Fund­ing fight puts 1M Texas kids at risk

With­out quick ac­tion, low-in­come fam­i­lies’ cov­er­age could lapse

The Dallas Morning News - - State - By CARO­LINE KELLY Wash­ing­ton Bu­reau ck­elly@dal­las­news.com Twit­ter: @car­o­line_mkelly

WASH­ING­TON — Chil­dren’s health ad­vo­cates are wor­ried that law­mak­ers’ dif­fer­ent ideas about how to fund a fed­eral in­sur­ance pro­gram will leave nearly 1 mil­lion Texas chil­dren with­out cov­er­age.

House and Sen­ate com­mit­tees each ap­proved bills last week to re­new the Chil­dren’s Health In­sur­ance Pro­gram, which ex­pired Sept. 30, for five years. Most states have left­over CHIP funds, but three — Ari­zona, Min­nesota and North Carolina — plus the District of Columbia ex­pect to run out by De­cem­ber. Last week, the Texas Health and Hu­man Ser­vices Com­mis­sion es­ti­mated that the state pro­gram would run out of fund­ing in Jan­uary in­stead of Fe­bru­ary, in part be­cause of de­mands fol­low­ing Hur­ri­cane Har­vey.

CHIP cov­ers 9 mil­lion kids na­tion­wide whose fam­i­lies make just above the thresh­old to qual­ify for Med­i­caid. If Con­gress doesn’t re­new the pro­gram quickly enough, kids on CHIP could see a sud­den lapse in cov­er­age, leav­ing many low-in­come fam­i­lies to fend for them­selves on the in­sur­ance mar­ket.

Su­san Gar­nett, CEO of the My Health My Re­sources men­tal health cen­ter in Tar­rant County, said more than 80 per­cent of the cen­ter’s child pa­tients are cov­ered un­der CHIP or Med­i­caid.

“CHIP in par­tic­u­lar is a re­source for work­ing fam­i­lies that don’t have ac­cess to in­sur­ance for their chil­dren,” she said. “It pro­vides a great op­por­tu­nity to help peo­ple get in­sur­ance, peo­ple who are al­ready help­ing them­selves.”

The fed­eral govern­ment pays 92 cents of ev­ery CHIP dol­lar in Texas. That’s higher than in re­cent years be­cause of a 23-cent boost un­der Oba­macare that will phase out by 2021.

Law­mak­ers in both par­ties sup­port fund­ing CHIP. Sen. John Cornyn com­pared the Sen­ate’s ap­proach to re­new­ing the pro­gram to a GOP pro­posal for re­plac­ing the Af­ford­able Care Act that failed last month. It would have given states block grants, or lump sums of money, to de­vise their own health care sys­tems, which is how CHIP is struc­tured.

“It’s a good ex­am­ple of how pro­vid­ing states with flex­i­bil­ity and re­sources in the form of block grants can be suc­cess­ful in im­prov­ing health cov­er­age and out­comes,” he said.

The pro­pos­als

The stick­ing points between the House and Sen­ate come down to how to fund it.

The Sen­ate ver­sion does not sug­gest cuts else­where in the fed­eral bud­get to cover the cost of CHIP. The House bill would al­low states to push pay­ment for pre­na­tal and pe­di­atric care to other in­sur­ance that Med­i­caid re­cip­i­ents may have, a prac­tice called third­party li­a­bil­ity. States cur­rently cover such costs and bill in­sur­ers later to make sure care and pay­ment move quickly.

The House bill would also drop Med­i­caid re­cip­i­ents who win a lot­tery jack­pot of at least $80,000 and raise Medi­care pre­mi­ums for se­niors earn­ing over $500,000.

Rep. Michael Burgess, chair­man of the En­ergy and Com­merce sub­com­mit­tee on health, de­fended the cuts Wed­nes­day.

“Is it OK for some­one who wins a mas­sive amount of money in the lot­tery to still draw on Med­i­caid if they were on Med­i­caid be­fore? They may not need a pub­lic as­sis­tance pro­gram any longer,” he said.

The Medi­care cuts would af­fect only the few se­niors lucky enough to have “a pretty big earn­ings pack­age,” Burgess said, and re­quir­ing care providers to col­lect from pri­vate in­sur­ance be­fore Med­i­caid is just part of the job.

“I was a provider. I had to bill Aetna, United, Cigna,” and other pri­vate in­sur­ers, he said, cit­ing his ca­reer as an OB-GYN. “Yes, they can be a pain in the neck to col­lect from. But that’s part of what you do, that’s what your of­fice is geared to take care of.”

Dur­ing the House’s re­view of the bill last week, Ar­ling­ton Rep. Joe Bar­ton, vice chair­man of the En­ergy and Com­merce Com­mit­tee, also said the cuts are rea­son­able.

“They’re not rocket sci­ence. We aren’t cut­ting back any ma­jor pro­gram,” he said. “It’s a good thing that we off­set the spend­ing.”

Ex­perts weigh in

But child health ad­vo­cates across the po­lit­i­cal spec­trum are wary of cut­ting other health care pro­grams, which could slow the re­newal process.

“Ob­vi­ously most ad­vo­cates are not go­ing to be in sup­port of pay­ing for chil­dren’s health in­sur­ance with some­thing that takes money away from some other vul­ner­a­ble group or some other health care pro­gram,” said Anne Dunkel­berg, di­rec­tor of the Health and Well­ness Pro­gram at the left-lean­ing Cen­ter for Pub­lic Pol­icy Pri­or­i­ties in Austin.

Deane Wald­man, di­rec­tor of the Cen­ter for Health­care Pol­icy at the right-lean­ing Texas Pub­lic Pol­icy Foun­da­tion, saw the pro­posed cuts as dis­trac­tions.

“In the past, [CHIP] has been funded rather than ap­proached as a rev­enue-neu­tral ac­tiv­ity,” he said. “Con­gress has funded it, pe­riod.”

Wald­man said he wor­ries that let­ting states put off pay­ment for pre­na­tal and pe­di­atric care could push providers from Med­i­caid be­cause they might not be paid as con­sis­tently.

“Any­thing that de­ters or re­duces pre­na­tal care is bad money man­age­ment, as well as what re­ally mat­ters, bad med­i­cal care,” he said.

Wald­man sup­ports more check-ins to make sure reg­is­tered wel­fare re­cip­i­ents are still el­i­gi­ble. But he said that Med­i­caid would save lit­tle from kick­ing off lot­tery win­ners, and that it isn’t fair to take fund­ing from Medi­care se­niors to cover CHIP kids when both groups need it.

Should the House and Sen­ate pass the bills, hav­ing to rec­on­cile their dif­fer­ences could push CHIP re­newal into a catch-all spend­ing pack­age that Con­gress plans to tackle in De­cem­ber.

But that may be too late for some states. Min­nesota has re­ceived $3.6 mil­lion to tide the state’s CHIP pro­gram over un­til the end of Oc­to­ber, and Utah filed an amend­ment in Septem­ber to start cut­ting el­i­gi­bil­ity and ben­e­fits as fund­ing runs out.

The Texas CHIP pro­gram would need at least a month to warn re­cip­i­ents and pre­pare a phase-out, Dunkel­berg said.

“If they don’t get this go­ing be­fore the end of the year, and prefer­ably Novem­ber, we could have some real problems,” she said.

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