CHIP stands for the Children’s Health Insurance Program.  It provides health coverage to eligible children, through both Medicaid and separate CHIP programs.  CHIP is administered by states, according to federal requirements.  The program is funded jointly by states and the federal government.

The website says that 8.9 million children were enrolled in CHIP (according to 2016 statistical enrollment data).  Eligibility is based on income.  It covers uninsured children up to age 19 in families with incomes too high to qualify them for Medicaid.  CHIP also covers pregnant women who meet income eligibility requirements.  In 2010, the Affordable Care Act extended CHIP eligibility to state employee’s children (who previously were not eligible, regardless of income.)

Here is what happened when the United States Congress failed to renew funding for CHIP in 2017.

This blog will be updated when new information regarding the CHIP program appears.

July of 2017: MACPAC, the Medicaid and CHIP Payment and Access Commission, posted an Issue Brief titled “Federal CHIP Funding: When Will States Exhaust Allotments?”  From the Issue Brief:

Under current law, federal funds for the State Children’s Health Insurance Program (CHIP) are only provided through fiscal year (FY) 2017.  Unless CHIP funding is extended, all states are expected to exhaust their federal CHIP funds during FY 2018; this includes unspent CHIP funding from prior years.  Three states and the District of Columbia are projected to exhaust their federal CHIP funds by March 2018.  These estimates are based on states’ projections of their CHIP spending for FYs 2017 and 2017.  How quickly states deplete CHIP funds could change if actual CHIP spending is above or below projections…

…With the fiscal end of FY 2017 approaching, congressional action to renew CHIP funding is urgent to ensure the stability of children’s coverage during a time in which health insurance markets are expected to face substantial changes, and to provide budgetary certainty for states.  If CHIP funding is not renewed, states will need to make decisions including whether to end CHIP, how to finance Medicaid-expansion CHIP with reduced federal spending, and how to provide information to families, providers, and plans…

MACPAC provided information on the “Projected Exhaustion of Federal CHIP Funds in Fiscal Year 2018”

  • First quarter (October-December 2017): 4 states – Arizona, District of Columbia, Minnesota, and North Carolina
  • Second quarter (January – March 2018): 27 states – Alaska, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Hawaii, Idaho, Kansas, Kentucky, Louisiana, Massachusetts, Mississippi, Missouri, Montana, Nevada, New York, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Virginia, and Washington
  • Third quarter (April – June 2018): 19 states – Alabama, Georgia, Illinois, Indiana, Iowa, Maine, Michigan, Maryland, Nebraska, New Hampshire, New Jersey, New Mexico, North Dakota, Oklahoma, South Carolina, Tennessee, Texas, West Virginia, Wyoming
  • Fourth quarter (July – September 2018): – 1 state: Wyoming

…The exhaustion of CHIP funding in FY 2018 will affect state budgets and will require states to make decisions about children’s coverage depending on the type of CHIP program states had in place in March 2010.  Under the maintenance of effort requirement in the Patient Protection and Affordable Care Act…states must maintain 2010 Medicaid and CHIP eligibility levels for children through FY 2019.

States with separate CHIP are permitted to terminate that coverage if federal CHIP funding runs out; states with Medicaid-expansion CHIP must continue that coverage for children at the lower Medicaid matching rate.  As of January 2016, 10 states (including the District of Columbia) ran CHIP as a Medicaid expansion, 2 states had separate CHIP, and 39 states operated a combination of both approaches…

…Separate CHIP

Of the 8.4 million children enrolled in CHIP-funded coverage during FY 2015, 43.9 percent (3.7 million) were enrolled in separate CHIP.  Once federal CHIP funding is exhausted, states are not obligated to continue covering these children.  In the absence of separate CHIP coverage, some of these children would be eligible for employer-sponsored insurance or subsidized exchange coverage.  MACPAC’s prior estimates indicated that 1.1 million children would become uninsured (MACPAC 2015).  States that elect to shut down CHIP in the absence of federal funding will bear little direct cost for children that they formerly covered whether they move to employer-sponsored or subsidized exchange coverage, or become uninsured.

Medicaid-expansion CHIP

In FY 2015, 4.7 million children were enrolled in Medicaid-expansion CHIP.  If CHIP funding is exhausted, the federal matching rate for these children falls back from the CHIP enhanced match to the regular Medicaid matching rate.  Although states are generally prohibited from reducing eligibility levels in Medicaid-expansion CHIP, through at least FY 2019, the budget consequences resulting from the higher state share of spending for those children could lead states to take other steps affecting access, such as lowering provider payment rates or increasing requirements for prior authorization.

September 6, 2017: A statement was released by more than 130 health and children focused organizations calling on legislators to save the Children’s Health Insurance Program (CHIP).  It was titled “Statement of the National Children’s Health Community Urging Quick Bipartisan Action on a Strong, Five-Year Extension of Funding for the Children’s Health Insurance Program”.  The statement said:

As advocates for children and pregnant women, we call on Congress to take immediate action to enact a five-year extension of CHIP funding.  Since its inception in 1997, CHIP, together with Medicaid, has helped to reduce the numbers of uninsured children by a remarkable 68 percent.  With CHIP funding set to expire on September 30, 2017, now is the time for Congress to stabilize the CHIP funding stream and protect the gains in children’s health coverage that have resulted in more than 95 percent of all children in America being enrolled in some form of insurance coverage.

CHIP has a proven track record of providing high-quality, cost-effective coverage for low-income children and pregnant women in working families.  CHIP was a smart, bipartisan solution to a real problem facing American children and families when it was adopted in 1997 and its importance and impact in securing a healthy future for children in low-income families has only increased.  Senators, representatives, and governors all recognize the importance of CHIP in providing affordable, pediatric-specific coverage to almost 9 million children who cannot afford private coverage or lack access to employer-based coverage.  CHIP also delivers quality, affordable care to pregnant women in 19 states, allowing them to obtain the care they need to have healthy pregnancies and give birth to healthy infants.

With federal CHIP funding set to end on September 30, 2017, states are facing critical decisions about the future of their CHIP programs.  Many states are just weeks away from setting in motion processes to establish waiting lists and send out disenrollment notices to families.  Once undertaken, these actions will have an immediate effect, creating chaos in program administration and confusion for families.

Extending CHIP is particularly important in light of the ongoing debate on and uncertainty regarding the future of the Affordable Care Act (ACA), Medicaid, and the stability of the individual insurance markets.  With state budgets already set for the coming year, states are counting on CHIP to continue in its current form.  Changes to CHIP’s structure – including changes to the Maintenance of Effort or the enhanced CHIP matching rate – would cause significant disruption in children’s coverage and leave states with critical shortfalls in their budgets.  Given CHIP’s track record of success, changes to CHIP that would cause harm to children must not be made.

Today, we stand united in urging Congress to honor CHIP’s 20 years of success by securing this critical source of coverage for children and pregnant women into the future.  As Congress continues to work on larger health system reforms, a primary goal should be to improve health coverage for children, but at a minimum, no child should be left worse off.  We urge our nation’s leaders to work together to enact a five-year extension of CHIP funding as an important opportunity for meaningful, bipartisan action.

The endorsing organizations that signed on to this letter include:

1,000 Days; Academic Pediatric Association; ADAP Advocacy Association (aaa+); AFSCME; AIDS Alliance for Women, Infants, Children, Youth & Families; Alliance for Strong Families and Communities;

America’s Essential Hospitals; American Academy of Family Physicians; American Academy of Nursing; American Academy of Ophthalmology; American Academy of Pediatrics; American Academy of Nursing; American Academy of Pediatrics; American Association for Pediatric Ophthalmology and Strabismus; American Association of Child and Adolescent Psychiatry; American Congress of Obstetricians and Gynecologists; American Dental Education Association; American Heart Association; American Lung Association; American Muslim Health Professionals; American Network of Oral Health Coalitions; American Pediatric Society; American Public Health Association; American Society for Radiation Oncology; American Society of Pediatric Hematology/Oncology;

Asian & Pacific Islander American Health Forum; Association for Community Affiliated Plans; Association of Asian Pacific Community Health Organizations (AAPCHO); Association of Maternal & Child Health Programs; Association of Medical School Pediatric Department Chairs; Association of Pediatric Hematology/Oncology Nurses; Association of School Business Officials International (ASBO); Association of University Centers on Disabilities (AUCD); Autism Speaks;

Cancer Support Community; Center for Law and Social Policy (CLASP); Center for Popular Democracy; Child Care Aware of America; Child Welfare League of America; Children and Family Futures; Children’s Brain Tumor Foundation; Children’s Cause for Cancer Advocacy; Children’s Defense Fund; Children’s Dental Health Project; Children’s Health Fund; Children’s Hospital Association; Children’s Leadership Council; Children’s Mental Health Network; Clearinghouse on Human Needs; Coalition on Human Needs; Community Access National Network (CANN); Community Catalyst; Cystic Fibrosis Foundation;

Division for Early Childhood of the Council for Exceptional Children (DEC); Doctors for America; Easterseals; Every Child Matters; Families USA; Family Focused Treatment Association; Family Voices; First Focus; First Star Institute; Forum for Youth Investment; Generations United; Health Care for America Now; Healthy Schools Campaign; Healthy Teen Network; Heart Rhythm Society; HIV Medicine Association; IDEA Infant Toddler Coordinators Association (ITCA); Judge David L. Bazelon Center for Mental Health Law; Justice in Aging; League of Women Voters of the United States; Leukemia & Lymphoma Society; Make Some Noise: Cure Kids Cancer Foundation, Inc.; March of Dimes; Mental Health America;

NAACP; NAMI (National Alliance on Mental Illness); NASTAD (National Alliance of State and Territorial AIDS Directors); National Alliance of Children’s Trust and Prevention Funds; National Association for Children’s Behavioral Health’ National Association of Community Health Centers; National Association of Councils on Developmental Disabilities; National Association of County Human Services Administrators; National Association of Pediatric Nurse Practitioners; National Association of Perinatal Social Workers; National Association of Social Workers; National Black Women’s HIV?AIDS Network; National Center for Transgender Equality; National Consumers League; National Council of Jewish Women; National Crittenton Foundation; National Health Law Program; National Immigration Law Program; National Partnership for Women & Families; National Patient Advocate Foundation; National Respite Coalition; National Women’s Health Network;

Nemours Children’s Health System; NETWORK Lobby for Catholic Social Justice; NMAC (National Minority AIDS Council); Nurse-Family Partnership’ Oral Health America; Out2Enroll; Partnership for America’s Children; Pediatric Infectious Diseases Society; Pediatric Policy Council; Physicians for Reproductive Health; Raising Women’s Voices for the Health Care We Need; Religious Institute; RESULTS;

School-Based Health Alliance; Society for Pediatric Research; Solving Kids’ Cancer; The Children’s Partnership; The Jewish Federations of North America; The United Methodist Church – General Board of Church and Society; Trust for America’s Health; United Way Worldwide; Universal Health Care Action Network; Voices for Progress; Young Invincibles; ZERO TO THREE

September 12, 2017: The Delaware House Democrats posted a letter written by the Delaware House Health and Human Development Committee to U.S. Senator Tom Carper (Democrat), U.S. Senator Chris Coons (Democrat) and U.S. Representative Lisa Blunt Rochester (Democrat).  All three of them represent Delaware in U.S. Congress.  From the letter:

Dear Sen. Carper, Sen. Coons and Congresswoman Blunt Rochester:

We often talk about how critical it is to invest in our future generations, to prepare them so they can pursue productive, successful lives and advance our society as the whole.  Access to quality, sometimes lifesaving healthcare for our children is a vital part of that investment.  A healthy child is more productive in school, at home and in all aspects of life.

