The GOP Has Officially Engineered a Children’s Health-Care Crisis

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From October:

More than 400,000 Texans' insurance at risk after Congress fails to renew CHIP
Insurance coverage for more than 400,000 Texas children and pregnant women is in jeopardy after Congress failed to renew authorization for a federal program.

Without federal funding, Texas has enough money for CHIP to last until February 2018, according to estimates by the Texas Health and Human Services Commission. However, federal lawmakers say they're working on a plan to continue the program before funding runs out for Texas.

The program, created in 1997 and adopted in Texas in 1999, has cut the percentage of uninsured children nationwide from 15 percent in 1997 to 5 percent in 2015. It also offers prenatal care to about 36,000 pregnant women in Texas. About 394,000 Texan children ineligible for Medicaid are covered under CHIP, and another 249,000 Texan children on Medicaid benefit from CHIP’s 92 percent matching rate. Together, Medicaid and CHIP cover about 45 percent of all children in the state.

Without CHIP, “there aren’t a lot of options” for children in low-income families, said Mimi Garcia, a spokesperson for the Texas Association of Community Health Centers. Community health centers, which often provide health care for uninsured Texans, also saw about 70 percent of federal funding expire on Sept. 30, Garcia said.

More than 400,000 Texans' insurance at risk after Congress fails to renew CHIP

 

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From October:

CHIP has been in this fix only one other time since it was established in 1997. In 2007, CHIP went weeks without funding authorization from Congress.

2. What are states doing in reaction to Congress missing the deadline?

Most states are doing little except reaching into their unspent federal funds.

However, Minnesota was among those most imperiled because it had spent all its funds. State officials said Tuesday that the federal Centers for Medicare & Medicaid Services (CMS) was giving Minnesota $3.6 million from unspent national funds to cover CHIP this month.

Emily Piper, commissioner of the Minnesota Department of Human Services, reported in a newspaper commentary last month that her state’s funds would be exhausted last Sunday.

Even without the last-minute infusion of funding from CMS, most of the children covered by CHIP would have continued to receive care under the state’s Medicaid program, but Minnesota would get fewer federal dollars for each child, according to Piper’s commentary. However, she added, those most at risk are the 1,700 pregnant women covered by CHIP, because they wouldn’t be eligible for Medicaid.

Utah has notified CMS that it plans to discontinue its CHIP program by the end of the year unless it receives more federal money. About 19,000 children are in the state’s CHIP program, state officials say. So far, though, the state said it is not moving to suspend service or enrollment or alert enrollees about any possible changes.

Nevada officials said if funding is not extended it might have to freeze enrollment on Nov. 1 and end coverage by Nov. 30.

Senate Finance Committee Chairman Orrin Hatch (R-Utah) and the committee’s ranking Democrat, Sen. Ron Wyden of Oregon, announced an agreement in mid-September to renew CHIP funding. Under the proposed deal, federal CHIP funding would drop by 23 percentage points starting in by 2020, returning to its pre-Affordable Care Act levels. The agreement would extend the life of the CHIP program through 2022.

Hatch and Wyden did not provide any details on how they would pay for the CHIP extension.

The House Energy and Commerce Committee posted its bill just before midnight Monday. It mirrors the Senate Finance plan by extending funding for CHIP for five years and gradually phasing down the 23-percentage-point funding increase provided under Affordable Care Act over the next two years.

5. Who benefits from CHIP?

While CHIP income eligibility levels vary by state, about 90 percent of children covered are in families earning 200 percent of poverty or less ($40,840 for a family of three). CHIP covers children up to age 19. States have the option to cover pregnant women, and 18 plus the District of Columbia do so.

The program is known by different names in different states such as Hoosier Healthwise in Indiana and PeachCare for Kids in Georgia.

For families that move out of Medicaid as their incomes rise, CHIP is an affordable option that ensures continued coverage for their children. Many states operate their CHIP programs as part of Medicaid.

5 Takeaways From Congress’ Failure To Extend Funding For Children’s Coverage

 

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From October:
States Gird for Worst as Congress Wrestles with Children’s Insurance Program
Federal officials on Monday approved a $3.6 million emergency infusion for Minnesota after the state’s human services chief warned that pregnant women and some children were at imminent risk of losing health care coverage under the Children’s Health Insurance Program.

Utah, meantime, has formally requested authority to “eliminate eligibility and services under CHIP” if the state does not have enough money to continue coverage.

Congress has known for two years that federal funds for the Children’s Health Insurance Program were expiring this fall.

The Utah program covers 19,000 children.

By the end of this year, Arizona, Minnesota and North Carolina are likely to run out of money for their programs, according to the panel, the Medicaid and CHIP Payment and Access Commission.

By March 2018, it said, CHIP funds will be exhausted in 27 additional states, including California, Colorado, Connecticut, Florida, Massachusetts, New York, Ohio, Oregon and Pennsylvania. Another 19 states are expected to use up their money from April to June 2018, with one state exhausting its funds from July to September 2018.

