Ever since mid-September, Emily Piper has been on high alert.
The commissioner of the Minnesota Department of Human Services drafted a letter to Minnesota’s congressional delegation on the 13th warning that funding for the state’s Children’s Health Insurance Program (CHIP) would run out soon and the state would have to “take extraordinary measures” to ensure coverage continued after the end of the month.
Congress, ultimately, did not act—leaving the fate of some 9 million children who depend on the program nationwide up in the air. And through the start of October, local officials like Piper have had to determine how to maintain coverage for the recipients while anxiously waiting on a resolution from Washington D.C.
Minnesota was eventually granted a $3.6 million lifeline from the Centers for Medicare & Medicaid Services in order to cover the cost of CHIP for this month alone. But Piper warned that the recipients “want health care to work and not just on a month by month basis.” And advocates fear that other states may not get intervention quickly enough.
“It’s a disaster for kids and an unnecessary one,” Bruce Lesley, president of First Focus, a nonpartisan advocacy organization with a specific focus on children told The Daily Beast. “It definitely is beginning to wreak havoc. Providers are now getting anxious and you know families are too.”
The CHIP program was created in 1997 by Sens. Ted Kennedy (D-MA) and Orrin Hatch (R-UT). It was designed to cover uninsured families with children whose household incomes were low but not low enough to qualify for Medicaid.
Over the years, it proved to be a smashing success. It helped decrease the uninsured rate among children in the United States dramatically and has enjoyed bipartisan support for its twenty year run. But the program hit a hurdle this year. The Republican-controlled Congress focused almost all of its efforts and attention on repealing and replacing the Affordable Care Act, leaving work on other health care matters unattended. Lawmakers were looking to put together a final fix in September. But instead, they tried to make another run at upending Obamacare and the deadline for reauthorization CHIP came and went.
In Lesley’s twelve years of previous experience on Capitol Hill, he said that “Congress has always pretty much taken care of CHIP.” He did note that in 2007, President Bush vetoed an expansion of the program but inevitably signed an extension of preexisting funding into law. And it was “very peculiar” to Lesley that the program hadn’t been reauthorized easily this year as Congress was well aware of the impending deadline. After all, they had set it themselves, choosing to authorize the program for just two years back in 2015, despite advocacy from Lesley and other groups for a four-year extension.
“They’ve known it’s been sitting there and they didn’t start acting on it until the deadline,” Lesley said.
Minnesota is just one of a number of states that has found itself exhausting its CHIP funds. There are 11 others whose funding will run dry by the end of the calendar year, according to the Kaiser Foundation. Those include California, Nevada, Utah, Ohio and Arizona. (The Medicaid and CHIP Payment and Access Commission has a more conservative estimate, saying that four states will run out by the end of the calendar year).
“We know that we can fund the program at least through November,” Heidi Capriotti, spokeswoman for the Arizona Health Care Cost Containment System, which administers the CHIP program, told The Daily Beast in a phone interview. “We are certainly monitoring the legislation as it moves through Congress so that we can appropriately communicate to our members should there be a need for any program changes.”
Hoping to stave off a wider-spread funding crisis, Congress is now beginning to ramp up its work. Last week, the Senate Finance Committee passed the Keeping Kids’ Insurance Dependable and Secure (KIDS) Act, a bipartisan bill drafted by CHIP program creator Sen. Orrin Hatch (R-UT) and Sen. Ron Wyden (D-OR) that would extend funding for CHIP for five years. The means by which the program would be funded are still being determined for this particular piece of legislation.
Meanwhile, the House Energy and Commerce Committee introduced its own bill late last Monday called the HEALTHY KIDS Act. And this is where, advocates say, the potentially major problems exist.
That’s because the House legislation would take money from the Affordable Care Act and Medicare to pay for the reauthorization of the program—a provision that has drawn strong opposition from Democratic members. The Energy and Commerce Committee’s Ranking Member, Frank Pallone, Jr. (D-NJ), has charged that the bill was a “partisan attack on the ACA and Medicare.” And all of his Democratic colleagues agreed. The bill made it through committee on a strictly partisan vote: 28-23.
Pallone is now calling for continued bipartisan negotiations.
“The primary concerns over the House CHIP and Community Health Centers package is the offsets,” a spokesman for Pallone told The Daily Beast. “The Republican package pays for CHIP by undermining Medicare, slashing the Prevention Fund, which plays a critical role in keeping children healthy, and stripping health insurance away from hundreds of thousands of Americans covered by the ACA by limiting grace periods.”
Republicans on the committee have defended using the ACA as a piggy bank to pay for CHIP’s reauthorization. But not to the extent that it is a red line. A spokesman for the Republican-led committee told The Daily Beast that members “are open to other creative ideas from our Democrats friends to reach consensus, but Congress must move forward quickly so children and critical public health programs do not suffer.”
Should each chamber pass their own re-authorization, the differences would then have to be hammered out in a conference committee, at which point lawmakers will finally have to grapple with the thorny issue of how to pay for the measure, if at all.
“The Chairman is pleased to see the House moving forward with the committee’s policy, and looks forward to working with his colleagues in the House and Senate to advance funding for this critical program,” a staff member from Hatch’s office told The Daily Beast.
While Congress figures out its immediate path forward, states have begun looking to emergency funding from the federal government to keep their programs afloat. Minnesota got its lifeline from CMS. But among the other states whose funding is running dry in the coming months, four (Arizona, Nevada, Utah and West Virginia) have state statutes that would require closing the program and/or discontinuing coverage if federal funding for CHIP decreases.
“There are some state regulations that stipulate that if funding is changed, we are required by state law to freeze enrollment in the program,” Capriotti of Arizona told The Daily Beast.
As she explained, CHIP in Arizona is 100-percent federally matched. So in the event that a reauthorization lowers the federal match rate in the state below 100 percent, an enrollment freeze could be instituted.
“So far in the conversations we’ve seen, I haven’t seen that in proposed legislation,” Capriotti said.
To add to the urgency, the program in Hatch’s own home state of Utah, would end CHIP if there is no reauthorization of funds.
Other states have a bit more time until projected funding runs out. In North Carolina, funding will run out by the end of the first fiscal quarter of 2018. Texas has roughly 435,000 clients and that will likely be covered through the beginning of February 2018. And in California, Anthony Cava, spokesman in the Department of Health Care Services, told The Daily Beast that CHIP funding would be available at least through December 2017. But after that, the care of approximately 1.3 million children and pregnant women who are enrolled in CHIP in California on a monthly basis are at risk.
Such deadlines are a bit off in the distance. But Congress has already shown that it is capable of missing far-off deadlines.
“I would just want to reiterate that the time of is of the essence,” Michael Munger, president of the American Academy of Family Physicians told The Daily Beast. “We don’t want states to literally run out of funds before something is done.”