Children should not be frivolous pawns in the budget and political negotiation process.  Note should ensuring their health be a partisan issue.

That’s why we, members of the Delaware House Health & Human Development Committee, write to you on behalf of Delaware children and their families who depend on the Children’s Health Insurance Program, a program that could be tragically upended without action by September 30.  It’s a program that has provided much solace and security to lower-income families as they grapple with emergency treatment, life-altering diagnoses and the everyday health needs from a flu shot to cold medication.

There is much uncertainty when it comes to budget planning, but for the nearly 10,000 Delaware kids and nearly 9 million lower-income children nationwide who depend on CHIP there is no question – this program is needed and necessary to their livelihoods.  It helps families not be forced to decide whether to pay for groceries or medication and basic treatment.  It gives parents a sense of security and peace in knowing that coverage is in place when a need for care arises.

Delaware is in the process of reforming its healthcare system, but it is not prudent or responsible to limit access as we move forward. Without an extension by Congress, a federal policy commission estimates that CHIP funding could be exhausted in the state by February 2018.

We acknowledge that Congress has many difficult decisions to make through the end of the year.  However, this is one decision that should not be gambled or left to early-morning debates.  Lives could very literally be at stake.  We urge you to take action and extend and fully fund CHIP so that Delaware children and children throughout our country will have the security and healthcare access they need.

The letter was signed by all members of the Delaware House Health & Human Services Development Committee:

  • Health Committee Chair David S. Bentz (Democrat)
  • Health Committee Vice-Chair Debra Heffernan (Democrat)
  • Paul S. Baumbach (Democrat)
  • Earl G. Jaques, Jr. (Democrat)
  • John A Kowalko (Democrat)
  • Sean M. Lynn (Democrat)
  • Sean Matthews (Democrat)
  • Edward S. Osienski (Democrat)
  • Kimberly A. Williams (Democrat)
  • Ruth Briggs King (Republican)
  • Kevin S. Hensley (Republican)
  • Harvey R. Kenton (Republican)
  • Joseph E. Miro (Republican)
  • Lyndon D. Yearick (Republican)

September 13, 2017: Minnesota Department of Human Services Commissioner Emily Piper sent a letter to the members of the Minnesota Congressional Delegation.  In the letter, she urged them to extend funding for the Children’s Health Insurance Program.  From her letter:

I urge you to extend funding for the Children’s Health Insurance Program (CHIP) before it expires on September 30, 2017.  Our department will exhaust CHIP allotment of $155 million for fiscal year (FY) 2017 at the end of September, resulting in the department having to take extraordinary measures to ensure coverage continues beyond October 1, 2017 if Congress does not act…

…If CHIP is not funded for FY 2018 by October 1, 2017, the state will go back to receiving Medicaid’s 50 percent matching rate for the two groups of children covered by CHIP as opposed to the enhanced rate of 88 percent that our state currently receives, resulting in a loss to the state’s general fund. The pregnant women covered by CHIP would be at risk of losing coverage altogether, however, we are exploring ways to continue coverage temporarily by carrying over FY 2017 CHIP funds so that their prenatal and postpartum care continues uninterrupted.  This action, however, comes with a significant financial penalty…

September 13, 2017: Delaware State News posted an article titled “Funding extended for CHIP program”.  It was written by Matt Bittle.  From the article:

Parents of about 8,000 children in Delaware no longer have to worry about their kids losing health care coverage at the end of the month.

The chairman and ranking member of the Senate Finance Committee said Tuesday that they reached an agreement to extend funding for the Children’s Health Insurance Program for five-years.  The program, which covers about 8.9 million people nationwide, was set to run out of federal funding Sept. 30.

CHIP, as it’s known, offers health care to children whose parents earn too much money to qualify for Medicaid.

In Delaware, individuals no older than 18 are eligible as long as their family earns less than 213 percent of the federal poverty level.  For a family of four, that’s about $51,500 a year.

Enrollees pay monthly premiums of $15 to $25 depending on their income.  They do not have copays….

…While lawmakers have not yet introduced the bill authorizing continued funding, they expect to do so within a few days and the measure should receive strong support form both sides of the aisle.

Had congress failed to extend funding, Delaware would have exhausted its federal dollars by March, according to the Medicaid and CHIP Payment and Access Commission. A spokeswoman for the Dela-ware Department of Health and Social Services said in an email the added cost to the state could total $13 million a year without federal funding.

Delaware already pays about $2.9 million every year for CHIP…

September 18, 2017:  S. 1827 – KIDS Act of 2017 was introduced in the Senate.  It was sponsored by Senator Orrin Hatch (Republican – Utah).  Here is the summary of the bill:

Keep Kids’ Insurance Dependable and Secure Act of 2017 or the KIDS Act of 2017

This bill amends titles XI (General Provisions), XIX (Medicaid), and XXI (Children’s Health Insurance Program) (CHIP) of the Social Security Act to extend funding for CHIP through FY2022 and otherwise revise provisions related to CHIP and Medicaid.

The bill also extends funding through FY2022 for:

  • the Child Enrollment Contingency Fund
  • the Childhood Obesity Demonstration Fund
  • the Pediatric Quality Measures Program, and
  • specified outreach and enrollment grants

In addition, the bill reauthorizes through FY2022:

  • the qualifying-states option (which allows states that provided coverage to now CHIP-eligible children prior to CHIP’s enactment to continue to provide such coverage) and
  • the express-lane eligibility option (which allows states to use eligibility findings from other public programs to determine children’s eligibility for Medicaid and CHIP).

Beginning in FY2020, the bill allows state child-health plans to adopt more restrictive eligibility standards with respect to children in families whose income exceeds 300% of the poverty line.

Current law provides states with an enhanced Federal Matching Assistance Percentage (FMAP) for child-health assistance through FY2019.  The bill maintains the enhanced FMAP in FY2020, but halves the percentage-point increase.

This bill was introduced in the United States Senate, but that was all that happened.  There was no vote.

September 21, 2017: The Conversation posted an article titled: “Clock running out on health program for 9 million kids”. It was written by Simon F. Haeder. From the article:

Since the inauguration of President Trump, health care has been front and center in American politics. Yet, attention has almost exclusively been focused on the Affordable Care Act, most recently in the form of Graham-Cassidy. With Congress preoccupied with a series of Republican efforts to repeal and replace the ACA, little attention has been paid to a long-running bipartisan program providing insurance coverage to millions of American children: the Children’s Health Insurance Program, often referred to simply as CHIP, which provides coverage to nine million American children.

Since its creation by a bipartisan coalition under the Clinton administration, CHIP has been crucial for the health and well-being of millions of American children, their families and their communities.

Yet funding for CHIP is running out at the end of September, leaving both state governments and families with great uncertainty. On September 18, Senators Orrin Hatch (R-Utah) and Ron Wyden (D-Ore.) announced an agreement to continue funding for the program, albeit at greater costs to the states because it would phase out the additional funding provided by the ACA. Yet, the renewed efforts by Republicans to repeal the ACA could derail this agreement.

What Is CHIP?

Today, CHIP serves about nine million children at a cost just below US$14 billion. Together with Medicaid, it serves as the source of insurance for more than 46 million children annually. CHIP has been crucial in ensuring that more than 95 percent of American children are covered by health insurance today. This compares to 89 percent at the time the program was created.

Like most other health care programs, CHIP is a collaborative program between the federal government and the states. Indeed, states have the option to use the CHIP funding to expand their Medicaid program, create a standalone program or establish a hybrid arrangement.

CHIP fills in the gap for those children who fall just above the Medicaid threshold, determined by family income, but still do not have access to affordable, employer-sponsored insurance. Indeed, almost all CHIP children live in households where at least one parent is working. Ninety percent live in households 200 percent below the federal poverty line.

Created on a bipartisan basis in the late 1990s, the program has been popular with both parties. It has been renewed multiple times, and eligibility and federal support have been increased multiple times. Indeed, the most recent extension made the federal government the sole funder of the program in 11 states.

States have been given significant leeway in implementing the program. For one, states have been able to set a diverse range of eligibility guidelines, ranging from just below 200 percent of the federal poverty line in states like North Dakota and Wyoming to more than 400 percent in New York.

They also have a significant amount of flexibility in terms of benefit design, copayments, premiums, enrollment and administrative structure. At the same time, the federal matching rate, or the financial contribution of the federal government, is significantly above the Medicaid match, ranging from 88 to 100 percent, making participation particularly enticing for states. Not surprisingly, with large amount of flexibility and generous financial support, states have long looked favorably toward the program.

CHIP is complementary to Medicaid but differs from it in several respects. Most crucially, it is not an entitlement but rather a block grant. This means that qualifying individuals who meet all the requirements are not legally entitled to receive the benefits provided by program in case no funding is available. Once federal funding is spent down for a given year, no more funds are available unless states choose to pay for the program in its entirety.

Since the inauguration of President Trump, health care has been front and center in American politics. Yet, attention has almost exclusively been focused on the Affordable Care Act, most recently in the form of Graham-Cassidy. With Congress preoccupied with a series of Republican efforts to repeal and replace the ACA, little attention has been paid to a long-running bipartisan program providing insurance coverage to millions of American children: the Children’s Health Insurance Program, often referred to simply as CHIP, which provides coverage to nine million American children.

Since its creation by a bipartisan coalition under the Clinton administration, CHIP has been crucial for the health and well-being of millions of American children, their families and their communities.