Gov. Andrew M. Cuomo of New York, a Democrat, said Tuesday that Congress’s failure to act jeopardized coverage for 330,000 children in the state.

Nearly 90 percent of children in the program had family incomes less than twice the poverty level (less than about $40,000 a year for a family of three).

States Gird for Worst as Congress Wrestles with Children’s Insurance Program

 

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From October:

By failing to reauthorize the Children’s Health Insurance Program before last week’s deadline, Congress has nudged the state of Minnesota toward a painful solution to the loss of federal funds: Unless it can find $95 million, the state said it will continue to provide full health care for certain low-income pregnant women in the program, while either reducing the number of children eligible for CHIP or scaling back their benefits.

Emily Piper, commissioner of the Minnesota Department of Human Services, sounded utterly exasperated with Congress’ failure to act in time.

“When you look at the people most urgently impacted,” she said, “pregnant woman and new moms, having this uncertainty looming over them at a time when they need that certainty to live their lives and care for their babies, it is really a disservice to them.”

Without the federal funds, Minnesota was preparing to adopt some drastic measures to keep the program operating. Piper said the state was planning to continue offering full services to the 1,700 pregnant women in CHIP, but to scale back either the eligibility of kids in the program or the services they would be entitled to. About 125,000 children are in Minnesota’s CHIP.

But then the Centers for Medicare and Medicaid Services informed the state earlier this week that it would send an additional $3.6 million in CHIP money from unused funds that had been distributed to the states between 2014 and 2016. The additional money would enable Minnesota to hold off any changes in the program until the end of October, the state human services agency said.

Shutting Down
Arizona, with about 88,000 kids in CHIP, said it too had recently learned it would soon receive “redistributed” funds, to the tune of nearly $22 million, which would enable it to run its program unchanged until the end of November, according to Heidi Capriotti, spokeswoman for the Arizona Health Cost Containment System, which runs the state’s Medicaid program and CHIP.

Utah has also said it expects to receive redistributed funds shortly, which Kolbi Young, a spokeswoman for the state’s Health Department said would enable the state to continue the program until the end of December. If Congress doesn’t act by then to resume CHIP funding, the program, which serves about 20,000 kids according to Young, would shut down, she said.

North Carolina, with a CHIP enrollment of more than 256,000, has not received redistributed funds, according to the state health department, and it too is expected to run out of funds this year.

Nevada, where nearly 69,000 kids are in CHIP, also expects the money to run out by the end of the year, according to Cody Phinney, a deputy administrator for Nevada’s Division of Health Care Financing and Policy.

Between 2013, the year before the ACA was implemented, and 2016, the share of kids without health insurance dropped from 4.8 to 3.8 percent.

 

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From October:

Arizona's KidsCare account is running on fumes. Boosted by an extra $22 million in leftover federal money, the program is still on track to run out of money by late November. That would force the state to kick more than 23,000 kids off the program.

That move could cost Arizona even more, as reliable health care is often seen as one safety net to keep children out of the state's foster-care system.

However, he wants to see the funding restored, spokesman Patrick Ptak said Thursday. Arizona planned on $112 million from the feds to pay for KidsCare in the current budget year. But without reauthorization, the money won't come. And Ducey wants Congress to act quickly, Ptak added.

A critical time for Arizona kids
The situation is particularly worrisome in Arizona, which just a year ago lifted a six-year freeze on enrollment in KidsCare. As a result, enrollment swelled nearly three-fold, to the current 23,199, state data show. State officials said it was a sign of the clear need in a state with one of the highest rates of uninsured children in the nation.

Depending on what Congress does next, two things could happen:

• All 23,000 would all lose coverage if Congress fails to restore funding.
• If Congress restores funding at anything less than the full cost of the program, Arizona law requires the state to halt enrollment in the program. (The program has grown every month since last year, with 810 kids signing up in September.)

The enrollment freeze is a provision lawmakers, wary of any federal responsibilities being transferred to the state, tucked into the fiscal 2018 budget earlier this year.

https://www.azcentral.com/story/new...ly-pushes-funding-childrens-health/796773001/

 

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From October:

Despite changes, House Dems still oppose CHIP bill

House Republicans have altered legislation to extend funding for the Children’s Health Insurance Program, but the changes won’t sway Democrats, who are accusing the GOP of using a must-pass bill to gut ObamaCare.

An updated version of the legislation eliminates a provision opposed by Democrats that would have charged higher premiums to Medicare beneficiaries earning more than $500,000 a year. But in its place, the bill would cut more money from ObamaCare's public health fund.

The bill would also shorten the grace period for ObamaCare enrollees who fail to make premium payments. According to an analysis by the left-leaning Center on Budget and Policy Priorities, between 259,000 and 688,000 people could lose their insurance as a result of the shortened grace period.

