States have a long history of providing families with the option to purchase Medicaid or Children’s Health Insurance Program (CHIP) coverage for their children, but these programs have dwindled in recent years. In a February 2020 Health Affairs blog post, we review states’ experiences with buy-in programs for children, present updated information on the four remaining CHIP buy-in programs, and compare them to child-only coverage on the individual market. Properly designed, targeted, and marketed, buy-in programs could be a cost-effective way of moving toward universal coverage for children.