Yet funding for CHIP is running out at the end of September, leaving both state governments and families with great uncertainty. On September 18, Senators Orrin Hatch (R-Utah) and Ron Wyden (D-Ore.) announced an agreement to continue funding for the program, albeit at greater costs to the states because it would phase out the additional funding provided by the ACA. Yet, the renewed efforts by Republicans to repeal the ACA could derail this agreement.

Why is CHIP so important?

The benefits for families and communities of CHIP are many. For one, CHIP is crucial in providing financial security and prevents families from suffering catastrophic losses.

Moreover, the program’s benefit design does a tremendous job at ensuring that children’s health needs are met comprehensively. Healthier children are more likely to attend school and graduate from high school and college. Healthier children also prevent parents from forgoing their own care or missing time at work. CHIP also serves a large number of children with special and costly health needs, such as ADHD and asthma.

The crucial role of CHIP has been repeatedly emphasized by health policy experts. Most recently, MACPAC, the congressionally chartered commission that provides Congress with advice on Medicaid and CHIP, recommended the continuation and further enhancement of the program…

September 21, 2017: Tennessean posted an article titled “Congress hasn’t extended funding for CoverKids, which insures 72K kids in Tennessee.”  It was written by Holly Fletcher.  From the article:

The future of a federal block grant that funds CoverKids in Tennessee is uncertain as the federal budget deadline approaches and the U.S. Congress hasn’t renewed funding for the children’s coverage program.

The funding cycle for the program – the Children’s Health Insurance Program or CHIP, ends on Sept. 30 and, despite bipartisan support and some movement in Congress to re-approve it, no legislation has been passed.

CHIP, which is complementary to Medicaid and called CoverKids in Tennessee, provides coverage for 72,000 children whose families make too much to qualify for TennCare, but don’t have private insurance.

…Some states will begin running out of its allotment in December.  But Tennessee, based on enrollment and spending trends, is “not at risk of exhausting the current allotment of funding until the spring of 2018,” [spokeswoman for TennCare, Sarah] Tanksley said.

According to Manatt Health, a consultant firm, Tennessee is expected to have funding until May 2018…

…Community health centers in Tennessee risk losing 70 percent of their federal funding – or about $53 million of $75.4 million – if Congress doesn’t reauthorize the expenditure.  The clinics, known federally as qualified health centers, are the primary source of care for about 400,000 poor, uninsured, underinsured, or homeless Tennesseans.

September 28, 2017: Vox posted an article titled: “9 million kids get insurance through CHIP. Congress is about to let its funding expire”. It was written by Dylan Scott. From the article:

On September 30, funding for the Children’s Health Insurance Program expires. After Republicans took a rushed and ultimately failed run at repealing Obamacare one last time, the program’s spending authorization is now at imminent risk of lapsing.

For technical reasons, the money wouldn’t just run out on October 1. But nevertheless, advocates are furious that Congress let the deadline get this close without acting…

…CHIP is a health insurance program created in the 1990s to piggyback on Medicaid and it provides coverage for kids in families with higher, though still lower-middle-class to middle-class, incomes. The program also helps cover pregnant women in some states. It is designed much like Medicaid, with states and the federal government both paying a share of its budget.

About 9 million children across the country get coverage through CHIP, and it costs about $14 billion a year (the feds pick up about three-quarters of that bill). It is a smaller program than Medicaid and Medicare, but it is still a big reason why America has nearly eliminated uninsurance among kids.

The warning signs have been there that Congress would allow CHIP’s funding to slip. While most states would have money left over to keep the program running for a matter of months, they have started preparing for the worst…

…The Outline of a CHIP deal is already in place

CHIP funding won’t simply run out on October 1 because of the way the program is financed. Federal money is distributed as a lump sum to the states annually, and they then have two years to spend it. So most states will have money left over next month, even if no new federal funding is coming in. But it is nonetheless a perilous position for the program, and some states are staring at big funding cliffs soon.

There was finally positive movement in Congress on CHIP a few weeks ago. Sens. Orrin Hatch (R-UT) and Ron Wyden (D-OR), the chair and ranking member of the Senate Finance Committee respectively, announced the outline of a deal to keep CHIP funded. It would:

  • Extend CHIP’s funding for five years, a big win for advocates who wanted a long-term extension
  • Maintain Obamacare’s enhanced CHIP federal funding for two more years and then start to phase it down to traditional levels. The 2010 law boosted the federal share by 23 percent — advocates knew that was unlikely to continue indefinitely but wanted a gradual phaseout to make sure states could adjust…

…But any action on CHIP was sidelined when Republicans decided to make one last attempt to repeal and replace Obamacare with the Graham-Cassidy plan. That bill fell short on Tuesday, leaving Congress just a few days to act before the program’s funding is technically expired.

There are two huge outstanding issues, aside from the calendar, that will likely stop Congress from extending CHIP before the end of the month.

  1. Hatch and Wyden haven’t yet identified how they’ll pay for their plan. Alker estimates they will need to find somewhere between $5 billion and $10 billion in offsets. That money has to come from somewhere. “No one has seen offsets yet,” Pellegrini said.
  2. The House has to agree to it. The Energy and Commerce Committee is working on its own plan, and we don’t yet know whether the lower chamber is amenable to such a long extension and the gradual phaseout of the enhanced Obamacare funding.

CHIP advocates have also been nervous that the program could become a battleground for the still-simmering Obamacare fight — that the program’s funding could get stuck not because of any disagreements over CHIP itself, but because it becomes the cipher for a separate health care fight.

There were reports earlier this month that Republicans wanted to tuck some Obamacare repeal provisions into the program’s funding extension…

…The clock is ticking, though. We’re days away from the deadline, and state officials are already preparing to send out notices on October 1 warning CHIP enrollees that their coverage could soon lapse.

September 28, 2017: The Salt Lake Tribune reported that Utah health officials submitted their intentions to close CHIP if Congress does not reauthorize its funding.  From the article:

The state’s Division of Medicaid and Health Financing sent a letter on September 15 to the Centers for Medicare and Medicaid Services (CMS), which outlined a plan to close its Children’s Health Insurance Program if Congress fails to renew its funding by its deadline Saturday.  Without the necessary federal dollars, division spokeswoman Kolbi Young said the program’s funding will run out by the end of the year.

The federal and state program, provides wellness exams, immunizations, doctors visits, prescriptions and other forms of health care to nearly 20,000 children in Utah.  The kids typically come from families that make too much to qualify for Medicaid, the federal and state insurance program for low-income people.

September 29, 2017: Michael Hiltzik wrote a column for the Los Angeles Times titled: “Time’s up: As CHIP expires unrenewed, Congress blows a chance to save healthcare for 9 million children.”  From the column:

Advocates for children’s health started worrying months ago that congressional incompetence would jeopardize the nation’s one indisputable healthcare success – the Children’s Health Insurance Program, which has reduced the uninsured rate among kids to 5% from 14% over the two decades of its existence.

Their fears turned out to be true.  Funding for CHIP runs out on Saturday, and no vote on reestablishing the program’s $15-billion appropriation is expected for at least a week, probably longer.  That’s the case even though CHIP is one of the few federal programs that has enjoyed unalloyed bipartisan support since its inception in 1997. The consequences will be dire in many states, which will have to curtail or even shut down their children’s health programs until funding is restored.  Hanging in the balance is care for 9 million children and pregnant women in low-income households.

Michael Hiltzik reported that the impact of the funding delay will vary by state, because states can apply unspent CHIP money in any fiscal year to the next year. The problem is that states cannot assume that Congress will eventually get around to reauthorizing CHIP funding. As a result, states have to start planning to shut down their CHIP programs or reallocate funding from other social programs.

September 30, 2017: The Atlanta Journal-Constitution posted an article titled “Funding now expired, Georgia health care providers see impact”.  It was written by Ariel Hart and Tamar Hallerman.  From the article:

In Washington this past week, lawmakers abandoned another all-out attempt to repeal Obamacare, and then headed home to take stock.

Meanwhile in Georgia, a clinic network funded by regular federal grants halted replacement of badly needed dental chairs and stopped work on a planned contract to recruit a pediatrician.

A Houston County couple watched their health insurance crumble.  The Georgia commissioner of community health drew up contingency plans.

All of that is happening here now because Congress – absorbed over the past few months in undoing the Affordable Care Act – has not approved funding for other long-standing, bipartisan health care programs that affect millions of patients and faces Sept. 30 expiration or crucial deadlines…

…In the most recent blow, some Georgia customers of the Obamacare exchange learned their premiums will jump by more than half, with a large part of that purely due to federal uncertainty…

Health officials worry about a handful of programs with deadlines that just passed:

  • Community Health Center subsidies such as Miracle’s fund 35 centers in Georgia with about $86 million a year, perhaps 70 percent of which was cut.  Nationally, the program is facing a $3.6 billion cut, and that cut will be distributed among the states.
  • Subsidies for rural hospitals, called “rural extenders,” have expired to the tune of at least $11.7 million in this state this coming year.  The small facilities say that represents a large part of their bottom lines.
  • Subsidies for hospitals that treat a disproportionate share of indigent patients, such as Grady Memorial Hospital, are cut by $49 million in Georgia for the coming year.  The figure depends on changing variables but is to expand to approximately $149 million by 2025.
  • Subsidies for working-class kids, called the Children’s Health Insurance Program nationally and PeachCare in Georgia, face cuts of $427 million in Georgia this year.
  • In addition, some companies offering policies on the Obamacare exchange market said they raised rates and pulled back coverage because of uncertainty about federal subsidies for lower-income customers.

…The inaction so far on CHIP may not make an impact on Georgia for several more months.  The state’s PeachCare Program is estimated to have the longest runway to bankruptcy of the endangered programs, likely running out of cash in the spring….

October 3, 2017: The Progressive Pulse, a blog from NC Policy Watch, posted an article titled “256,000 N.C. children are at risk of losing health coverage as Congress lets federal funding for CHIP expire”.  It was written by Luis Toledo.  From the article:

…Congress’ failure to renew funding for the CHIP program means over 256,000 children across North Carolina are at risk of losing their only source of health care coverage.  Furthermore, this decision by Congress also spells budget trouble for our state in 2018, as our General Assembly assumed continued federal funding for CHIP in the most recent state budget and failed to take seriously proposed federal budget cuts.

North Carolina is now projected to exhaust all of its federal funds for CHIP within the first three months of 2018.  In other words, our state could be one of many states facing a funding shortfall in this area if Congress does not extend federal funding.