A Democratic aide said the changes make the bill even worse.

“It is a further example that this has become a vehicle to sabotage the Affordable Care Act,” the aide said.

The bill extends CHIP for five years and was combined with a separate bill that extends funding for community health centers for two years.
Despite changes, House Dems still oppose CHIP bill

Political tussle over gender surgery for trans kids may delay health care for low-income kids in Pa.
A popular federally-funded children’s health program that has long enjoyed bipartisan support is locked in an unprecedented state political battle over cutting medical services to transgender youth.


Pennsylvania Senate Republicans want to restrict funding for trans kids to get gender reassignment surgery, also called affirmation surgery. Democrats and LGBTQ advocates are accusing them of playing doctor and discriminating against particularly vulnerable children.

Meanwhile, this ideological tug-of-war is holding up reauthorization of the Children’s Health Insurance Program (CHIP), which pays for health care for about 176,000 Pennsylvania children from families with limited incomes.


On Wednesday, the Senate by 37-13 passed a reauthorization bill that would deny CHIP funds for gender reassignment surgery. Other services, like counseling and prescribed puberty-blocking hormones, will be covered by the program. The new amendment is a softening of a version that denied transgender youths access to all of those additional services.

Sen. Don White (R., Indiana), the sponsor of the amendment, posted a statement last week that using state funds to “pay for sex change operations for children” is “completely inappropriate.” White said he believes most Pennsylvanians would agree with him.

The Trump administration and other states have been making attempts to limit transgender people’s access to publicly funded health care.


LGBTQ advocates and state Democrats – including Gov. Wolf – accused lawmakers of interfering with decisions about what medical care children should receive.

“The amendment effectively segregates transgendered children from how other children in the program are treated,” wrote Gov. Wolf to Senate leaders after Wednesday’s vote. “Plain and simple, this is wrong, and all health decisions for these kids should be made with their parents, counselors, and doctors – not by politicians.”

In a statement issued after Wednesday’s vote, Senate Democratic Leader Jay Costa of Allegheny County said it “pained” him to vote against CHIP but said, “I cannot support discrimination.”

Omar Gonzalez-Pagan, staff attorney with Lambda Legal, a national LGBTQ civil rights advocacy organization, said the Senate’s move could put the state in violation of federal law. He also called the amendment “discrimination against the most vulnerable.”

Transgender children, often the targets of bullying and discrimination, tend to be at heightened risk for suicide.

Carrie Jacobs, executive director of the Attic, a Philadelphia-based support center for LGBTQ youth, said obstructing a transgender child’s access to appropriate health care “is detrimental, even life-threatening, to the growth and well-being of that child.”

Jacobs added: “The Attic firmly believes that … any attempt of lawmakers to obstruct access to medically deemed treatment for transgender youth is rooted solely in discrimination.”
Political tussle over gender surgery for trans kids may delay health care for low-income kids in Pa.

 

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From November:
Nearly half-million low-income Texas kids may not lose health insurance after all, Abbott says
Texas has offered CHIP to working families since 2000. The $1.7 billion-a-year program provides private insurance coverage to kids whose parents' incomes are too high to qualify for Medicaid but are less than 200 percent of the federal poverty level. For a family of four, the income limit this year is $49,200.

In August, CHIP covered about 402,500 children and nearly 35,000 women receiving prenatal care and post-delivery checkups. In Dallas County, slightly more than 50,000 children and 5,800 women were enrolled.

Congress allowed funding for the program to expire Sept. 30. Originally, the state Health and Human Services Commission estimated it had enough money to keep CHIP running until February. But a decision to waive Hurricane Harvey victims' CHIP fees and co-payments burned through some of the money, raising the prospect funds could run out in January, said commission spokeswoman Carrie Williams.

Nearly half-million low-income Texas kids may not lose health insurance after all, Abbott says | Politics | Dallas News

Arizona to keep kids health-care program funded, but for how long is up in the air
Arizona will ensure some 23,000 children from lower-income families don't have to live without health insurance — at least for now — and the governor is officially asking Congress to make sure those kids stay covered.

Gov. Doug Ducey's office said Wednesday that the state will shift money around in existing budgets to cover the costs of KidsCare. The state-run, federally funded program was expected to drain its existing budget later this month, potentially leaving all 23,000 children without care.

The new funding plan assumes Congress will renew funding for the popular program by early spring, said Christina Corieri, a senior adviser to the governor. That's something Congress failed to do before the new federal budget year started Oct. 1.

In his letter, Ducey noted the program is not a typical welfare program that provides a service at no cost. Instead, it requires buy-in from the families whose children benefit from the program. They must pay a monthly premium of up to $70 a month, with the amount pegged to their income.

