States’ Christmas Letter to Kids: No Health Care for You

Sh*t has begun hitting the fan with CHIP, the federal program giving health care to 9 million people that has run out of money.

Photo Illustration by Lyne Lucien/The Daily Beast

Kristy Kirkpatrick Johnson is a 32-year-old stay-at-home mom in Brewton, Alabama, with two small kids and an impending medical crisis.

Her son, Thomas, needs EpiPens for his nut allergies and they aren’t cheap. Without insurance, the pens cost $1,500. Her husband Parker, the family’s sole breadwinner, is the pastor of the local First Presbyterian Church. The family was spending roughly $800 a month for insurance before her daughter, Elizabeth Ann, was born.

They soon got a break though. The Johnsons enrolled both their children in All Kids, a program that covers some 84,000 children in Alabama through the federal Children’s Health Insurance Program (CHIP). And, like that, Thomas’ EpiPens were free, minus the $13 copay they have to put down every time they go to the doctor.

“It’s just been a huge blessing to our family,” Johnson told The Daily Beast in the middle of preparing for a large dinner gathering at their home on Tuesday night. “We just feel that the Lord has really provided for us through All Kids.”

But that break is now perilously close to ending. Alabama officials have announced that, just three days after Christmas, thousands of families could face the news that their children will be denied CHIP coverage unless Congress intervenes. A month after that, families like the Johnsons may lose their current coverage altogether.

“We don’t really know what that means for our kids,” Johnson said. “It kind of makes you nervous.”

The crisis unfolding in Alabama may be shocking to CHIP recipients. But it should not be surprising to anyone who has followed the debate over the program. For months now, advocates have warned that state officials would eventually have to resort to severe measures in the wake of Congress’ failure to re-authorize CHIP at the end of September. Those measures were put off as the federal government sent emergency funding for states in need. But, at some point, the money runs out and reality presents itself.

For Cathy Caldwell, the director of the Bureau of Children’s Health Insurance at the Alabama Department of Public Health, that reality came at the end of last week. It was then that the department determined that they would inform families on Dec. 28 that their children could be disenrolled soon.

“It is very stressful particularly the worry over these families who are stressing over this and the children who are at risk of losing their health insurance coverage,” Caldwell told The Daily Beast on Monday.

The department posted a stark warning on its website on Friday telling families of the perilous path ahead—a warning that it plans to reissue on Dec. 28 with formal letters to families like the Johnsons. On Jan. 1, the state will functionally stop accepting children into All Kids, absent Congress reauthorizing funding for CHIP. By Feb. 1, All Kids will have to start disenrolling current enrollees as well. Separately, Alabama has 74,000 other kids enrolled in CHIP via the state’s Medicaid program, Caldwell explained, who would not be impacted by this contingency plan.

Johnson wasn’t even aware of the possibility that her kids may soon lack insurance until she got a phone call on Tuesday morning from Dr. Marsha Raulerson, a pediatrician in Brewton.

“We had no clue,” Johnson said, remembering how she called her husband incredulously saying, “Did you know? What does that mean?”

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Congressional leadership has said it plans to fund CHIP, before the end of the year, thereby putting an end to the crisis in Alabama before it actually starts. But there is no actual indication that Republicans and Democrats are near an agreement over how to fund the program, which insures nearly 9 million children and pregnant women nationwide. As they’ve dithered, a number of states have devised contingency plans and even received millions in additional funding from the Centers for Medicare & Medicaid Services (CMS). Congress passed a measure that would provide additional stopgap funding from CMS for programs until the end of the calendar year.

Absent a long-term fix, however, states have been forced to contemplate more drastic steps. In Connecticut, officials have warned that the state’s program, known as Husky B, which covers some 17,000 kids and teenagers, will end on Jan. 31 unless Congress reauthorizes funding. And David Dearborn, communications director at the Connecticut Department of Social Services, told The Daily Beast that they are planning to cut off new enrollments on Dec. 23 in preparation for the possibility of the program ending.

“Hopefully, Congress will re-fund CHIP, needless to say,” Dearborn told The Daily Beast. “But, absent that, we have no choice but to plan sunset—which pains us all, including some of us who were on the ground floor of implementing this historic program 20 years ago.”

In addition to Connecticut and Alabama, Colorado sent notices to families on Nov. 27 informing them that the state’s program may end on Jan. 31. A second letter will be sent on Dec. 29, if there is still no congressional action. Utah has posted a similar notice on its website. The board of directors for CHIP in West Virginia voted last month to shutter the program at the end of February if funds are not renewed. And in Virginia, the Department of Medical Assistance Services (DMAS) sent a letter to families on Dec. 12 informing them that the state’s program could be shut down on Jan. 31.

But the situation is so fluid that Linda Nablo, chief deputy director of DMAS in Virginia, told The Daily Beast on Tuesday that they may not make it until the end of January.

“We’re very much in limbo right now,” she said in a phone interview. “We’re not sure what Congress is going to do.”

Nablo said that CMS informed her last Thursday that after appropriating funds to other states, following the stopgap measure, the federal government had less for Virginia than it had anticipated.

“It’s just causing incredible chaos and confusion and extra work and money at the state level to send letters and to change systems, when everyone keeps saying, ‘Oh sure we’re going to reauthorize CHIP,’” Nablo, exasperated, told The Daily Beast.

“It’s just kind of nuts.”