October 3, 2017: The Baltimore Sun wrote an editorial titled “Congress can’t even handle health care for kids.”  It was written by The Baltimore Sun.  From the editorial:

The fate of the Affordable Care Act may be deeply divisive, but there’s one aspect of the health care system that retains broad support across the political spectrum – the Children’s Health Insurance Program….

…But Congress is so screwed up that, as of last weekend, it allowed the program to expire.  A bipartisan deal was in the works in the Senate, but Republicans in both chambers got distracted by yet another attempt to repeal the Affordable Care Act, and the deadline to reauthorize funding for CHIP passed on Saturday.

That doesn’t mean all 9 million children lose health insurance right away.  The program is administered by the states, and they generally have leftover funds from previous years.  A few locales are expected to run out of money quickly – locally, Washington D.C., is in that category – but most will be able to keep their programs going into the next calendar year.  Maryland, which has about 140,000 CHIP enrollees, has enough money to last through March, state officials estimate.

Consequently, some Republicans in Congress have downplayed the urgency of the situation, saying they will be able to act before kids start getting kicked off coverage.  That may not be true in every state – Minnesota officials report that their funding situation is already dire, and they aren’t alone – and there’s no reason for confidence that Congress will actually get its act together in time.  Though CHIP in general is popular, there are details enough in the reauthorization to trip up this Congress…

…In some states, where CHIP operates autonomously from Medicaid, the program could be shut down completely as soon as the federal funds run out; Arizona actually has a law requiring it.  Maryland’s program is structured differently, and the state would not be allowed under Medicaid maintenance of effort rules to kick kids out of the program without federal approval.  But it would take a big financial hit.  Currently, the federal government picks up 88 percent of the cost of CHIP in Maryland, and if funding runs out, that would drop to 50 percent, costing the state about $160 million a year…

October 6, 2017: The Star Tribune posted an article titled “Congress misses health care deadline, Minnesota feels the pinch”.  It was written by Jennifer Brooks.  From the article:

Congress missed a deadline and Minnesota was one of the first states to pay.

The national Children’s Health Insurance Program covers care for more than 9 million low-income children – or it did until September, when it lapsed before lawmakers could get a reauthorization bill to the floor.  Most states had enough funding in reserve to keep their programs running for several months until Congress could catch up.  Minnesota, which relies on CHIP funding to provide health care for more than 100,000 low-income children, didn’t have the cushion.

A $3.6 million infusion of unspent CHIP funds from the Centers for Medicaid & Medicare Services this week will keep two key programs – one that provides care for pregnant women eligible for Medicaid, another for infants and toddlers under age 2 – funded through the end of the month….

…The Minnesota Department of Human Services, meanwhile, is scrambling to figure out how to cover the multimillion-dollar hole it had expected to cover with CHIP funding.  The $115 million in funding that ran out at the end of September covered 125,000 Minnesota children on Medicaid, 200 babies in low-income families whose income didn’t quite qualify them for assistance otherwise, and 1,700 pregnant women, many of them undocumented and in need of prenatal care…

…The National Flood Insurance Program lapsed at the end of September.  So did the Perkins Loan Program, which helps low-income students pay for college. The Community Health Center Fund wasn’t reauthorized, leaving clinics across Minnesota bracing for the worst…

October 7, 2017: Orlando Sentinel posted an article titled “Children’s health program faces uncertain future”.  It was written by Gray Rohrer.  From the article:

A 20-year-old health care program for low-income children is in danger of dying, putting nearly 30,000 Central Florida children at risk of losing coverage.

Congress failed to renew the Children’s Health Insurance Program before its authorization ran out Sept. 30, and its unclear whether legislation to extend the program will pass before states, such as Florida, run out of money for it.

Florida has $359 million carried over from the prior year it can use for the program, but a report from a commission set up to analyze CHIP and Medicaid says Florida will run out of funding for the program sometime in January if it isn’t reauthorized…

…Enrollees in the state’s CHIP program, known in Florida as KidCare, are required to pay monthly premiums of $15 or $20.  KidCare administrators recently extended the deadline for October’s premium from Oct. 1 to Oct. 31 because of Hurricane Irma.

KidCare records show there were 28,356 Central Florida enrollees as of Sept. 1, including 14,022 in Orange County…

…KidCare is heavily reliant on federal funding which makes up 96 percent of the program’s overall spending.  If Congress doesn’t reauthorize CHIP, the state would have to make up the spending, or else the program would fold or face deep cuts.

Florida lawmakers are already facing a tight budget year, with a likely shortfall due to Hurricane Irma expenses and an expected influx of Puerto Ricans fleeing Hurricane Maria, making it unlikely they’d be able to find state funds to make up the difference, about $300 million.

This would force CHIP recipients to look for coverage in the private market or on Obamacare exchanges, or go without coverage…

October 10, 2017: The American Academy of Pediatrics posted a statement titled “AAP Statement on Senate Failure to Extend CHIP Funding by Deadline”. From the statement:

We are at a pivotal moment for children’s health.  After failing to extend funding for the Children’s Health Insurance Program (CHIP) before its expiration date on Sept. 30, Congress now has an opportunity – and indeed a charge – to act in children’s best interest and immediately pass the Keep Kids’ Insurance Dependable and Secure (KIDS) Act of 2017.

The KIDS Act would extend CHIP funding for five years while keeping the program operating as it does currently, allowing CHIP to continue providing affordable, comprehensive health care coverage to nine million children nationwide.  As efforts to repeal the Affordable Care Act dominated the agenda in the Senate, needed attention to CHIP was lost, even though the KIDS Act of 2017 has bipartisan cosponsors and CHIP enjoyed widespread support among both chambers and both political parties.

There is no disagreement among members of Congress that CHIP is a vital program for children that needs to be funded. The problem, which we often see in advocating for children’s issues, is one of benign neglect – assuming, wrongly, that states can continue without renewed funding right away – assuming, dangerously, that members of Congress will eventually come together to do the right thing but not making an urgent plan to ensure its so.

Several states have already announced they will shut down CHIP because they have no funding left to run it, leaving families facing an uncertain future and causing children’s access to the program to depend on where they live.

When it comes to extending CHIP funding, the American Academy of Pediatrics urges our 66,000 pediatrician, pediatric subspecialist and pediatric surgical specialist members not to tolerate support without action.

Congress must pass the KIDS Act of 2017 not next week, not next month, but today.  Right now, children and families need to know that they can continue counting on a program essential to their health and lives.  Members of the Academy of Pediatrics will continue to demand that of our elected leaders until we see real progress.

October 13, 2017: US News & World Report posted an editorial titled “When Even the Simple Stuff Is Too Hard”.  It was written by Robert Schlesinger, Managing Editor for Opinion at US News & World Report.  From the editorial:

If you want a sense of how debilitated our political system has become, consider the uncertain fate of the Children’s Health Insurance Program.

The 20-year old program, which provides health care coverage to low- and moderate- income kids, has been an indisputable success: Between 1997 and 2015, the uninsured rate for children under 18 was cut by more than two-thirds, from 13.9 percent to 4.5 percent. Not surprisingly, it’s a popular program: In a Kaiser Family Foundation poll last month, 75 percent of Americans surveyed rated reauthorizing it as “extremely” or “very” important.  And it has enjoyed bipartisan support since it was created by Utah GOP Sen. Orrin Hatch and Massachusetts Democratic icon Edward Kennedy.

So of course Congress let the program’s reauthorization deadline, the end of September, come and go without action, leaving CHIP in limbo and putting all 50 states into a wary waiting game as their funding dwindles away.  Everything’s a crisis or a cliff with these people, even what should be the simple stuff…

…The good news is that the various state programs are not themselves out of money yet. But as the days tick away so do the dollars.  According to a survey by the Kaiser Family Foundation, 11 states figure to run out of federal CHIP dollars before the end of the year, with another 21 likely to run out of money by the end of March.  But that data comes mostly from a summer survey.  “We’re very concerned about some of the states that have been hit by the hurricanes, that their burn rate is going to spike over the next month or two”, says Cynthia Pellegrini of the March of Dimes, noting that the disasters are likely to lead increases both in eligibility and use….

October 16, 2017: The St. Louis Post-Dispatch posted an article titled “Threatened Medicaid, CHIP program vital to our health care system.”  It was written by Judy Baker, who is a professor of Health Policy at Washington University.  She is also a former CEO of large clinic systems, former regional director for HHS, and a former state representative.  She is identified as a “guest columnist”.  From the article:

If there is one thing I have learned most certainly in my career working to raise quality and lower cost of health care, it is that people don’t stop getting sick or injured just because they don’t have insurance.  For both rural hospitals and Level 1 Trauma centers, this poses particularly challenging consequences.  They are left with the bills of the uninsured and underinsured.  This has caused a real crisis for rural and safety net hospitals….

…So now looms another quiet threat to these hospitals and our neediest citizens.  The Medicaid disproportionate share hospital (DSH) program provides crucial support to hospitals that treat patients whose care is not fully covered by third-parties like Medicaid, and it is essential to keeping hospitals that treat low-income patients open and running. Congress failed to act to renew the DSH program before October 1 allowing massive cuts.  Missouri will be hit particularly hard, facing a devastating $2.2 billion in cuts through 2025 after having already passed on nearly $2 billion per year in Medicaid funds for working low-income families.  For Missouri, it represents a double hit.

Simply put, our state’s hospitals cannot sustain such drastic cuts.  Here in Missouri, where Medicaid has not been expanded to cover low-income working families, a large part of our population remains uninsured.  If the DSH program is cut, our hospitals would be forced to absorb the costs of treating low income patients whose we are bound by law and ethics to treat.  Though Missouri hospitals are operating more efficiently than ever before, they are not in a position to take on such costs.  Hospitals will be forced to either cut services, raise rates, or both, resulting in higher premiums, job losses, and in some cases, even closure…

…The Children’s Health Insurance Program (CHIP) was also allowed to lapse on October 1.  Nearly 90,000 Missouri children receive their health care through the bipartisan Medicaid/CHIP program. Many employers do not extend coverage for children through their plans, leaving many children of working people without any other option for access to health care.

October 31, 2017: The APP posted a statement tiled “AAP Statement on House CHIP Legislation”.  From the statement:

The American Academy of Pediatrics is disappointed that the legislation currently advancing in the U.S. House of Representatives to extend funding for the Children’s Health Insurance Program (CHIP) does not continue the program’s strong bipartisan history.  While the bill includes sound policy that pediatricians support – extending CHIP for five years, stabilizing enrollment, and preserving current funding levels through 2019 – it is paid for in a way that may harm children’s health.  Specifically, the bill cuts the Prevention and Public Health Fund, makes risky changes to Medicaid financing and puts in place new barriers for families to access affordable health care coverage in the private marketplace.