KidsCare is designed for children from families who make too much to qualify for the state's Medicaid program, but who can't afford to buy coverage through their employer or through the health-care exchange. Families with incomes up to 200 percent of the federal poverty level are eligible. For a family of four, that is $49,200.
https://www.azcentral.com/story/new...program-funded-but-how-long-up-air/823732001/

 

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From November:

Dr. Neil S. Calman, the president and chief executive of the Institute for Family Health, which operates 31 community health centers in New York, said the uncertainty over federal funding “affects every decision” he makes. He has deferred hiring doctors and nurses and put off purchases of dental chairs and other equipment because “we know we soon won’t have the money.”
House to Vote on Child Health Care, but Funding Will Remain in Limbo

Children’s Health Bill Clears House as States Struggle to Keep Programs Afloat
The House passed a bill on Friday that would provide five years of funds for the popular Children’s Health Insurance Program, over vehement objections from Democrats who opposed the way it would be financed.

The vote, 242 to 174, came a month after funds for the program expired.

In the House, 15 Democrats joined 227 Republicans in voting for the measure on Friday. Only three Republicans voted against it.

To offset the cost, the House bill would increase premiums for Medicare beneficiaries with income of more than $500,000 a year, remove some lottery winners from the Medicaid rolls, and cut $6.35 billion over 10 years from a fund established by the Affordable Care Act to pay for public health initiatives such as preventing diabetes, heart disease, cancer and opioid abuse.

In addition, the bill would end insurance coverage for several hundred thousand people who fail to pay their share of premiums for insurance purchased in marketplaces under the 2010 health care law.

Most people who buy insurance through the Affordable Care Act marketplace receive subsidies to help pay their monthly premiums. Under the law, if they do not pay their share of premiums, insurers must give them a three-month grace period before terminating their coverage. The House bill would reduce the grace period to one month unless a state specified a different period.

The Congressional Budget Office estimates that the government would save nearly $5 billion over a decade because fewer people would have government-subsidized coverage.

Republicans defended their path to pay for the children’s health program, especially the higher Medicare premiums. It was reasonable to require wealthy people to help defray the cost of care for children from families of modest means, they said.

“When you are making a half-million dollars a year, you can pay a little bit more,” said Representative Tom Cole, Republican of Oklahoma. “Warren Buffett and Donald Trump don’t need the same Medicare program that Ma and Pa Kettle living on Social Security do.”

Democrats, who often seek higher taxes on high-income people, denounced the proposal.

“I’m not worried about whether wealthy families can afford to pay increased Medicare premiums,” said Representative Debbie Dingell, Democrat of Michigan. “But I’m worried that these changes will result in wealthy people abandoning the program in large numbers, which would worsen the risk pool and ultimately increase the cost for middle- and lower-income seniors. It would fracture the universal nature of Medicare and put the entire program at risk.”

But Representative Greg Walden, Republican of Oregon and the chief author of the bill, said, “We are just asking the wealthiest seniors in America, those making $40,000 a month — not a year, a month — to pay about $135 a month more for their Medicare, so we can fund children’s health insurance for five years.”

Children’s Health Bill Clears House as States Struggle to Keep Programs Afloat

CQ: West Virginia Could Close Children's Health Program
West Virginia could close its Children’s Health Insurance Program as early as February if Congress does not act soon to renew federal funds for the program. The state’s CHIP board of directors voted Wednesday to close enrollment on Feb. 28, 2018, if funds are not provided before then. If needed, notifications with additional information will be sent to families and providers in early January, but benefits would continue as usual until the end of February. (Raman, 11/9)

 

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From November:

A growing number of states are relying on leftover federal dollars to keep their Children's Health Insurance Programs afloat since Congress failed to reauthorize funding for the program before it expired at the end of September. The Centers for Medicare and Medicaid said Thursday that it distributed roughly $600 million to 14 states and territories in October and November as a temporary fix. The money is leftover from previous years of CHIP and is being given out to states as necessary. (Raman, 11/16)
CQ: Growing Number Of States Are Relying On Stopgap CHIP Funding


If funds aren’t appropriated by Jan. 1, about 72 percent of health centers across the country plan to put a hiring freeze in place — and some already have.

Health centers are considering or already instituting other measures: Roughly 41 percent would lay off staff, 47 percent would reduce their staff hours and/or hours of operation, and slightly more than half would cancel or delay renovating or expanding their facility. That’s according to a survey by the National Association of Community Health Centers performed a few days before the reauthorization expired.
Facing 'hard decisions,' health centers plead for restored funding



Colorado’s version of the program is called the Child Health Plan Plus, or CHP+. The state spends about $185 million per year on CHP+, according to a report by the Colorado Department of Health Care Policy and Financing, and nearly 90 percent of that money comes from federal funds given to the state. The program also charges some enrollment fees and copays.
Congress has two months to act or 75,000 kids and pregnant women in Colorado will lose health insurance – The Denver Post



Iowa’s CHIP program is called Hawk-i and covers about 65,000 kids, a number expected to grow in upcoming years. Families pay a monthly premium of $10 to $20 per child for comprehensive coverage that costs taxpayers an average of only a few thousand dollars per year.

