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Objective. To understand why families enroll in and disenroll from Children's Health Insurance Program (CHIP), their experience with the CHIP application and renewal process, and the insurance coverage of their children after disenrolling.

Methods. We conducted a large household telephone survey in 2012 of CHIP enrollees and disenrollees in 10 states. We used survey responses to assess the perceptions and experiences of families with the CHIP application and renewal process. In addition, we combined the survey data with CHIP/Medicaid administrative data to analyze coverage outcomes of children after disenrolling.

Results. A large majority of recent CHIP enrollees had positive impressions of the application process; 89% found the process very or somewhat easy, and 90% of those receiving assistance found it very helpful. Families had similarly favorable impressions of the renewal process, including those recently disenrolling from CHIP. After disenrolling, children were far more likely to gain Medicaid coverage (49%) than private insurance (18%), while a sizable percentage were uninsured (32%). The likelihood of becoming uninsured was especially high among 18- and 19-year-olds (62%), who lost CHIP coverage due to their age.

Conclusions. Satisfaction with the CHIP application and renewal process is high among those with recent coverage, consistent with efforts by many states to simplify these processes for families. Medicaid is a critical source of coverage for those leaving CHIP, a role that may only increase as states expanding Medicaid through the Affordable Care Act create a new coverage option for older teens losing CHIP eligibility.