program administrators, but were more annoying to providers of care who had to collect the fees.
While families are supposed to be able to receive reimbursement for these fees if they exceed
five percent of annual incomes, this requirement presents a major difficulty in maintenance of
records for families in states with such a program.
Many states initially had difficulty reaching enrollment targets. Thirty-six states did not
reach their enrollment targets and had to return portions of their federal dollars received for the
CHIP program in its initial year of operation. As one example, Arizona had to return about $77
million in CHIP funding, or about 66 percent of what had been received. (Groppe and Chavez,
2000). Arizona is an example of a state with special issues linked to large numbers of Latinos in
the state. Although recent rulings by the INS (Immigration and Naturalization Services) have
concluded that receipt of CHIP funds will not count as a “public charge” and therefore will not
hurt the chances of a family becoming eligible for citizenship, this concern has created an
important barrier to enrollment in border states and others with large Latino populations. The
stigma of a “welfare” program and complexity of the application process or the cost-sharing
features are other barriers to enrolment in many states.
As the program became more familiar, however, state policy makers generally responded
favorably, and after the initial enrollment difficulties now attributed to the effect of welfare
reform, there began a steady increase in enrollment through 2001 (Mann et al, 2001). In general,
between 1998 and 2001, Medicaid and Chip enrollment grew by an average 30 percent across
states, with enrollment declining in only three states (Grogan and Patasnik, 2003). States that
used CHIP funds for Medicaid expansion tended to have higher enrollment increases than those
that created a new separate program (Grogan and Patasnik, 2003). In states than devoted
resources to changing Medicaid’s public image, improving ease of entry or creating outreach
Convention