CHIP operation types differ by state. Traditionally, states had the flexibility to administer CHIP, which has been operated as 1) a Medicaid-expansion CHIP, 2) a program entirely separate from Medicaid, and 3) a combination program in which states use the Medicaid-expansion CHIP to cover younger or lower-income children and the separate CHIP for other children. To date, 10 states and Washington, DC, have implemented CHIP as a Medicaid-expansion CHIP, 2 states operate a separate CHIP, and 38 states use a combination approach, which is reflected in this figure. Data publicly available online from https://www.medicaid.gov/chip/state-program-information/index.html.