September 15, 2017 Kim Krisberg 3Comment

Earlier this week, members of the Senate Finance Committee announced an agreement to extend funding for the Children’s Health Insurance Program. The announcement had been anxiously awaited by families and advocates across the nation, as the program’s federal funding expires in about two weeks. The agreement is good news, but coverage for CHIP’s 8.9 million children isn’t safe just yet.

According to reports, the agreement would extend CHIP’s funding for five years — a win for advocates worried that lawmakers might propose another two-year extension as it did in 2015. The agreement would also maintain the Affordable Care Act’s enhanced CHIP matching rate — a measure that boosted the federal share by 23 percent — for another two years and then begin a phase-down to pre-ACA matching rates. CHIP currently provides nearly 9 million U.S. children with timely access to medical care, covering kids whose families make too much to qualify for Medicaid but not enough to access affordable coverage in the private sector.

While news of the Senate CHIP agreement is encouraging, there are still big questions and concerns. Senate Finance Committee leaders — Sens. Orrin Hatch, R-Utah, and Ron Wyden, D-Ore. — haven’t yet identified how they’ll offset the cost of re-funding CHIP, which is between $5 billion and $10 billion. That omission has some worried that CHIP funding could come at the expense of other critical health funding. Two other big questions: Will members of the House agree to a five-year CHIP extension? And will lawmakers attempt to attach CHIP funding to more divisive measures that could hinder its quick passage?

And quickness is key. Most states set their CHIP budgets months ago, and most made those budgets assuming federal lawmakers would reauthorize CHIP funding at its enhanced rate, according to a recent Kaiser Family Foundation survey of state Medicaid officials. That means if Congress doesn’t follow through on CHIP funding, states will face serious funding shortfalls and officials will be forced to find ways to make up the money gap (not likely) or reduce costs (such as cutting back on services and eligibility). The Kaiser survey found that of the 42 states that provided information on when they will exhaust their current CHIP funds, 10 states said funding will likely run out by the end of 2017. Some states, the survey noted, have statutes on the book that require officials to shut down their CHIP programs if federal lawmakers stop funding CHIP.

Just the fact that lawmakers have allowed CHIP’s funding reauthorization to come down to the wire is unprecedented, said Carrie Fitzgerald, vice president for Children’s Health Programs at First Focus.

“We were hoping and working hard to try to get CHIP done early in the year, but the larger health care debate took precedent and it was impossible to get this going,” Fitzgerald told me. “But it does seem that (lawmakers) know this has to get done and that it will get done. …Still, it’s tough on states. They’re doing the best they can to keep things moving smoothly, but everyone needs to see this done.”

Echoing the Kaiser findings, Fitzgerald said she hadn’t heard from any state officials worried about running out of CHIP funds on Oct. 1 — as far as she knew, none were planning to shut down their CHIP programs or scale back either. In fact, she said state CHIP officials are “trying to walk a fine line” — they want to raise awareness about CHIP’s importance, but they don’t want to worry families during CHIP’s crucial fall enrollment period. But if Congress doesn’t act by the Sept. 30 expiration date, she said it would force states to start considering their options, none of which bode well for children’s health coverage.

“There isn’t another option that’s as affordable and child-specific as CHIP,” Fitzgerald said.

The consequences of Congress’ inaction vary depending on how a state organizes its CHIP program. According to the National Academy for State Health Policy, the ACA requires that Medicaid expansion CHIP programs maintain eligibility levels for kids through 2019, regardless of federal funding. However, the 42 states that run separate CHIP programs can scale back enrollment if federal funds cease.

Eva Marie Stahl, director of the Children’s Health Initiative at Community Catalyst, said if children did begin to lose CHIP coverage, some might find coverage in Medicaid and some may be able to access employer-sponsored insurance (though employer coverage is generally more expensive than CHIP for many working families). Families who lose CHIP could turn to the ACA marketplace, but Stahl said many would face another hurdle known as the “family glitch.” The way the ACA was written, part of eligibility for marketplace subsidies is whether a family has access to affordable employer-based coverage. However, the ACA’s definition of “affordable” employer coverage is based on the cost of covering the individual, not the whole family — hence, the family glitch.

“There’s no question that Congress should move swiftly to refund CHIP and they should cleanly extend it for five years at a minimum — especially with so much uncertainty around other forms of health coverage” Stahl told me. “This program is 20 years old, enjoys bipartisan support and works well. It’s good for keeping children healthy and it’s a really important program for helping working families.”

Across the U.S., more than one in three children are covered by either Medicaid or CHIP — in fact, the two programs have helped drive the children’s uninsured rate to record lows. (The newest Census data puts the 2016 children’s uninsured rate at 5.4 percent.) Medicaid and CHIP typically offer more comprehensive children’s coverage than private insurance, such as covering dental care and myriad services for children with special health care needs. Research finds that children with Medicaid or CHIP coverage have better access to primary care and preventive care than uninsured children and fare just as well as on those two indicators as privately insured kids.

Dennis Cooley, a general pediatrician in Topeka, Kansas, for 37 years, said about 30 percent of his patients get coverage through the state’s combined Medicaid/CHIP program, KanCare. Statewide, more than 73,000 Kansas children get their coverage thanks to CHIP. For many low- and moderate-income Kansas families, CHIP provides affordable care that’s also high-quality care, said Cooley, who chairs the American Academy of Pediatrics’ Subcommittee on Access. For example, CHIP follows Early and Periodic Screening, Diagnostic and Treatment guidelines, which ensure children get appropriate medical and preventive care. In other words, CHIP is designed specifically to support the needs of children, whereas private insurance is typically designed for a more general population.

