This study evaluates the impact of coverage in ALL Kids, the Alabama Child Health Insurance Program (CHIP), by examining asthma-related utilization and outcomes among children continuously enrolled for 3 years (N = 1954)with persistent asthma at enrollment. Outcomes and costs were compared for the first, second, and third years of enrollment using repeated measures analysis of variance and controlling for age, gender, and year fixed-effects. Compared with subsequent years, first year enrollment utilization was higher for asthma-related hospitalizations (6% vs 2% vs 2%; P <.0001) and emergency visits (10% vs 3% vs 2%; P <.0001). Also decreasing were asthma-related outpatient visits (1.46 vs 1.12 vs 0.94; P <.0001), quick-relief prescriptions (2.6 vs 2.2 vs 2.1; P <.0001), and long-term control prescriptions (5.8 vs 5.2 vs 4.4; P <.0001). As a result, significant declines in the mean costs per child were observed. Ongoing ALL Kids coverage is associated with improved disease-management and lower costs for persistent asthma. © 2012 SAGE Publications.