When money is available to help children get the health care they need, every dollar counts — especially for families already stretched thin. A recent analysis from Georgetown University's Center for Children and Families highlights a federal funding mechanism called CHIP Health Service Initiatives, or HSIs, that some states may be underusing. For families struggling to afford children's health care, understanding this program could open doors to services that may otherwise feel out of reach.

What Are CHIP Health Service Initiatives?

The Children's Health Insurance Program — better known as CHIP — has been a lifeline for millions of American children since it was created in 1997. CHIP provides low-cost or free health coverage to children in families who earn too much to qualify for Medicaid but cannot afford private insurance. Each year, states receive federal CHIP funding to run their programs.

Health Service Initiatives are a specific provision within CHIP law that allows states to redirect unspent CHIP funds — money left over after covering standard benefits — toward broader health initiatives that benefit children. These are not a separate program families apply to directly. Instead, they are a tool that state governments may use to fund a wider range of services and support systems that help children get and stay covered.

According to Georgetown University's analysis, these HSI funds may be used to support things like:

  • Outreach and enrollment programs that help families find out if their children qualify for CHIP or Medicaid
  • School-based health centers that bring medical care directly to children in their communities
  • Mental health and behavioral health services for children who may not otherwise have access
  • Oral health programs like dental screenings or fluoride treatments
  • Home visiting programs that connect families with health resources early in a child's life

These are services that go beyond simply paying for a doctor's visit. They are designed to address barriers that keep children from getting care in the first place — things like not knowing you qualify, not having transportation, or not having a nearby provider.

Why Some States May Be Leaving Money on the Table

Despite the flexibility HSIs offer, not every state has chosen to use them. The Georgetown analysis raises an important question: are some states passing up funding that could meaningfully improve children's health outcomes?

There are several reasons a state might not pursue HSI funding. The application process requires states to demonstrate that proposed initiatives will benefit CHIP-eligible children. Some state agencies may lack the administrative capacity to design and submit these proposals. In other cases, it may simply be a matter of awareness — state officials may not fully understand the range of programs HSI funds can support.

For families, the consequence is real. A child in one state may have access to a school-based health clinic funded through a CHIP HSI, while a child in another state does not — simply because of where they live, not because the money isn't available.

What This Means for Families Right Now

If your child is uninsured or you are worried about affording their health care, CHIP remains one of the most accessible coverage options available. Depending on your state and family income, your child may qualify for free or very low-cost health coverage that includes doctor visits, immunizations, emergency care, dental care, vision care, and more.

Beyond standard CHIP coverage, some states have used HSI funding to create programs that may be available in your community. These might include free dental screenings at your child's school, navigator programs that help you enroll in coverage, or mental health resources for children and teens.

The first step is finding out what your state offers. You can visit your state's Medicaid and CHIP agency website, call 1-800-318-2596 (the Health Insurance Marketplace number), or visit Benefits.gov to search for programs in your area. Local community health centers and school social workers may also be able to connect you with HSI-funded services that exist in your community.

How Advocates Are Pushing for Change

Healthcare advocates and researchers at organizations like Georgetown's Center for Children and Families are actively working to raise awareness about underused CHIP funding. Their goal is to encourage more states to tap into HSI funds and design programs that address the specific needs of uninsured and underinsured children in their communities.

For families, this kind of advocacy matters. When researchers publish findings showing that states may be leaving money unused, it can prompt state legislators, Medicaid directors, and child health advocates to take action. You can also play a role by contacting your state representatives and asking whether your state is using all available CHIP Health Service Initiative funding.

Mental Health and Oral Health: Two Areas of Particular Need

Georgetown's research points to mental health and oral health as two areas where HSI funds could make a significant difference. Children's mental health needs have grown significantly in recent years, and many families face long wait times or high costs for counseling and behavioral health services. Oral health, meanwhile, is often overlooked — tooth decay remains one of the most common chronic conditions in children, yet dental care is frequently the first thing families cut when money is tight.

States that use HSI funds to address these gaps may be able to reach children who fall through the cracks of standard coverage. If your child needs mental health support or dental care and you are unsure how to pay for it, ask your state CHIP office whether any HSI-funded programs may be available to help.

Program eligibility and availability vary by state. Not affiliated with any government agency.