It never occurred to Joy Pizzuto to sign up for government-sponsored health care. "I was making enough money to support my girls. We had a tight budget, but we were making it," said the single, working mother of three.

But today — reflecting on her now-12-year-old daughter's diagnosis with diabetes and her 14-year-old's diagnosis of epilepsy — she has this to say to parents who are too proud to ask for help: "Better to have it and not need it, than to need it and not have it."

Pizzuto's kids are among the 200,000 in Utah benefiting from Medicaid or the Children's Health Insurance Program (CHIP).

On Thursday the Lehi mom joined doctors, advocates and a throng of kids at the Boys and Girls Club of Murray to celebrate CHIP's 15th anniversary.

Created in 1997 by a bipartisan group in Congress, including Utah Republican Sen. Orrin Hatch, CHIP is an expansion of Medicaid to kids in middle-income families for whom health coverage is out-of-reach.

The program keeps working parents working and pays off in healthy, well-adjusted children, said Karen Crompton, executive director of Voices for Utah Children, which sponsored the event. "We know that kids who start out healthy get a better shot at life. They do better at home and in school."

Without CHIP and Medicaid, the number of uninsured kids in the U.S. would have followed the same trajectory as uninsured adults. Still, about two-thirds of Utah's 107,000 uninsured children are likely eligible, but have not signed up.

Advocates called upon state leaders to cut bureaucratic red tape and do more outreach and marketing to families.

"Many things can wait. The child cannot," said pediatrician Tom Metcalf, stressing the importance of preventive care for developing bones and bodies. "These programs provide continuity of care and early screening for illness. And they're much less expensive than regular insurance."

CHIP's "sweet 15" comes at a time of uncertainty about America's health safety nets. Medicaid has become a political flash point for states, which, following the Supreme Court's ruling on federal heath reform, must decide whether to expand the low-income program to cover people at 133 percent of poverty, $29,726 for a family of four.

Utah CHIP covers kids at 200 percent of poverty, half of whom will shift into Medicaid come 2014, assuming the state opts to expand. The other half will be eligible for federal subsidies to buy private coverage on an insurance exchange.

Whether that coverage will be affordable, or of equal or better value than CHIP, remains to be seen. So, as a fail-safe Congress reauthorized the program to last through 2019.

"But they only funded it through 2015," Crompton said. "What happens after that is a big question mark."

For now, though, CHIP is available and open year round for enrollment.

Pizzuto's kids have at different times qualified for CHIP and Medicaid depending on her income and assets.

"It has meant life or death for my family," said Pizzuto, who encourages parents "to take five minutes and check the income brackets. You may be surprised to learn you qualify."

The 38-year-old works as an insurance inspector, which doesn't come with health coverage. Until 2007, when one of her girls was hospitalized with pneumonia and a hospital worker urged her to apply for Medicaid, she paid cash for the occasional doctor's visit.

"I swallowed my pride and I'm happy I did," she said, recalling waking one morning two years ago to find her middle daughter, Avery, vomiting and writhing in pain.

The family's new pediatrician, a resource provided by Medicaid, diagnosed Avery with type 1 diabetes and sent her immediately to an ER. Her blood sugar level had spiked and she was on the verge of kidney failure, said Pizzuto.

A year later Pizzuto's oldest, Taylor, was diagnosed with epilepsy. Her treatment and Avery's $700 monthly supply of medicine, meters and test strips are all covered by Medicaid.

"It's such a blessing," said Pizzuto. Avery doesn't like being defined by her disease and doesn't have to be, she said.

"She's like any other kid. She likes to sing and play soccer. She's boisterous with tons of energy and a big fan of Justin Bieber." —

About CHIP

What is CHIP? • Utah's Children's Health Insurance Program is comprehensive coverage for qualifying legal residents under the age of 19.

How do I apply? • CHIP is always open for enrollment. Apply online at health.utah.gov or call 877-KIDS-NOW (877-543-7669)