CHIP funding expired one month ago. The nearly 9 million children who rely on the program, along with their families, have been forced to face an uncertain future as they hear conflicting reports of what this inaction means for them. These families do not follow the latest policy developments and they do not care about process.  They simply want to know that they can continue to access reliable, affordable health care coverage for their children.  Because of congressional inaction, they have not had that piece of mind.

CHIP has been celebrated as a bipartisan success story since the very beginning 20 years ago.  The program enjoys widespread support among both chambers and political parties, and more importantly, it works for the children it serves.  Like CHIP, the Maternal Infant and Early Childhood Home Visiting program also ran out of funding on Sept. 30. Like CHIP, home visiting is also a bipartisan program.  And like CHIP, its bipartisan success is being needlessly jeopardized.  These programs are too important for the children and families they serve to be caught up in politics.

It is past time that members of Congress come together to do what is right for children and families and extend CHIP funding for five years, without jeopardizing other important child health policies in the process.

November 2, 2017: The Henry J. Kaiser Family Foundation (KFF) posted “Comparison of Key Provisions in the Senate and House CHIP Bills”.  Here are some key pieces of information from that post:

In early October 2017, the Senate Finance Committee and House Energy and Commerce Committee reported bills out of committee to extend federal funding for the Children’s Health Insurance Program (CHIP).  As of November 1, the House bill was amended to combine the extension of CHIP with an extension of funding for the Community Health Center (CHC) fund.  The House is scheduled to vote on this bill on November 3rd.  Final legislation to extend CHIP still requires passage by the full House and Senate, resolution of any differences between House and Senate bills, and signature by the President….

…Without congressional action, the majority of states will face a FY2018 budget shortfall.  As states run out of federal funds, some will take action to freeze enrollment or end coverage, which would lead to coverage losses for children…

The Senate bill is S. 1827, which is titled “KIDS Act of 2017”.  The information KFF has was as of October 4, 2017.  The House bill is H.R. 3922, which is titled “CHAMPIONING HEALTHY KIDS Act”. The information KFF has on it was as of November 1, 2017.  Two comparisons of the two bills were done. The first comparison was “High Level Comparison of Senate and House CHIP funding Bills”.  The second was “Detailed Comparison of Key Provisions in the Senate and House CHIP Funding Bills.”

FY means “Fiscal Year”.  TANF is the Temporary Assistance for Needy Families program.  SNAP is the Supplemental Nutrition Assistance Program.  CHIP is the Children’s Health Insurance Program.  FMAP is the Federal Medicaid Assistance Percentage.  The House and Senate bills match in general terms, but the Senate bill lacks the details that are necessary to actually implement anything.

Here’s where the two bills match:

  • Extend federal funding for CHIP for five years, with transition down from enhanced match rate to regular CHIP match rate.
  • Extends state maintenance of effort requirement for children in families with incomes below 300% FPL, Express Lane Eligibility, and demonstration and outreach programs.
  • Extends federal CHIP funding for 5 years, from FY2018-FY2022
  • Also extends Child Enrollment Contingency Fund payments for states with a funding shortfall and CHIP enrollment exceeding a state-specific target level.
  • Continues 23% CHIP enhanced FMAP for FY2018 and FY2019, then decreases to 11.5% in FY2020, and removes enhanced FMAP in FY2021, and FY2022.
  • Extends authority for states to rely on findings from agencies such as those that administer TANF or SNAP for initial Medicaid/CHIP eligibility determinations and renewals.
  • Extends states’ maintenance of effort requirements for children in families below 300% FPL for 10/1/19 through 9/30/22
  • Extends federal funding for childhood obesity demonstration project and pediatric quality measures program for FY2018-FY2019.

Here’s where the two bills do not match:

The House bill has a bunch of stuff in it that is not in the Senate bill.  In order to pass, both of these bills need to match each other.  In general, this means that changes will be made in order to get the two bills to match.

  • Delays Medicaid DSH cuts to FY2020 and increases reductions to $8 billion per year over the FY2021-2025 period
  • Provides $1 billion in Medicaid financing to Puerto Rico and additional relief to the U.S. Virgin Islands.
  • Increases collection of third-party payments under Medicaid
  • Includes lottery winnings and other lump sums in Medicaid eligibility determinations
  • Increases Medicare premiums for higher income beneficiaries
  • Extends Community Health Center fund and other public health provisions for two years
  • Offsets costs by reducing funding for the Prevention and Public Health Fund and shortening the grace period for unpaid premiums for individuals in subsidized Marketplace plans
  • Specifies that organizations that utilize parent mentors are able to receive grant funding and that any income or stipend a parent receives through this grant funding should not be considered in Medicaid eligibility determinations
  • Allows states to include CHIP children and those in look-alike programs in the same risk pool and specifies that CHIP look-alike programs qualify as minimum essential coverage.  Look-alike programs are for children under 18 who are ineligible for Medicaid and CHIP and purchase coverage through the state that provides benefits at least identical to CHIP funded through non-Federal funds including premiums
  • Removes $2 billion DSH cut for FY2018 and $3 billion DSH cut for FY2019, retains $4 billion DSH cut for FY2020, increases federal DSH cuts to $8 billion in FY 2021 through 2025.
  • Increases federal Medicaid payments to Puerto Rico and the Virgin Islands by 1% for FY2018 and FY2019 (new rate is medical CPI +1%) Also provides an additional $880 million for Puerto Rico.
  • Provides a further increase of $1.2 million from 10/1/17 through 12/31/19 if Puerto Rico Financial Oversight and Management Board certifies that Puerto Rico has taken reasonable and appropriate steps to reduce Medicaid fraud, waste, abuse; implemented strategies to reduce unnecessary, inefficient, or ineffective Medicaid spending; improved the use and availability of Medicaid data for program operation and oversight; and improved Medicaid care quality and patient experience.
  • Also provides 90% federal matching funds to Puerto Rico and the Virgin Islands for staff and costs to eliminate Medicaid fraud for 1/1/18 through 12/30/19.
  • Also provides for additional funding to the Virgin Islands based on the Virgin Islands per capita equivalent amount of the $880 million plus $1.2 million provided to Puerto Rico as described above.
  • Increases states’ ability to pursue Medicaid reimbursement from liable third parties, incentives states to do so for expansion adults, and requires state Medicaid Integrity Programs to include training on third party liability. Also requires Secretary to post third party liability best practices online and monitor state efforts.
  • Allows Secretary to reduce state’s FMAP by 0.1% for quarters in the year after a state fails to comply with federal third party liability requirements (reduction can be cumulative for failure to comply in consecutive years.)
  • Applies Medicaid third party liability provisions to CHIP
  • Provisions are effective 10/1/19 unless otherwise specified (subject to exception if state legislature not in session.)
  • Require states to consider lottery winnings and other lump sum payments (including gambling winnings, damages from suits other than personal physical injuries or physical sickness, and liquid assets from an estate) as income over a period of months in determining Medicaid eligibility for an individual based on MAGI as of 1/1/18.  Secretary can establish hardship criteria and state can intercept lottery winnings for Medicaid recoupment.
  • Sets Medicare part B and D premium subsidies at 80% for individuals with incomes between $160,000 and $500,000 and removes Medicare Part B and D premium subsidies for those with income above $500,000 (current law is 80% for all those above $160,000.). Beginning in 2027, the $500,000 amount is increased by percentage that the CPI for the 12 months ending with August of the previous CY exceeds average CPI for the 12-month period ending with August 2025
  • Extends funding for FY2018 and FY2019 for the Community Health Center Fund and other public health provisions, including the National Health Service Corps, Special Diabetes Program, Teaching Health Center Graduates Medical Education program, Youth Empowerment Program, Personal Responsibility Education Program, and Family-to Family Health Information Centers.
  • Offsets costs by reducing funding for the Prevention and Public Health and shortening the grace period for unpaid premiums for individuals in subsidized Marketplace plans. Beginning 1/1/2018, reduces grace period for discontinuing coverage due to nonpayment of premiums for people who enroll in subsidized Qualified Health Plans under the Affordable Care Act from three months to one month, unless a state sets a different period.

November 3, 2017: Gideon Resnick wrote a short article for The Daily Beast titled House Reauthorizes Children’s Health Insurance Program, But There’s Trouble Ahead.”  From the article:

The House passed a bill to reauthorize funding for the Children’s Health Insurance Program, which lapsed at the end of September, on Friday afternoon.  The bill passed by a margin of 242-174 with only 15 Democrats voting in favor. Democrats have perceived the House legislation as partisan in nature due to the method by which the program would be funded.  Republicans have wanted to try and expedite the process so as not to keep nearly 9 million children without health care coverage and to try and force the hand of Democrats.  Now, as Democrats had warned, there is a potential for an even further delay of a final bill’s passage until the end of the year.

The bill referred to in the article is H.R. 3933.  It is titled “CHAMPION Act”, or the “CHAMPIONING HEALTHY KIDS Act“. If you take a close look at what is in that bill, it becomes very clear that this isn’t really about funding CHIP.  It was about destroying it.  Here are some portions of the bill:

  • Extends funding through FY2022 for CHIP allotments, as well as the Child Enrollment Contingency Fund, the Childhood Obesity Demonstration Project, and Pediatric Quality Measures Program, and specified outreach and enrollment grants;
  • Allows state CHIP programs to adopt more restrictive eligibility standards with respect to children in families whose income exceeds 300% of the poverty line who have an offer of employer-sponsored insurance;
  • Ensures the unwinding of the enhanced Federal Matching Assistance Percentage (E-FMAP) for child-health assistance by not extending the E-FMAP beyond FY2019, providing a 11.5 percent E-FMAP in FY2020, and returning to the traditional pre-ACA CHIP matching rate in FY2021 and FY2022.
  • Allows states to define their requirements for patients receiving advanced premium tax credits (APTCs) and cost sharing reductions (CSRs) or move to a default of one month.
  • Improves current law related to third-party liability under Medicaid and CHIP to save Medicaid and CHIP programs by ensuring other liable third parties to pay to the extent of their liability.
  • Specifies how a state must treat qualified lottery winnings and lump-sum income for purposes of determining Medicaid eligibility.