So where the heck is Sen. Chuck Grassley?

He has been among CHIP’s most vocal advocates, issuing press release after press release over the years about the value of CHIP and his dedication to the program. In 2007, he was an activist in moving through a bill to reauthorize it, working with House Democratic leadership and trying to convert House Republicans against the wishes of their leaders and President George W. Bush.
https://www.desmoinesregister.com/s...dren-health-insurance-program-chip/897529001/



It gets worse. The same day that CHIP expired, so too did the Community Health Center Fund, which was created in 2010 to help keep clinics serving low-income patients afloat. The CHC fund is caught in the same limbo as CHIP; without its $3.6 billion in government funding, 1,400 clinics will face average budget cutbacks of 70%, according to the National Assn. of Community Health Centers.
http://www.latimes.com/business/hil...GL-PE5q4dujvUZccTnIRO2AyfItQmg&_hsmi=58853384

 

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From November:

MADISON - The state stands to lose up to $115 million a year if Congress doesn't renew a program that helps to cover nearly 118,000 children here. In Wisconsin, however, children will remain covered because a state law requires it, state Health Services spokeswoman Julie Lund said. But state taxpayers will end up paying more if the federal money runs out, as it is on track to do in March. Without a renewal of the CHIP program, federal taxpayers will cover only 59% of the costs of insuring those children in Wisconsin. That's a difference that adds up to about $9.5 million more per month that state taxpayers will have to pay to maintain the coverage.
https://www.jsonline.com/story/news...snt-renew-childrens-health-program/899776001/




Texas eager to avoid telling nearly half million kids before Christmas about lost health coverage
Gov. Greg Abbott’s administration is trying to avoid mailing health insurance cancellation notices to nearly half a million children three days before Christmas.

Unless it can get $90 million more in federal funding, though, Texas will end its Children’s Health Insurance Program on Jan. 31. It would send notices about the program’s termination to affected families on Dec. 22.

The state Health and Human Services Commission, which runs Texas’ version, requested $90 million from the federal Centers for Medicare and Medicaid Services. That would allow CHIP to continue in Texas through February. If the federal agency does not agree by Dec. 9, the commission would prepare to end the program in January and refer families to the Affordable Care Act's online health insurance marketplace.

“Families might fall through the cracks, families might not be able to afford coverage in the marketplace,” Kohler said. “And then there’s the system issue that needs to be worked out. On the online marketplace, if you qualify for other insurance programs like CHIP, you cannot enroll in a marketplace plan. So these kids are technically eligible for CHIP, but their coverage will lapse after January.”

Earlier this month, Texas House Speaker Joe Straus prodded commission chief Charles Smith to look at ways in which Texas can “continue coverage for children currently enrolled in CHIP as Congress completes the reauthorization process.” Straus cited a budget provision that calls for the state to transfer funds from other state agencies to avoid CHIP shutdown, but it’s not clear if other GOP state leaders are as eager as Straus to move money around for that purpose.
Texas eager to avoid telling nearly a half-million kids — right before Christmas — that they’ve lost health coverage | Health Care | Dallas News

(one day later)

Texas confident in additional federal funding to extend CHIP through February
Texas officials got good news Wednesday: They may not have to send out health insurance cancellation letters to nearly half a million kids three days before Christmas.

The federal Centers for Medicare and Medicaid Services on Wednesday signaled it’s very likely to give Texas enough additional money to keep its Children’s Health Insurance Program running through February, according to a spokeswoman for the state’s CHIP program.

“Based on our conversations with CMS today, we are confident that a redistribution of funds will happen, which will allow the program to continue through February,” said Carrie Williams of the Health and Human Services Commission.

The commission’s plan to mail out termination notices on Dec. 22 “would be pushed back a month once we know for certain funding is extended through February,” Williams said in an email.

When Congress allowed funding for CHIP to expire on Sept. 30, Texas planned to use its remaining federal funds as long as possible -- until Jan. 31. State law requires cancellation notices to be sent 30 days before coverage ends.

The law also says that if federal funding runs out, CHIP ends. Commission lawyers have said that trumps language in the state budget that tries to minimize effects on enrollees if there are funding disruptions. From the program’s inception 17 years ago, state leaders have been wary that federal funds might someday dwindle or be shut off — and that state taxpayers would have to bear the full tab.

The Legislature’s 1999 bill creating CHIP stressed that it was “not an entitlement” and would cease if the federal money ran out.

So while some other states, such as Minnesota and Oregon, are talking about dipping into state funds to keep their CHIP programs going, that’s verboten in Texas — at least until lawmakers are back in session, which may not happen for more than a year.

