Not everyone knows that states are allowed to use a limited amount of CHIP funding to implement health services initiatives (HSIs) – activities that protect the public health, promote a state’s capacity to deliver public health services, or accomplish public health goals relating to improving the health of children, including children in Medicaid and CHIP. Until recently, there have been few national data sources that identify the variety of activities that states have undertaken as HSIs.

One of the last acts of the Obama administration was to release an FAQ on HSIs in January 2017. The National Academy of State Health Policy (NASHP) followed with some examples of state activities in June 2018. 

But still, no comprehensive list of HSIs was available, so we (Kaiser Family Foundation and CCF) decided to add a question to our Annual 50-State Survey on Medicaid and CHIP Eligibility, Enrollment, Renewal and Cost-Sharing Policies (see table 3, page 35). We noted that 22 states affirmed that they use CHIP funding for a variety of activities, some of which were briefly described in footnotes.

Now MACPAC has released a more comprehensive list in its new HSI FactSheet. The MACPAC study identified 71 different HSIs in 24 states. The factsheet summarizes the types of activities along with the number of states engaged in similar initiatives. In addition to describing HSIs in general, the MACPAC factsheet helpfully links to the state CHIP annual reports which provide more details about these initiatives. 

Child health stakeholders may want to consider HSIs as a source of funding to support innovative approaches to improving child health outcomes. It could be particularly helpful in launching pilot demonstration projects. Of course, funding isn’t unlimited. States are only able to use CHIP funds to the extent that CHIP administrative costs combined with HSI spending do not exceed the 10 percent caps on CHIP administrative costs. This may make it more challenging for small states where fixed CHIP costs could be a higher share of CHIP spending. Still, it’s an opportunity worth exploring.