November 8, 2017: Charleston Gazette-Mail posted an article titled “WV CHIP to shut down in February unless Congress allocates funds”.  It was written by Erin Beck.  From the article:

The board of directors for the West Virginia Children’s Health Insurance Program voted Wednesday to shut down the CHIP program on Feb. 28, if Congress doesn’t allocate funding to the program soon…

…State officials had said in early October that West Virginia had enough funding that had been allocated, but not spent during the fiscal year, to continue paying for the program until early 2018. CHIP became 100 percent federally funded in West Virginia after the Affordable Care Act, also called Obamacare, boosted funds to the program.

CHIP board members voted on the plan Wednesday morning, following a discussion focused on the need to transfer children eligible for the CHIP program from PEIA to CHIP.

Ted Cheatham, director of PEIA, talked about the need to inform lower-income state employees that their children are eligible, and increase the cost of plans that cover children.  One board member asked why state employees are unaware that their children are eligible.

“I don’t know if I can auto-enroll them into CHIP,” Cheatham said.  “What I’m going to do is, I’m going to make it so expensive, they’ll hopefully see the light at the end of the tunnel.”…

…[Jeremiah] Samples, [West Virginia Department of Health and Human Resources deputy secretary] said the DNNR would notify families and providers in early January that the program would shut down in Feb. 28 if Congress has not reauthorized it.  The DHHR expects the program to run out of money in March…

…The DHHR said last month that about 21,000 children are covered by CHIP.  An additional 17,000 are covered by Medicaid plans that rely on CHIP money.  Nearly 9 million children are covered nationwide.

November 22, 2017: Gideon Resnick wrote an article for the Daily Beast titled “Congress Created a Health-Care Crisis for Kids Right in Time for the Holidays”. From the article:

…Since its inception in 1997, CHIP has had strong bipartisan support and been a measurable success, covering nearly 9 million children nationwide.  It helped lower the nation’s percentage of uninsured children from almost 14  percent when it started to about 4.5 percent in 2015.  But this year, amid efforts to repeal and replace the Affordable Care Act, Congress allowed the deadline to reauthorize the program to come and go.  Almost two whole months have passed since and there is growing concern that no action will come until the end of the year.

Families and state agencies have been forced to scramble amidst the uncertainty.  Arizona, the District of Columbia, Minnesota, and North Carolina are expected to run out of CHIP funding next month according to the Medicaid and CHIP Payment and Access Commission (MACPAC).  Another 27 states are anticipated to have their funds exhausted by March 2018.

In Texas… the Texas Health and Human Services Commission has estimated that money will run dry by the end of February 2018.  There are concerns that it may come even sooner, putting families…in emotional turmoil just as the holiday season hits…

…In Texas, advocates worry that funding will run out sooner than anticipated due to recovery effort needs following Hurricane Harvey.  That could mean that families will receive a 30-day notice about the program ending right around Christmas.

November 27, 2017: CNBC posted an article titled “Colorado warns residents kids’ health program will shut down soon if feds don’t act.”  From the article:

The state of Colorado began warning residents Monday that a health insurance program for children will cease operations next month if Congress fails to approve funding for it.

While Colorado’s warning is dire, the state’s Children’s Health Plan Plus program actually has enough money in its coffers to continue operations through Jan. 31, even as Congress drags its feet on renewing funding.

Other states are not so lucky – and are even closer to running out of cash to operate their own programs that had received funding from the federal Children’s Health Insurance Program….

…Nearly a dozen states are preparing to join Colorado in alerting enrollees in their kid’s health program that CHIP funding is on the verge of running out…

…Arizona, California, the District of Columbia, Minnesota, Ohio and Oregon are on track to drain their kids’ health program by the end of 2017 or early January, according to Georgetown University’s Center for Children and Families.

In addition to Colorado, five other states will run out of CHIP money by January or February: Pennsylvania, Texas, Utah, Virginia and Washington…

…On Monday, Colorado health officials sent out letters to enrollees urging them to begin researching their options for obtaining private health insurance in the event that Congress doesn’t approve new funding.

More than 75,000 children in Colorado and almost 800 pregnant women are covered by the program, which is available to low-and middle-income families.

The Colorado Department of Health Care Policy and Financing posted information on their website regarding the CHIP program and the possibility that Congress will fail to reauthorize funding for it.

November 29, 2017: Mohave Valley Daily News posted an article titled “Arizona set to fund CHIP through March”.  It was written by DK McDonald. From the article:

The state of Arizonas is prepared to implement a contingency plan to prevent nearly 23,000 children from losing access to health insurance.

Congress failed to reauthorize funding for Children’s Health Insurance Program – known as KidsCare in Arizona – which insures 9 million children nationally, by a Sept. 30 deadline.

In the interim, Arizona redistributed funding from another program to fund CHIP programming through December, said Heidi Caprotti, Arizona Health Care Cost Containment System public information officer.

Five states anticipated to run out of funding by Dec. 31, including Arizona, received redistributed unused CHIP funding to prevent shutdown of the program, according to Kaiser Family Foundation.  However, once those funds are exhausted, no further money will be available unless authorized by Congress.

The state also created a contingency plan, which will fund the program into the first quarter of 2018, Capriotti said….

December 1, 2017: Nashville Public Radio posted an article titled “Tennessee Buys Time As Funding Runs Out On CHIP Health Insurance for Kids”.  It was written by Blake Farmer.  There is an audio version of the article embedded in the website.  From the article”

…Tennessee is in a better position than most states as funding for the Children’s Health Insurance Program runs out.  Congress still hasn’t reauthorized what’s known as CHIP, and some states are already beginning to send out letters telling families to prepare for coverage to go away.

Tennessee has enough money to make it through May before having to think about next steps, even though the program lapsed at the end of September.  According to a government analysis…the state has built up more reserves than most and can use that money until it runs out.

The assumption is that Congress will approve new funding to insure roughly 74,000 Tennesseans.  These are mostly children and some pregnant women who make too much to qualify for TennCare but still have trouble affording health insurance….

…If the program is not reauthorized, Tennessee will have to decide whether to fund the insurance with state money like Minnesota is doing or follow Colorado and warn families that they’ll need to find another option….

December 3, 2017: The Intercept posted an article titled “Author of GOP Tax Plan Says Children’s Health Insurance Program Is Held Up “Because We Don’t Have Money Anymore”.  It was written by Rachel M. Cohen.  From the article:

The lead author of the Senate Republican tax plan, Finance Committee Chair Orrin Hatch of Utah, said the federal government no longer has the money to fund the popular Children’s Health Insurance Program, known as CHIP.

“The reason CHIP is having trouble [passing] is because we don’t have money anymore,” Hatch said.  “We just add more and more spending and more and more spending, and you can look at the rest of the bill for the more and more spending.”

CHIP is an $8 billion program.  The Senate bill passed in the early hours of Saturday morning includes $6 trillion in tax cuts, financed by $4.5 trillion in tax hikes elsewhere.  Hatch, though, promised CHIP would still pass. “We’re going to do CHIP, there’s no question about it in my mind.  It has to be done the right way.” he said…

…As tax reform picks up, health experts are feeling nervous.  Never mind that more than 60 percent of Americans say CHIP reauthorization should be a top federal priority, while only 28 percent say tax reform should be…

…So what’s the hold up?

Part of it involves Congress fighting over how CHIP will be paid for, with legislators looking for $8 billion in what’s known as “offsets.”  There are rules requiring Congress to determine where these offsets – or money for new spending – will come from, but these rules are often waived.  Just last month, when Congress passed a bill to repeal the Independent Payment Advisory Board, a panel created through the ACA to make cost-saving recommendations, legislators waived the $18 billion offset requirement.  And now Congress is preparing to pass a mammoth tax reform bill that the Joint Committee on Taxation said Wednesday would fall almost $1 trillion short of paying for itself. Offsets be damned…

…In early November, the House passed a bill, 242-174 largely on party lines, to reauthorize CHIP by taking money away from the ACA’s public health preventive care fund, which pays for programs like opioid treatment and vaccinations.  Energy Commerce Committee Ranking Member Frank Pallone, Jr., D-N.J., charged that Republicans were capitalizing on CHIP reauthorization as a new way to sabotage the ACA.  Pallone proposed changing the payment schedule of Medicare Advantage Plans to fund CHIP, but Republicans rejected that in the Rules Committee.

In mid-September, Hatch and ranking member Ron Wyden, D-Ore., announced a bipartisan agreement to reauthorize CHIP for five years, but they haven’t brought the bill to the floor.  They also haven’t made clear where the offsets will come from…

…  “There are procedural barriers to just putting CHIP as an independent bill no matter what,” said [senior Vice President of public policy at the March of Dimes, Cynthia] Pellegrini.  “In this climate, it would have to go through cloture and have to have floor time.  The Senate only has 15 to 17 more legislative days – though they may extend that into Christmas week – but there is literally no time left with everything else they want to be doing to put it up by itself. With the budget, CR (continuing resolution), tax reform, potentially Iran, all these bills have piled up.  The question is, can they combine CHIP with other bills in a package and get it through faster?”

One option could be to move it through a strategy known as “hotlining” – in which the Senate gets the unanimous consent of all 100 members and moves it though rapidly on a voice vote.  That means the package they’d be approving would either be noncontroversial or very bipartisan….

…Another option is to include CHIP reauthorization in a continuing resolution that provides short-term funding for fiscal year 2018.  The current continuing resolution expires on December 8, so Congress may try to include CHIP in its next one.  House Republicans are also trying to push a two-week continuing resolution to fund the government until December 22, which would require yet another continuing resolution after that for 2018,  CHIP reauthorization could conceivably be included in either or those, too…

December 5, 2017: Bridge (News and analysis from The Center for Michigan) posted an article titled “Flint lead pipe replacement could be jeopardized by CHIP stalemate”. It was written by Jim Malewitz.  From the article:

If Congress fails to renew the Children’s Health Insurance Program (CHIP) before state funding runs dry, plans to replace lead pipelines in Flint may stall and jeopardize Michigan’s efforts to protect children from lead poisoning.

The federal government last year gave Michigan permission to spend about $119 million of CHIP funds over five years to detect and remove lead hazards from homes in Flint and elsewhere, dramatically expanding aid to Michiganders who worry about lead paint or pipes in their homes.

…Over the last year, the program funded lead detection and removal in 159 homes, mostly in Flint and Detroit, according to the Michigan Department of Health and Human Services.

The state also tapped those funds to replace about 1,000 lead service lines in Flint, which is still reeling from the scandal that exploded after a state-appointed emergency manager ordered a switch of municipal water sources that led to the release of lead from pipes into city drinking water…

The article points out that if the CHIP funding dries up – it could be devastating.

