Four-year-old Caren Silva was squirmy in the waiting room of the Dirne Community Health Center on Friday, before a doctor's appointment for an ear infection.

Even the cost of basic appointments like these can add up quickly, said her mother Shannon, which is why the family has enrolled Caren in Medicaid.

"(She's been enrolled) since she was born," Shannon said. "Medical expenses are so high, and obviously kids have to go to the doctor constantly."

The family is in a tough financial spot, Shannon explained. Having her children on Medicaid has spared them of a lot of expense, she said, whether for mundane illnesses or when her 10-year-old son broke his leg.

"Medicaid really helped us," Shannon said. "It's such a great program to have. It's important for people to be covered and have medical insurance."

It looks like more parents statewide are also discovering that Medicaid is a viable option for their kids, when private insurance isn't.

Idaho has seen a recent jump in the number of eligible children enrolled in the Medicaid Children Health Insurance Plan, according to a new study by the Robert Wood Johnson Foundation.

CHIP provides low-cost or free healthcare coverage to low-income children in Idaho. It covers a wide range of services, including check-ups, immunizations, prescription drugs, X-rays and hospital visits.

"Research evidence has indicated that having Medicaid or CHIP coverage affords much better access to care than being uninsured," said Jennifer Haley, the study's co-author. "This can only seem like a positive thing, that more of them have coverage."

According to the study, 79.9 percent of eligible Idaho children without private insurance were enrolled in CHIP in 2010, up from the 73.6 percent of eligible kids enrolled in 2008.

While the study authors attribute the increase to new enrollment standards, Idaho officials say the economy is more likely the impetus.

Rising CHIP enrollment is occurring nationwide, Haley said, which she believes is due to efforts to expand eligibility requirements and expedite the application process.

"It looks to us like a lot of outreach and efforts to make enrollment easier seem to be working," she said.

But Tom Shanahan with Idaho Department of Health and Welfare questions if that's the whole story.

"Looking at 2008 to 2010, we really didn't do anything different as far as the application or eligibility process," Shanahan said of state standards. "We didn't do any campaigns at all."

Idaho's growing CHIP participation is more likely due to the recession, he contended.

"If a parent had the coverage for their child at work, and then they may have got laid off and lost that coverage, they were more apt to look how to get themselves or their children insured," Shanahan said.

Medicaid may have become an option for more kids, he said, since families have seen their incomes drop.

A financial crisis might also spur families to seek insurance coverage, he added, to avoid the additional burden of medical costs.

"I think a lot of them were looking for something to cover their kids with, so basically nothing catastrophic would happen," Shanahan said.

He noted that 173,245 children statewide are currently enrolled in Medicaid. In Kootenai County, of the 20,670 enrolled in Medicaid, 13,949 are children.

Mike Baker, CEO of the Dirne Health Center in Coeur d'Alene that serves low-income patients, believes that both the economy and outreach have prompted more local families to enroll their children in CHIP.

"We are still seeing the struggling economy. There are more and more people who are finally hitting that tipping point of, 'I've got to do something,'" Baker said.

Dirne Community Health Center itself worked to raise awareness of the CHIP program, he said.

Thanks to a grant obtained by the Mountain States Group, Dirne funded a staff person to educate the community on enrolling children in Medicaid, Baker said.

"She worked with five or six different organizations in the community, to help them learn how to fill out the Medicaid applications, and to teach parents about the program," Baker said.

An employee is always available at Dirne to walk people through the program and how it works, he added.

Dirne has seen an increase of roughly 10 to 15 percent of children patients this year, Baker said.

"It's just nice to see people getting the care they need," he said.

There still remains the fact that 20 percent of uninsured Idaho children eligible for CHIP were not enrolled in 2010, according to the Robert Wood Johnson Foundation.

"That's the million dollar question," Baker said of why families aren't applying. "There's still a stigma around receiving help. I think that's certainly part of it."

Shanahan thinks enrollment is only going to increase, though.

Regardless of what the economy does, he said, more people will pursue insurance as the final stages of the Affordable Care Act take effect.

"With the insurance mandate, then yes, you'd think these children would be coming in for coverage," Shanahan said.