Officials in nearly a dozen states are preparing to notify families that a crucial health insurance program for low-income children is running out of money for the first time since its creation two decades ago, putting coverage for many at risk by the end of the year.
Congress missed a Sept. 30 deadline to extend funding for CHIP, as the Children’s Health Insurance Program is known. Nearly 9 million youngsters and 370,000 pregnant women nationwide receive care because of it.
Many states have enough money to keep their individual programs afloat for at least a few months, but five could run out in late December if lawmakers do not act. Others will start to exhaust resources the following month.
The looming crunch, which comes despite CHIP’s enduring popularity and bipartisan support on Capitol Hill, has dismayed children’s health advocates.
“We are very concerned, and the reason is that Congress hasn’t shown a strong ability to get stuff done,” said Bruce Lesley, president of Washington, D.C.-based First Focus, a child and family advocacy organization. “And the administration is completely out, has not even uttered a syllable on the issue. How this gets resolved is really unclear, and states are beginning to hit deadlines.”
Others paying close attention to the issue remain hopeful that Congress will extend funding before January, but states say they cannot rest on hope.
“Everybody is still waiting and thinking Congress is going to act, and they probably will, but you can’t run a health-care program that way,” said Linda Nablo, chief deputy director at Virginia’s Department of Medical Assistance Services. “You can’t say ‘probably’ everything is going to be all right.”
Most CHIP families, who earn too much for Medicaid but too little to afford private insurance, are not aware lawmakers’ inaction is endangering coverage. They’re about to find out, though. Virginia and several other states are preparing letters to go out as early as Monday warning families their children’s insurance may be taken away.
The Centers for Medicare and Medicaid Services (CMS), which administers the program at the federal level, issued a notice to state health officials on Nov. 9 detailing their options if CHIP funding does run dry. States forced to end the program will need to determine whether enrolled children are eligible for Medicaid or whether their family will need to seek insurance through an Affordable Care Act marketplace, the guidance said.
Longtime physician William Rees remembers the years before CHIP’s safety net, when families without coverage would put off bringing a sick child to the doctor until symptoms were so severe they would end up in a hospital emergency room.
“Pediatrics is mostly preventive medicine, it’s so important what we do,” said Rees, who has practiced in Northern Virginia since 1975. “It’s about trying to keep up with routine visits. If (children) don’t have insurance, that often doesn’t happen, so CHIP keeps them in the system and they get their vaccines when they’re due.”
The program, which is credited with helping to bring the rate of uninsured children to a record low of 4.5 percent, has been reauthorized several times over the years. And under the ACA, the federal government sharply boosted its match rate. It now provides 88 percent or more of every state’s CHIP costs.
Congress has been unable to agree on how to pay for the $15 billion program moving forward, however. President Donald Trump’s 2018 budget proposed to cut billions from CHIP over two years and limit eligibility for federal matching funds.