December 6, 2017: TRIB Live posted an article titled “Pennsylvania official warns CHIP program could end by late March without federal funding.”  It was written by Wes Venteicher.  From the article:

About 180,000 Pennsylvania children could lose health insurance early next year if Congress doesn’t reauthorize spending for the Children’s Health Insurance Program, according to Department of Human Services Secretary Teresa Miller…

…Miller has been holding events to raise awareness about the potential funding shortfall and plans to visit Pittsburgh on Thursday.

The program, which costs about $500 million a year in Pennsylvania, receives nearly 90 percent of its funding from the federal government.

The flow of federal dollars stopped Oct. 1 after Congress missed a deadline to continue funding CHIP programs across the country.  If Congress doesn’t approve funding, Miller estimates the cash-strapped state will have to end the program by the end of March…

…Once the department identifies exactly when the money will run out, it will send letters to families with the insurance 30 days before the program ends – an outcome Miller says she hopes to avoid.  She said Pennsylvania has fared better than a handful of other states that have already sent out such notices and will have to restart their programs if Congress reauthorizes funding…

…The Republican-led U.S. House passed a bill along party lines that would cut a public health program established under the Affordable Care Act and raise Medicare premiums on the program’s highest-income recipients, according to the Associated Press.  House Republicans says the moves could help free up money needed to continue funding CHIP programs across the country.

House Democrats opposed the proposal.  They said cutting the public health program would reduce access to vaccines and opioid abuse programs and the Medicare changes would prompt people to drop coverage, undermining that program’s finances and eroding political support for it, according to the AP.

December 6, 2017: The Henry J. Kaiser Family Foundation posted a fact sheet titled: “State Plans for CHIP as Federal CHIP Funds Run Out”.  From the fact sheet:

…Federal stopgap funds available to states include remaining federal funds from each state’s federal fiscal year (FY) 2017 CHIP allotment and redistribution funding from prior years provided by the Centers for Medicare and Medicaid Services (CMS) from a limited amount of unspent funds across all states.  However, once states exhaust those funds, no additional funds will be available unless Congress enacts legislation.  As of December 6, nine states have exhausted their FY 2017 allotments and have received redistribution funds from CMS to continue coverage.  CMS is expected to release the final redistribution payments in the near-term but these amounts will be insufficient to cover states’ FY 2018 CHIP shortfalls…

…Among the 48 states that provided an estimate of when they will exhaust federal funds, including the 38 states that provided an update in November 2017, 16 states projected they will exhaust federal funds by the end of January 2018, and an additional 21 states projected they will exhaust federal funds by the end of March 2018.  State projections are fluid and change as enrollment and costs fluctuate and states receive redistribution funds….

…A total of 14 states reported plans to terminate or phase out coverage for children, including 5 states that plan to end coverage by the end of January 2018… In addition, three states plan to take action in February (AL, OK, and WV), one state plants take action in March (SD).  The additional five states (MS, NC, ND, PA, and WY) plan to take action later or did not indicate a date for planned action.  States will begin notifying families of the upcoming changes one month or more in advance of the planned action date.  As of December 6, 2017, at least three states had begun informing families about potential changes.  Colorado sent a warning to families about potential coverage losses, and Utah and Oklahoma had posted notices on their websites warning of potential coverage reductions…

Note: The fact sheet pointed out the five states that planned to end coverage by January 31, 2018:

  • Colorado – planned to notify families November 27, 2017 – Estimated number of individuals affected: 74,873
  • Connecticut – planned to notify families December 15, 2017 – Estimated number of individuals affected:  17,000
  • Texas – planned to notify families December 22, 2017 –  Estimated number of individuals affected: 452,179
  • Virginia – planned to notify families early December 2017 – Estimated number of individuals affected: 67,000
  • Utah – planned to notify families November 2017 – Estimated number of individuals affected: not reported

Here are a few more key points from the fact sheet:

…In addition, several states reported plans to reduce CHIP coverage for pregnant women.  Colorado and Virginia both plan to terminate or phase out coverage for enrolled pregnant women on January 31, 2018.  Virginia also plans to close new enrollment for pregnant women or establish an enrollment cap on January 1, 2018.  Oklahoma has also indicated plans to terminate coverage for pregnant women covered through its unborn child option as of February 28 2018…

…Reductions in CHIP coverage will result in coverage losses for children and negative effects on children’s health and family finances.  If states close enrollment and/or discontinue coverage for children in separate CHIP programs, some children could shift to their parents’ employer-sponsored plans or Marketplace plans, but others would become uninsured.  Previously, some states closed enrollment in CHIP for limited periods in response to state budget pressures, and studies show that this led to coverage losses, left eligible individuals without access to coverage, and had negative effects on health and family finances…

December 8, 2017: CityLab posted an article titled “Congressional Gridlock is Putting Flint’s Pipe Replacement in Peril”. It was written by Teresa Mathew.  From the article:

Political gridlock has created a lapse in funding for a program that provides health insurance to poor children.  It may also end up being culpable for preserving lead service lines that still run under the city of Flint, Michigan.

Since its creation in 1997, the Children’s Health Insurance Program (CHIP) has provided healthcare for children and pregnant women from low-income families who don’t qualify for Medicaid. But this year, Congress failed to meet the September 30 deadline for the program’s renewal. Although committees in both the House and Senate have passed bills to reauthorize CHIP, no one is sure when a final measure will appear.  The state of CHIP’s funding is up in the air, and those who rely on it are left in limbo.

CHIP doesn’t just provide money for straightforward medical needs like immunizations and doctor’s visits. Under a special contract with Michigan approved by the federal government last year, families in Flint can apply to asses their pipes and sample their water quality, in the wake of a water crisis that contaminated water throughout the Rust Belt city and elevated the blood lead levels of thousands of children.  Under the five-year agreement, CHIP has also provided aid for pipe replacement; contractors get paid using CHIP funds for those homes with children who qualify for the program.  That money has been a boon for the underfunded city.  And the longer the federal government takes to fund CHIP, the more administrators worry about how they can pay to keep Flint’s residents safe…

December 11, 2017: Jimmy Kimmel brought his son, Billy, onto the show.  Billy has heart problems and just had heart surgery.  Jimmy Kimmel talked about the CHIP program.

December 12, 2017: Twelve state governors sent a letter to Speaker of the House Paul Ryan (Republican), Senate Majority Leader Mitch McConnell (Republican), House Minority Leader Nancy Pelosi (Democrat) and Senate Minority Leader Charles E. Schumer (Democrat).  From the letter:

We ask that you make it a priority to reauthorize the Children’s Health Insurance program (CHIP as quickly as possible.  We believe in covering children and pregnant women without disruption is one thing we can all agree on.

For twenty years, this program has successfully provided vital health coverage and care to about nine million children.  Without it, access to essential health services like well child exams, asthma medicine, and hospitalizations will be at risk.  As health insurance premiums climb at unsustainable rates, this program gives hard-working families access to otherwise unaffordable coverage.

In the absent of Congressional action, we have worked to protect coverage for children and pregnant women in each of our states, but we will need federal support to continue the program.  Resources are nearly exhausted and some states have already begun to inform families that their children’s coverage may end on January 31.

Since its creation, CHIP has enjoyed strong bipartisan support.  We encourage you to work across the aisle to find common ground that will allow this important program to continue and give the families who rely on CHIP the peace of mind of knowing that their children will be able to get the health care they need in the new year.

The letter was signed by:

  • Governor John Hickenlooper – Colorado (Democrat)
  • Governor John Kasich – Ohio (Republican)
  • Governor Bill Walker – Alaska (Independent)
  • Governor John Bel Edwards – Louisiana (Democrat)
  • Governor Tom Wolf – Pennsylvania (Democrat)
  • Governor Christopher T. Sununu – New Hampshire (Republican)
  • Governor Terence R. McAuliffe – Virginia (Democrat)
  • Governor Charles D. Baker – Massachusetts (Republican)
  • Governor Steve Bullock – Montana (Democrat)
  • Governor Phil Scott – Vermont (Republican)
  • Governor Brian Sandoval – Nevada (Republican)
  • Governor Mark Dayton – Minnesota (Democratic-Farmer-Labor-Party)

December 13, 2017: The U.S. House of Representatives Committee on Appropriations posted a press release titled “Resolution Introduced to Fund National Defense, Extend Children’s Health Insurance Program, and Continue Short-Term Government Operations”. From the press release:

House Appropriations Chairman Rodney Frelinghuysen today introduced legislation to fully fund the national defense programs for the entire fiscal year (including emergency funding for missile activities), to continue the Children’s Health Program (CHIP) and to maintain current federal operations and prevent a government shutdown (H.J. Res 124)….

This press release makes it clear that H.J. Res 124 is NOT a bill specifically focused on renewing funding for the Children’s Health Care Program. Instead, it includes funding for missiles, and funding to prevent the government from shutting down.

The press release also contains a paragraph about the Republicans’ opinion of the CHIP program, which is mentioned after a paragraph about how important missiles are.  (The quote is from House Appropriations Chairman Rodney Frelinghuysen):

“It is also critically important that we provide resources for our children’s health.  Families across the nation rely on the National Children’s Health Program to help sick kids get better and to ensure healthy and happy futures.  This legislation includes a measure that would extend this important program throughout the year.”

H.J. Res. 124 is titled “Making further additional continuing appropriations for fiscal year 2018, and for other purposes”.  The majority of this bill funds the military.  It is very detailed and specific about that funding.  Eventually, it gets around to mentioning health care related things.

Sec. 20201 changes the grace period between when a person fails to pay their “Obamacare” health insurance premiums, and when the health insurance company can rip away that person’s coverage.  Plans beginning before January 1, 2018 would have a 3-month grace period.  Plans beginning on or after January 1, 2018, would either have to adhere to a specific state’s grace period – or, if their isn’t one, then they can take away a person’s health insurance coverage after a 1-month grace period.

If this bill passes, unamended, it would allow health insurance companies to cancel your “Obamacare” plan because your check arrived a few days late, or the website glitched and didn’t record your payment date accurately.  And, just to be clear, all “Obamacare” plans that were renewed during the intentionally shortened sign-up period in November and December of 2017 would have a start date of January 1, 2018.  So, everyone would have that 1-month grace period hanging over their heads.

The next part basically allows individual states to make the enrollment period for Medicaid, and Medicare parts C and D occur at the same time as the “Obamacare” enrollment period. That’s a problem because we already know the “Obamacare” enrollment period is intentionally shorter than it was in past years.  In addition, a person who has “Obamacare” and then loses their job, would not be able to enroll in Medicaid until next year.

