families seeking coverage on the exchange in 

some states. Families obtaining coverage through exchanges are 

provided a choice with regard to health plans, which may include some 

that cover pediatric dental and others that do not, along with the option to 

purchase a stand-alone dental plan. In 2013, before the exchanges were 

fully in place, we reported that exchange officials in three states told us 

that some families may face confusion in obtaining the appropriate 

amount of pediatric dental coverage. Now that exchanges are in place, 

our ongoing work is obtaining data on the types of plans in which families 

have enrolled, including stand-alone dental plans. As we found in 2013, a

cost consideration for families is that stand-alone dental plans have outof-pocket maximum costs that are in addition to the QHP maximum costs. 

For 2014, the out-of-pocket maximum costs for stand-alone dental plans 

offered in some states’ exchanges were $700 for a plan with one child or 

$1,400 for a plan with two or more children. For example, a family with an 

annual income of $53,663,18

In the current landscape of coverage options, many children eligible for 

CHIP, Medicaid, or the premium tax credit will have different eligibility 

than their parents, which can create complex scenarios of coverage for 

families. Eligibility can vary within households because low- to moderateincome adults with household incomes greater than 133 percent of FPL 

will typically be ineligible for any assistance or will be eligible for the 

premium tax credit rather than Medicaid or CHIP, while children in some 

of these households will be eligible instead for Medicaid or CHIP. As one 

example, a family of three in Oregon could begin the year eligible for 

Medicaid. If the father gained part-time employment, the household 

income could increase such that the parents would no longer be eligible 

for Medicaid but would be eligible for the premium tax credit and costsharing subsidies and the child would become eligible for CHIP.

that enrolls their two children in a standalone dental plan that is in addition to their QHP, would be subject to a 

total out-of-pocket maximum cost of $11,800.

In 2012, we estimated that 21 percent of children eligible for Medicaid, 

CHIP, or the premium tax credit under PPACA would have different 

 

18For a family of four in 2014, an annual income of $53,663 equates to 225 percent of the 

FPL in the 48 contiguous states and the District of Columbia. 
 

Page 8 GAO-15-268T

eligibility from their parents as of the beginning of the year, and an 

additional 9 percent would encounter that situation due to an income 

fluctuation during the course of the year.19 This could lead to breaks in 

children’s coverage and, potentially, negative implications for health 

outcomes given the strong association between a parent’s and a child’s 

health insurance status. For example, in 2011, we found that children 

were more likely to be insured when their parents were insured, and that 

there is a strong association between a parent’s health insurance 

status—whether they are privately insured, publicly insured, or 

uninsured—and a child’s health insurance status.

Our prior work suggests that CHIP enrollees generally reported having 

access to care at rates comparable to children with private insurance, 

with some exceptions. In 2013, our analysis of national survey data 

indicated that CHIP enrollees reported positive responses regarding their 

ability to obtain care, and the proportion of positive responses was 

generally comparable to those with Medicaid or with private insurance.20

For example, at least 88 percent of CHIP enrollees reported they had a 

usual source of care and usually or always got the care they needed. 

When compared with respondents with other sources of insurance, the 

proportion of CHIP enrollees with positive responses to these questions 

were, for most questions, comparable to respondents with Medicaid or 

with private insurance—that is, within 5 percentage points. In addition, in 

2011, we found that most physicians were enrolled in Medicaid and CHIP 

and serving children covered by these programs. On the basis of our 

2010 national survey of physicians, we estimated 78 percent of primary 

and specialty care physicians were enrolled as Medicaid and CHIP 

providers and serving children covered by these programs.21

Access to specialty care in CHIP may be more limited than in private 

insurance. In analyzing national survey data in 2013, we found that the 

proportion of CHIP enrollees with positive responses to the question 

 

19A child’s eligibility for CHIP, Medicaid, and the premium tax credit can change over time 

as his or her household income fluctuates. For example, a child who begins the year 

eligible for the premium tax credit may become eligible for CHIP if household income 

declines during the year. See GAO-12-648. 

20See GAO-14-40. 

21See GAO-11-624. 

Access considerations
 

Page 9 GAO-15-268T

about the ability to obtain specialty care was roughly comparable to 

respondents with private insurance.22

The findings of our 2011 and 2013 studies predated the introduction of 

QHPs sold through exchanges. As such, little is known about the 

comparability of provider networks for CHIP versus QHPs purchased 

through exchanges and the effects on access to care. Knowing more 

about the potential differences in provider networks is important for 

understanding the possible disruptions in care that could lead to negative 

health outcomes for children moving from CHIP to QHPs.

However, in 2011, we found that 

the physicians we surveyed experienced much greater difficulty referring 

children in Medicaid and CHIP to specialty care, compared to privately 

insured children. We also found that the percentage of specialty care 

physicians who accepted all new children with private insurance was 

about 30 percent higher than the percentage of those who accepted all 

children in Medicaid and CHIP.

In conclusion, Congress, HHS, and the states will be faced with making 

important decisions regarding the future of CHIP. In the short term, 

Congress will be deciding whether to extend federal funding for CHIP 

beyond fiscal year 2015. In the longer term, states and Congress will face 

decisions about the role of CHIP in covering children once states are no 

longer required to maintain eligibility standards in fiscal year 2020.

Chairman Pitts, Ranking Member Pallone, and Members of the 

Subcommittee, this concludes my prepared statement. I would be 

pleased to respond to any questions that you may have at this time.

For further information about this statement, please contact 

Carolyn L. Yocom at (202) 512-7114 or yocomc@gao.gov. Contact 

points for our Offices of Congressional Relations and Public Affairs 

may be found on the last page of this statement. Susan Barnidge, 

Assistant Director; Priyanka Sethi Bansal; Sandra George; Drew Long; 

and Rachel Svoboda were key contributors to this statement. 

 

22About 81 percent of CHIP enrollees responded positively to the question about the 

ability to obtain specialty care compared to 87 percent of respondents with private 

insurance. We considered responses to be comparable if they were within 5 percentage 

points.

GAO Contact and 

Staff 

Acknowledgments
Related GAO Products

Page 10 GAO-15-268T

Children’s Health Insurance: Information on Coverage of Services, Costs 

to Consumers, and Access to Care in CHIP and Other Sources of 

Insurance. GAO-14-40. Washington, D.C.: November 21, 2013.

Medicaid and CHIP: Considerations for Express Lane Eligibility. 

GAO-13-178R. Washington, D.C.: December 5, 2012.

Children’s Health Insurance: Opportunities Exist for Improved Access to 

Affordable Insurance. GAO-12-648. Washington, D.C.: June 22, 2012.

Pre-Existing Condition Insurance Plan: Comparison of Implementation 

and Early Enrollment with the Children’s Health Insurance Program. 

GAO-12-62R. Washington, D.C.: November 10, 2011.

Medicaid and CHIP: Most Physicians Serve Covered Children but Have 

Difficulty Referring Them for Specialty Care. GAO-11-624. Washington, 

D.C.: June 30, 2011.

Medicaid and CHIP: Reports for Monitoring Children’s Health Care 

Services Need Improvement. GAO-11-293R. Washington, D.C.: 

April 5, 2011.

Medicaid and CHIP: Given the Association between Parent and Child 

Insurance Status, New Expansions May Benefit Families. GAO-11-264. 

Washington, D.C.: February 4, 2011.

Medicaid and CHIP: Enrollment, Benefits, Expenditures, and Other 

Characteristics of State Premium Assistance Programs. GAO-10-258R. 

Washington, D.C.: January 19, 2010.

Related GAO Products

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