Cooley said he’s been traveling to Washington, D.C., and talking with legislators about the importance of CHIP for years now — and he agrees that CHIP does enjoy bipartisan support. But he’s still worried.

“Each time, legislators say ‘no one’s against CHIP’ or ‘don’t worry,’” he told me. “But then politics gets involved.”

CHIP’s federal funding officially expires on Sept. 30. For more on CHIP, visit First Focus.

Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for 15 years. Follow me on Twitter — @kkrisberg.

3 thoughts on “CHIP provides health insurance to nearly 9 million kids. Its funding expires on Sept. 30.

  1. Kim Krisberg’s post, “CHIP provides health insurance to nearly 9 million kids. Its funding expires on Sept. 30” provides insight into the worry and hardship relating to the expiration of CHIP, the Children’s Health Insurance Program. While it has been a little over two months after her initial posting on this issue, I am responding, hoping to reflect on the issue of CHIP’s expiration and what it means within the current context as an issue of social insurance. As of recent, CHIP’s extension has not been renewed, and so the funding directed toward the program has expired.
    As is mentioned in Kim’s post, CHIP intends to serve the population of children whose families do not qualify for Medicaid, as they do not meet the financial requirements, yet cannot afford to purchase market insurance. While it primarily seeks to provide children with health insurance, it also has the potential to cover pregnant women, depending on the state and their specific budget allocation. Although the two situations vary drastically, the expiration of CHIP reminds me of the Medicaid buy-in in Nevada that was vetoed by the state’s government. Much like CHIP, the Medicaid buy-in was an alternative health insurance plan for those who were not eligible to benefit from a traditional Medicaid insurance plan, yet could not afford the financial cost of a private insurance plan. The proposed plan would have provided individuals and families with more affordable access to health, just as CHIP has allowed children to access health care and health-related services by making health insurance accessible regardless of their family’s financial status.
    Considering that, in the amount of time that CHIP has been in effect, it has helped reduce the percentage of children who are uninsured in the United States from 14% to 5%, it is crucial that steps be taken to ensure the program doesn’t completely crumble away and undo all of the progress and success it has led to thus far. Kim Krisberg’s post mentions various directions families of previously-CHIP insured members can go in to deal with the expiration of CHIP, including turning to Medicaid or employer-based insurance as alternative insurance plans. However, CHIP insurance members receive CHIP because they do not meet the qualifications to receive Medicaid, so they may run into complications in that regard. Krisberg mentions that using an employer-based insurance plan will prove complicated as well, as these types of insurance plans are typically based on the individual rather than the family as a whole. This presents yet another issue, as the alternative insurance options are not actually serving as reasonable solutions to the problem at hand.
    Switching these families to a market insurance plan for their children is not the answer, as it can potentially lead to more harm than it will lead to good. With families unable to afford the prices of market insurance plans, and as they may not qualify for social insurance, children will not be receiving the care that they need to treat them, and so they will not be present in school as often as they need to be in order to excel, which will impact them negatively.
    In response to this unfortunate expiration, some responses have included requesting an eligibility freeze. This freeze essentially means that no further individuals can become CHIP insurance recipients and receive the benefits associated with the plan. States like Utah are currently looking into applying this to their state if funding for the insurance plan cannot be reauthorized. Other states, like Wisconsin, have enough CHIP funding to allow the insurance plan to run through a portion of the following year and are taking a different approach. Wisconsin is not planning to stop serving its children, even if it means pulling funding from a wider source.
    As Kim Krisberg’s post suggests, I believe that raising awareness about what is currently happening with CHIP and its expiration is a crucial way to work toward solving the issue at hand. While the population CHIP serves is limited to children and pregnant women who are in need of a more affordable health insurance plan, it is important that the rest of the United States population supports CHIP as a form of social insurance for those in need. With campaigns centered around raising awareness, more people will understand the significance of the insurance plan and its impact on the lives of so many people. From there, it may be easier to further the campaign and persuade constituents to contact the government officials in their areas in an attempt to pressure them to take action and work toward providing the necessary funding for a CHIP renewal to fully benefit those in need once again. I think that more work needs to be put into getting legislation centered around CHIP passed because any other attempt to resolve this issue will not be as fruitful as actually ensuring that this program that has worked so well continues to provide those in need with the services they require.
    Ultimately, CHIP is an example of a rare point of agreement among different political parties, as its intentions are to primarily provide children with the access to healthcare that they need in order to lead healthy and successful lives. Despite this, the lack of attention given to the insurance plan’s deadline for renewal puts the plan at risk of fully disintegrating, as a lack of funding will keep the plan from moving any further. While what this means for CHIP insurance recipients varies from state to state, depending on the state’s budget, it ultimately means that if action is not taken soon to address the expired proposal for renewal, then none of the states will be able to afford the insurance plan any longer, as they can only reallocate the funds from within their budget so much before they are not able to any longer. Thus, I believe that there needs to be more work done to call for a renewal so that no child is left without the ability to receive the care that they need.

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