Advancing Children’s Coverage Toolkit

As states take different approaches to implementing the Affordable Care Act (ACA) and new coverage options primarily designed for adults, they may be challenged to maintain and further the progress made in children’s coverage. When the Children’s Health Insurance Program (CHIP) was enacted in 1997, 25 percent of low-income children were uninsured in the United States.1 Since then, CHIP and Medicaid have significantly reduced the number of uninsured low-income children and youth to as low as 14 percent in 2012.2 The ACA brings significant change to the health insurance landscape, with the goals of expanding insurance coverage, streamlining enrollment processes, and increasing access to care. Within the new insurance landscape, it is important that states take into consideration the impact of their health reform-related decisions and approaches on children’s coverage.

Using the Toolkit

To begin exploring the Toolkit for Advancing Children’s Coverage through Health Reform Implementation use the right side navigation to explore specific topics.

Through longstanding work on Medicaid, CHIP, and private sector coverage, NASHP has supported, analyzed, and reported on state efforts to implement effective children’s coverage policies and programs. NASHP draws on years of experience fostering collaborative learning and serving as a key resource for state policymakers and other stakeholders.

Toolkit Goals:

  • Provide a centralized source of information and tools relevant to the impact of the ACA on children’s coverage.
  • Draw attention to some of the challenges states may be facing in maintaining and advancing children’s coverage while implementing the ACA.
  • Assist states in considering policy actions to advance children’s coverage by compiling relevant research and state examples.

The Toolkit for Advancing Children’s Coverage through Health Reform Implementation complements NASHP’s June 2013 report, Health Care Reform and Children: Planning and Design Considerations for Policymakers. The report and toolkit highlight ideas learned through NASHP’s Children in the Vanguard initiative. Since 2011, this initiative has convened a network of state officials and children’s advocates to support their work in strengthening children’s coverage as health care reform decisions are made in their states. This work is supported by The Atlantic Philanthropies, dedicated to bringing lasting change to the lives of vulnerable or disadvantaged people.


1Margo Rosenbach, et al., National Evaluation of the State Children’s Health Insurance Program: A Decade of Expanding Coverage and Improving Access. (Washington DC: Mathematica, September 2007)
2The Kaiser Family Foundation, Health Insurance Coverage of Low Income Children 0-18 (Under 200% FPL) (2011-2012). Accessed March 10, 2014.

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