Health and Human Services recently requested $90 million from the Centers for Medicare & Medicaid Services, and gave the federal agency until Dec. 9 to respond with written commitment. Once that comes in, everything related to shutting the program down — sending out cancellation letters, determining eligibility of potential CHIP recipients — would be pushed back one month, Williams said.
Texas confident in additional federal funding to extend CHIP through February | Health Care | Dallas News

 

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From November:
What happens if Congress doesn't fund the health insurance used by almost 2 million kids and pregnant women in California?
But a few years ago, California rolled its children’s insurance program into Medi-Cal — the state’s version of Medicaid — through the Affordable Care Act. That meant the federal government would cover 88% of the cost, but it came with a caveat: California cannot freeze enrollment or end the program for most families until October 2019, even if federal funding ends.

If the program’s money runs out, nearly all of the recipients would continue to get insurance through Medi-Cal, said California Department of Health Care Services spokesman Anthony Cava. But the federal government would pay only 50% of the cost, as it does for adult Medicaid recipients.

California would have to make up the difference, which the independent California Legislative Analyst’s Office estimates would be $280 million this fiscal year and up to $600 million next fiscal year.
What happens if Congress doesn't fund the health insurance used by almost 2 million kids and pregnant women in California?


Mass. braces for possible loss of federal funding for children’s health program
Massachusetts is on track to run out of money in January for a federal program that provides health coverage for 172,000 children in the state unless Congress moves quickly to approve new funding.

Without congressional action, Massachusetts is slated to lose $295 million in annual funding, according to state health officials.

In Massachusetts, CHIP is administered through the state Medicaid program, called MassHealth. Baker administration officials said they are exploring alternative coverage options for children on CHIP if Congress fails to continue federal funding.

The Blue Cross Blue Shield of Massachusetts Foundation, a group that has studied the issue, said most Massachusetts children now covered by CHIP would be able to stay covered under MassHealth, according to a previous agreement between state and federal officials. But the state would be stuck with higher costs to pay for that coverage unless Congress moves to keep the federal dollars flowing.

For Massachusetts, the program is particularly attractive because the federal government pays for 88 percent of the costs, while it pays a smaller share — about 50 percent — for MassHealth members.

Shelto said about 7,000 unborn children and their pregnant mothers who are now eligible for the program in Massachusetts would lose coverage if the federal government fails to approve new funding.

About 40 percent of Massachusetts patients admitted to Children’s Hospital are covered by MassHealth or CHIP.
State braces for possible loss of federal funding for children’s health program - The Boston Globe

 

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From December (earlier this month):
Hey, Texplainer: How much money does Texas spend per child through CHIP?
The state's budget for fiscal years 2018 and 2019 allocates about $200 per child per month to the roughly 400,000 CHIP-eligible Texans.

About 394,000 Texas children who are ineligible for Medicaid – the joint state-federal health insurer of last resort — are covered under CHIP, and another 249,000 Texas children on Medicaid benefit from CHIP.

During the 2016 fiscal year, Texas spent $93 million on CHIP, while the federal government contributed $1.2 billion.

But it's virtually impossible to know how Texas' CHIP spending compares to other states because there are different ways to operate the program.

“Some states have CHIP programs that look exactly like their Medicaid program,” said Maureen Hensley-Quinn, senior program director at the National Academy for State Health Policy, a nonpartisan group that advises states on health policy. “Some states require cost-sharing of families in the form of premiums, and some states do not.”

Hensley-Quinn said there are states like Texas that operate two programs: one that uses CHIP funds to expand Medicaid for children up to a certain income level, and another for children in families with slightly higher incomes. The two programs work in concert with one another but are technically different despite both using CHIP funds.

“For the states that use a Medicaid expansion ... how much they spend per child would not be a truly comparable number to a state that uses either a combination program or a separate CHIP program,” said Anne Dunkelberg, an associate director for the Center for Public Policy Priorities, a left-leaning think tank. “By definition, a separate CHIP program is almost never going to offer that same generous guaranteed coverage of all necessary care as a Medicaid program does.”

Together, Medicaid and CHIP cover about 45 percent of all children in the state. The primary difference between the two programs, Garcia said, is that CHIP is like a “gap insurance” program. It is specifically designed for children whose families make too much for them to qualify for Medicaid, but who are less likely to have an employer offer of coverage through their parent. The cap for CHIP is roughly 200 percent above the federal poverty line.

Hey, Texplainer: How much money does Texas spend per child through CHIP?

 

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From December(earlier this month):
Greg Peters column: Congress is creating a nightmare for Virginia families

If Congress does not vote to fund CHIP within the next two weeks, 60,000 children and 1,000 pregnant women in Virginia will have no health care starting in 2018. These families will not be able to turn to Medicaid for coverage because they earn too much to qualify. But, with health care costs rising, they cannot afford the expensive premiums and deductibles for private insurance.

