States worry as fu­ture of CHIP re­mains un­cer­tain

Modern Healthcare - - NEWS - By Vir­gil Dick­son

Af­ter a week of speeches ex­tolling the virtues of a pro­gram that pro­vides health in­sur­ance to 8.9 mil­lion chil­dren and 370,000 preg­nant women, fed­eral law­mak­ers again failed to au­tho­rize any fund­ing.

Un­cer­tainty around the fate of the Chil­dren’s Health In­sur­ance Pro­gram is plac­ing states in a dif­fi­cult predica­ment of fig­ur­ing out if cov­er­age for these in­di­vid­u­als can con­tinue. Min­nesota found it­self nearly out of fed­eral CHIP money last week be­fore a last-minute trans­fu­sion of $3.6 mil­lion from the CMS.

The funds were a re­dis­tri­bu­tion of un­spent CHIP fund­ing na­tion­wide, but it will only get the state through the rest of Oc­to­ber.

If Congress fails to fully reau­tho­rize CHIP, Min­nesota may not be able to con­tinue cov­er­age much longer for preg­nant women with in­comes up to 278% of the fed­eral poverty level and in­fants in fam­i­lies with in­comes up to 275% of the poverty level. These groups don’t qual­ify for Med­i­caid.

“We don’t have un­lim­ited re­sources to cover this pop­u­la­tion,” said Emily Piper, com­mis­sioner of Min­nesota’s Depart­ment of Hu­man Ser­vices. In ad­di­tion, Min­nesota would face new bud­get pres­sures if of­fi­cials were forced to move 125,000 now in CHIP to Med­i­caid.

Un­der a pro­vi­sion for en­hanced CHIP fund­ing in the Af­ford­able Care Act, Min­nesota re­ceives an 88% fed­eral match for en­rollees. The state only re­ceives a 50% fed­eral match for its Med­i­caid pro­gram. Mov­ing CHIP en­rollees to Med­i­caid would leave Min­nesota with a mul­timil­lion-dol­lar tab to con­tinue cov­er­ing those ben­e­fi­cia­ries.

With no new funds com­ing in, Ari­zona and the District of Columbia also ex­pect to ex­haust their fed­eral dol­lars in the com­ing weeks, while a few oth­ers like Utah and North Carolina will be out of money by De­cem­ber.

“The prob­lem is one of be­nign ne­glect in that (Congress) as­sumes wrongly that states can con­tinue with­out re­newed fund­ing right away, and they as­sume dan­ger­ously that mem­bers of Congress will even­tu­ally come to­gether to do the right thing but not mak­ing an ur­gent plan to en­sure it’s so,” Dr. Karen Rem­ley, CEO of the Amer­i­can Academy of Pe­di­atrics, said in a state­ment.

Congress last funded CHIP through the Medi­care Access and CHIP Reau­tho­riza­tion Act, pro­vid­ing nearly $40 bil­lion in fed­eral fund­ing to states for fis­cal 2016 and 2017. That fund­ing stream ended Sept. 30.

There was some op­ti­mism that Congress would act last week when the Se­nate Finance Com­mit­tee and the House En­ergy and Com­merce Com­mit­tee passed bills al­lo­cat­ing $21 bil­lion to $25 bil­lion an­nu­ally through fis­cal 2022. They also elim­i­nate an ACA pro­vi­sion that en­hanced fed­eral al­lot­ments for the pro­gram by 23%, with states re­ceiv­ing match­ing lev­els rang­ing from 88% to 100%. The match­ing funds would con­tinue through fis­cal 2019, fall to 11.5% in fis­cal 2020 and be elim­i­nated en­tirely in fis­cal 2021.

But there are hang-ups be­fore the bills can pass their re­spec­tive chambers. The Se­nate com­mit­tee failed to in­clude any bud­get off­sets to fund the pro­gram and now re­al­izes that it must do so, ac­cord­ing to com­mit­tee spokesman Tay­lor Har­vey. Sen­a­tors, how­ever, were sched­uled to be on a week­long re­cess start­ing Oct. 9.

And then there’s the par­ti­san di­vide that im­pacts every­thing in Wash­ing­ton these days. House Democrats slammed a Republi- can pro­posal to par­tially pay for CHIP by charg­ing higher Medi­care pre­mi­ums to se­niors earn­ing more than $500,000.

“Here we are with a par­ti­san bill that asks for cov­er­age of chil­dren on the backs of se­niors,” said Rep. Diana DeGette (D-Colo.).

Re­pub­li­cans were con­fused as to why Democrats were against charg­ing wealthy se­niors roughly $135 more per month on av­er­age to en­sure cov­er­age for poor chil­dren.

Off­sets may not be the only thing that slows the process. Sen. Pat Toomey (RPa.), who was the sole no vote on mov­ing the bill out of com­mit­tee, has vowed to in­tro­duce an amend­ment that would pre­vent mem­bers of Congress from ap­pro­pri­at­ing CHIP funds for items not re­lated to the pro­gram.

Toomey pointed to a Con­gres­sional Re­search Ser­vice find­ing that $42 bil­lion in un­spent, CHIP-al­lo­cated funds had been redi­rected to un­re­lated pro­grams via the ap­pro­pri­a­tions process since 2009. The most re­cent con­tin­u­ing res­o­lu­tion drew $2.65 bil­lion from ex­cess CHIP fund­ing to spend on un­re­lated pro­grams.

States have statu­tory time lines in which they must alert CHIP en­rollees if there will be a cov­er­age change due to loss of fed­eral funds. So even if a state has enough fund­ing to make it through Dec. 31, they would need to send out let­ters to en­rollees 30 to 60 days be­fore an ex­pected change.

“Here we are with a par­ti­san bill that asks for cov­er­age of chil­dren on the backs of se­niors.”

Rep. Diana DeGette (D- Colo.)

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