This means that children with diabetes will not have access to life-saving medicine. Children with asthma will not be able to refill their prescription for an inhaler. Children who have been thriving despite their medical conditions will battle symptoms that are easily avoidable.
Greg Peters column: Congress is creating a nightmare for Virginia families


Millions of Poor Children Could Lose Health Care If Congress Doesn’t Act Soon
That’s bad news for people like Yvette Lucas, a nurse and mother of two in Virginia, who worries that her 5-year-old son could lose coverage. He was born as a micro-premature baby, weighing in at under 2 pounds (900 grams), and was later diagnosed with cerebral palsy. His older brother needs weekly speech therapy, which is paid for by CHIP.

“I don’t know what I would do if I didn’t have it, what other families would do,” Lucas said. “These are working parents who are trying to make ends meet.”

Under Obamacare, states are required to maintain Medicaid CHIP programs until 2019, but if the bill isn’t reauthorized, they would receive a lower federal matching rate. Meanwhile, separate CHIP programs, which cover about 3.7 million children, would be terminated, unless states figure out a new source of funding. The Kaiser Family Foundation, a nonprofit, estimates that a majority of states will run out of CHIP money by March.

When states started running out of money for the program in October, they began reaching into the federal government’s $3 billion pool of reserve funds. But that’s still $10 billion short of what they need for 2018, according to the Centers for Medicare and Medicaid Services. So far, 15 states, plus the District of Columbia and the U.S. territories, have received a total of $1.2 billion from the pool to keep their programs going, even if only for an extra month or two.

TC Bell, a 30-year-old Denver resident, said that when he learned that the letters were sent, “it really hit home.” His two daughters, 5 and 8, have been on CHIP since they were born.

“I make barely any money,” he said, adding that he recently started college after working dead-end jobs in the service sector. “I can hardly pay my rent. If CHIP goes away, I’m going to end up with my kids without insurance.”

Jasmine Harris, a 27-year-old mother of two toddlers from Logan, Utah, signed up for CHIP in January, when she went part-time as a preschool aide after being diagnosed with Crohn’s disease. Their income took another hit when her husband got laid off from his jobs and went back for his college degree.

“With my own health being rocky, it’s nice to not have to worry about my kids,” she said. “It’s helpful that they keep the costs low, and we can afford it without cutting out food or something else in our budget.”
Millions of Poor Children Could Lose Health Care If Congress Doesn’t Act Soon

 

[tru_m.a.c]

From December (earlier this month):

Funding bill could provide short-term CHIP relief
The legislation to fund the government for two weeks could also provide some short-term relief to help states keep their Children’s Health Insurance Programs (CHIP) afloat.

The bill, which would fund the government through Dec. 22, would temporarily lift certain spending constraints to allow states to get more money for CHIP from the federal government.

A provision in the funding bill would make it easier for states to receive leftover money from CMS. There are restrictions on the amount of unused funds a state can get, but the bill would lift those through Dec. 31.

The House has already passed legislation for a five-year extension of CHIP, along with funding for community health centers, but Democrats objected to how the bill was paid for.

The Senate Finance Committee passed a CHIP extension bill but did not say how it would be paid for.
Funding bill could provide short-term CHIP relief


Holding on to hope, Virginia avoids sending letters to parents warning of the end of children's health insurance program
When the Sandston family lost their employer-based coverage for four months earlier this year, she and her husband, David, fell back on Family Access to Medical Insurance Security, a Virginia Medicaid program that acts as a safety net for families who lose coverage, or low-income families who cannot afford insurance.

Though the Hassmers’ children were only enrolled in the program from March to June, coverage couldn’t have come a moment too soon. Just after he was enrolled, their oldest son, 7-year-old Wesley, fell off a fence and severely broke two bones in his arm. Six hours in the emergency room at VCU Medical Center, medication, countless doctors’ visits and weekly X-rays followed.


“If we did not have FAMIS for him, we would still be paying thousands and thousands worth of medical bills,” Kim Hassmer said. “And I can tell you, we’re doing OK, but Christmas is going to be tight. We are still paying off student loans, we have a mortgage to pay, and food for three children is not cheap.”

By Hassmer’s estimates, the family could be paying up to $20,000 in medical bills had it not been for the program.

Without CHIP funding, Virginia will run out of funds for its program by the end of January.

That reality is so unbelievable to officials with the Department of Medical Assistance Services, though, that they’re grasping at hope and are avoiding sending families letters warning them about the end of their children’s coverage, which were initially supposed to be sent out Friday in order to give them 60 days notice.

The new hope is that Congress will fund CHIP by Friday, the deadline to pass a continuing resolution to prevent a government shutdown.

“We don’t want to send a letter Dec. 1 and then Congress act by Dec. 8,” said Linda Nablo, deputy director of DMAS, which runs Medicaid in Virginia. “At this point, it’s going to be a week-by-week, day-by-day judgment call, still knowing we need to give families a lot of notice because we are still saying we can’t cover any services after Jan. 31.”

But Nablo also wants to avoid unnecessarily scaring or confusing families. If a letter goes out too late, it could arrive around the holidays and be lost or ignored. If it goes out too soon and Congress does act within the next few weeks, families may get the first letter saying the program is ending, but not the second saying it is continuing.

“And what does that do in terms of shaking their confidence in this program and government in general?” Nablo said. “It’s an ugly scenario. It’s an unnecessarily complicated, depressing scenario for families and quite honestly for state workers as well.”
Holding on to hope, Virginia avoids sending letters to parents warning of the end of children's health insurance program

 

[tru_m.a.c]

From December (earlier this month):
Please Save Kids’ Health Care
Similarly, without CHIP reauthorization, Massachusetts and Nevada face huge reductions in federal funding — $295 million and $74 million each year, respectively — meaning officials in these states would have to make painful choices about how to pay for children’s health care.

As governors, we have heard countless stories from our constituents who need CHIP’s critical services. Take the Gorry family of Oregon. Erin Gorry was pregnant with her second child when her family’s health insurance premiums increased. The Gorrys struggled to pay the $800 a month required to continue coverage for Erin and her unborn baby. They couldn’t afford the additional payment to cover their 2-year-old daughter, Simone.

As Erin went into labor, they noticed Simone was limping and had a fever. Emergency room doctors discovered that she had a fast-growing and serious bone infection. Simone needed surgery to save her leg, but the Gorrys had no means to pay for the procedure.

A nurse realized the family might be eligible for CHIP and helped them fill out the application. They qualified, and the program paid most of Simone’s medical bills. “Without CHIP, we probably would have had to sell our house and declare bankruptcy,” Ms. Gorry said.
Opinion | Please Save Kids’ Health Care



Parents Worry Congress Won't Fund The Children's Health Insurance Program
"So, we're like a low-middle-class family, right?" she says. "I'm studying. My husband's working, and our insurance right now is 12 percent of our income — just for my husband and I. And it's not very good insurance either."

The policy that covers the couple requires high fees to even see a doctor, and it has a high deductible for further treatment.

In contrast, her young children — 2-year-old Nonnie and his big sister, Rose — are covered right now through the Children's Health Insurance Program, or CHIP, a federal-state program that was created two decades ago to ensure that kids whose parents don't have a lot of money, yet make too much money to qualify for Medicaid, can still get health care.

Right now, that coverage for the children doesn't cost the family anything.

But Pennsylvania's CHIP program is forecast to run out of money in February.

Keeping kids insured doesn't cost much, he says, and it sure pays off.

"It's extremely important," he says, "because it's developmental — it's vaccines. You know it can reduce the likelihood that a person has a lifelong chronic disease."

The experience of Ariel Haughton's daughter, Rose, bears that out.

Haughton says her own insurance policy charges $150 for each of her doctor visits, but her kids' policy doesn't. That allows her to take Rose and Nonnie for care when they need it.

"That's not a small deal to a family like mine," Haughton says. "A hundred and fifty dollars. If you have to pay that, you kind of ask yourself, like, 'Are they sick enough? Does this merit a doctor visit?' "

A few years ago, Rose came down with a fever and a rash on her face. It didn't seem severe, but Haughton took Rose to the pediatrician anyway, just to check.

"The doctor looked at her and she said, 'She has Lyme disease,' " Haughton recalls. "And she found a little tick!"

The doctor put Rose on antibiotics immediately and the little girl's symptoms went away. If left untreated, Lyme can turn into chronic arthritis or other chronic problems.

"I know that if I had had to pay $150, I would have thought, 'You know, let's wait,' " Haughton says.

Dr. Todd Wolynn is the Haughtons' pediatrician. He says families all over Pittsburgh are worried about the lapse in the federal insurance program's funding.

"Parents are literally telling us they don't know what to do," Wolynn says. "They make too much to get Medicaid and they don't have jobs or earn enough to get the commercial insurance. I don't know what to tell them to do."

Utah announced it will end CHIP at the end of January if Congress doesn't come up with money for the program. West Virginia's CHIP board voted to end the programFeb. 28. And Colorado sent letters to its CHIP families saying that without new money the program will be cut off at the end of January.

Oregon has already run out of federal money and is borrowing from its Medicaid budget to ensure that its 80,000 CHIP kids keep their coverage through April.
Parents Worry Congress Won't Fund The Children's Health Insurance Program


PeachCare funds could dry up in weeks without a new deal in D.C.
Georgia could run out of federal funding for its PeachCare for Kids program as early as next month, state officials say.

The Georgia Department of Community Health said Monday that if the state maintains its current funding, Georgia will run out of money for PeachCare in March, if the congressional impasse continues.

But a spokeswoman, in an email to GHN, added that if the feds “recapture our carryover and Georgia does not receive a redistribution, the state will run out by January.’’

Georgia receives about $400 million in federal funding annually for PeachCare.

PeachCare funds could dry up in weeks without a new deal in D.C.