Sec. 21202 is about the Patient Protection and Affordable Care Act.  The Republicans want to defund it – like this:

  • Fiscal year 2018 – $900.000,000
  • Fiscal year 2019 – $500,000,000
  • Fiscal year 2020 – $500,000,000
  • Fiscal year 2020 – $500,000,000
  • Fiscal Year 2021 – $500,000,000
  • Fiscal Year 2022 – $500,000,000
  • Fiscal Year 2023 – $500,000,000
  • Fiscal Year 2024 – $500,000,000
  • Fiscal Year 2025 – $750,000,000 – an unexplained increase from the past six years
  • Fiscal Year 2026 – $1,000,000,000 – another unexplained increase from the year before
  • Fiscal year 2027 and each fiscal year thereafter – $200,000,000

The next part finally gets around to the CHIP extension and other Medicaid and CHIP Provisions.  It says it is a “Five-Year funding extension of the Children’s Health Insurance Program.  This part starts with Sec. 22101.

But first… it sets a total allotment for funding for the Social Security Act – which CHIP appears to be a part of.  At a glance, it appears that the dollar amount per fiscal year increases, and then becomes not one, but two allotments per year starting in October of 2021.  That sounds good – but it’s hard to tell if it really is good without knowing what the amount of the original allotments were before this bill amended them.

The Republicans decided to call the part about CHIP the “Healthy Kids Act”.  There are no specific numbers about how much funding the Children’s Health Insurance Program would get.  That’s odd, since they were super details about military funding, and the funding reduction (and then increase) of “Obamacare”.  Instead, it has a confusing … I’m going to say “formula”… that vaguely instructs each Secretary of State to figure out an allotment for CHIP.  I think?

H.J. Res 124 was introduced in the U.S. House of Representatives on December 13, 2017.  No further actions have been taken on this bill as of December 24, 2017 (which is when I looked it up and read it).

December 14, 2017: CNN posted an article titled “These states are running out of CHIP funding”.  It was written by Sam Petulla.  From the article:

…CHIP has come into the news lately because Congress has not yet reauthorized its funding mechanism, and, as a result, states are running out of money.  Once the money runs out, potentially hundreds of thousands — if not millions– of low-income kids could lose their health insurance.  That could be a dire situation for some families.

Versions of CHIP reauthorization have passed both the House and a key Senate committee, but there have been disagreements on how to pay for the program.  Lawmakers on both sides of the aisle agree that it will ultimately be reauthorized, but for families who rely on the coverage, the stopgap temporary solutions have caused heartburn and Democrats have complained that Republicans want to focus on tax reform first.

The loss of federal funds could cause state budget shortfalls because nearly all states assumed continued federal funding in their 2018 budgets.  States have already made plans for what to do in the event that federal funds are exhausted…

…The steps Congress has taken to fill the funding gaps while it debates a more permanent solution have been small and drawn the ire states and medical groups.

President Donald Trump signed a short-term government funding bill which called on the Department of Health and Human Services to allocate any remaining funds to the states most at risk of running out of CHIP funding…

…Already, some states are sending mailers to families saying their coverage may be affected.  There is concern among health experts that added insecurity about programs or just a brief hiccup in coverage can have lasting damage.

Research into programs that have suspended or modified coverage found that once programs like CHIP experience temporary program suspension, it can take years to bring coverage levels back to previous levels.

The article lists the sixteen states that are expected to run out of funding by January 2018: Arizona, California, Colorado, Delaware, Florida, Idaho, Massachusetts, Minnesota, Nevada, New Hampshire, Oregon, Pennsylvania, Texas, Utah, Virginia, Washington.

December 15, 2017: The Texas Tribune posted an article titled “Texas to receive $135M to keep Children’s Health Insurance Program alive through February”. It was written by Marissa Evans.  From the article:

The Trump administration is guaranteeing Texas $135 million to continue helping more than 450,000 uninsured children and pregnant women if Congress doesn’t renew authorization for the Children’s Health Insurance Program.

Charles Smith, executive commissioner for the Texas Health and Human Services Commission, sent a letter to Gov. Greg Abbott on Friday saying the federal Centers for Medicare and Medicaid Services is giving the state funding to continue the program through February…

…The letter comes after more than two months of fear among families who rely on the program that children in Texas and beyond would lose their health insurance benefits for checkups and treatments.  The program expired Sept. 30 after Congress failed to renew funding.

December 15, 2017:  Husky Health Connecticut, which is Connecticut’s Health Care for Adults and Children, posted a notice that part of their CHIP program would be closing.  Key parts of the notice said:

Unfortunately, federal funding for the Children’s Health Insurance Program (CHIP), known in Connecticut as HUSKY B, ended on September 30, 2017, because Congress failed to take action to extend the program.  Connecticut has been able to continue offering HUSKY B beyond that date by using federal funding.  However, these funds are expected to run out on January 31, 2018.

As a result, we must plan to close the HUSKY B program. Unless additional funding becomes available, HUSKY B services and coverage for eligible children and teenagers will end on January 31, 2018…

…Please note that if Congress does vote to keep funding the CHIP program, services received and coverage in HUSKY B will continue. However, as of December 15, 2017, Congress has not acted to continue the funding, so we must plan to close HUSKY B….

December 15, 2017: The Star Tribune posted an editorial titled: “Congressional failure on CHIP, health center funding is a disgrace”.  It was written by the Star Tribune Editorial Board.  From the editorial:

…In 2015, Congress approved $3.6 billion over two years with minimal fuss. There is no good reason this year should be any different. Yet funding for these centers and another vital medical assistance effort, the Children’s Health Insurance Program (CHIP), has been bogged down since fall despite broad bipartisan support for both.

CHIP serves 125,000 Minnesota kids, with a total of 5.9 million enrolled nationally at an annual cost of $15.6 billion.  Along with community health centers, it’s part of the nation’s medical safety net.  Even though the House recently passed funding for both programs, Senate passage remains unclear.  A key reason: The House bill pays for the two programs with dollars taken from other important public health programs.

While other states have sent out notices warning CHIP enrollees about possible coverage disruptions, most Minnesota families relying on the program thankfully won’t need to worry. If federal funding isn’t approved, the state will take a budget hit of $178 million – an amount almost equal to the projected budget deficit – but will keep coverage going for most in the program. This commitment to kids’ health reflects positively on Minnesota’s political leaders.

Community health centers don’t appear to have state fallback….

December 16, 2017: posted an article titled “State looking to stretch CHIP funds while waiting on Congress”. It was written by Katie Lannan.  The article is about Massachusetts. From the article:

Health and Human Services Secretary Marylou Sudders has a Christmas wish: that Congress will again fund the Children’s Health Insurance Program.

Lawmakers on Capitol Hill missed a September deadline to reauthorize the program, known as CHIP, and Sudders said at a Massachusetts Health Connector board meeting Thursday that the state will run out of its federal CHIP allotment in mid-January without action from Congress.

The state would be able to maintain CHIP coverage through the end of this fiscal year by taking “administrative actions,” if it looks like Congress will ultimately reauthorize the program, Sudders said.

If Congress does not reauthorize CHIP, the state stands to lose an estimated $147.5 million in the fiscal year that concludes at the end of June, and $259 million annually starting in fiscal year 2019 if MassHealth, the state Medicaid program, maintained the current program, according to the Executive Officers of Health and Human Services….

…Sudders said most CHIP participants are eligible for Medicaid and would stay on Medicaid if the CHIP funding was lost.  The people “most at risk of having no coverage available to them” are 5,000 pregnant women on CHIP who are not eligible for Medicaid because of their immigration status,” Sudders said.

December 17, 2017: Richmond Times-Dispatch posted a blog titled: “Virginia letters meant to warn, not scare or confuse, CHIP families.” It was written by Katie O’Connor.  From the article:

With the holiday season in full swing and a million other things likely on their minds, 68,000 Virginia families will receive, or have already received, a letter warning them that by the end of the January, their children might not have health insurance.

That is because, for nearly three months, an effort to reauthorize a 20-year-old bill that has always been supported by both sides of the aisle has been neglected.

…In Virginia, the program pays for some children covered through Medicaid, who will still receive coverage from the state even if CHIP isn’t reauthorized, but also those children who qualify for FAMIS, or Family Medical Access to Medical Insurance Security. Those on FAMIS essentially don’t qualify for Medicaid but don’t make enough to purchase any other type of insurance.

The vast majority of these FAMIS families have few other options.

The first letter that the Department of Medical Assistance Services, or DMAS, which runs in Virginia, sent to parents last week was a warning. It was meant to notify them that, though nothing is certain yet and though hope still swirls around Congress that it will reauthorize CHIP, their children might become uninsured come Jan. 31…

December 18, 2017: ThinkProgress posted an article titled “Alabama is the first state to freeze enrollment to Children’s Health Insurance Program”. It was written by Amanda Michelle Gomez.  From the article:

Alabama is the latest state to bear bad news to recipients of the Children’s Health Insurance Program (CHIP), warning families Monday that it will no longer enroll children starting on Jan. 1, 2018, and will terminate entirely on Feb. 1, 2018 if Congress fails to act.

Congressional lawmakers have yet to renew federal funding for CHIP since the program expired on Sept. 30. Since then, state officials have had to relay devastating news of funding shortages to families of modest incomes right around the holidays….

…Alabama is reportedly the first state to freeze enrollment…

…”It’s different this time,” Cathy Caldwell, the director of the Bureau of Children’s Health Insurance Programs in Alabama, told ThinkProgress.  “This time, the freeze is to stop the flow of incoming children.”  Later this month, officials will notify affected families that the program may terminate…

…Alabama’s contingency plan is predicated on Congressional action.  Political bickering jeopardizes the health care of millions of low-income families.  Members on both sides of the aisle agree that funding CHIP is critical; however, Republican and Democratic lawmakers don’t agree on the pay-fors.  A stopgap measure introduced last week funds the program for five-years by charging wealthier Medicare beneficiaries higher premiums and making significant cuts to the Obamacare Prevention and Public Health fund (which accounts for 12 percent of the Centers for Disease Control and Prevention annual budget).

December 18, 2017: Modern Healthcare posted an article titled “States freeze CHIP enrollment, get ready to move kids to new plans”.  It was written by Susannah Luthi.  From the article”

…CHIP funding lapsed Sept. 30 and has yet to be renewed by Congress, leaving states to patch together funding with monies redistributed by the CMS.  But most of those dollars will run out by March at the latest, and states will have to finish processing all claims by the end of January and find a new plan to cover CHIP-enrolled children.

Connecticut and Colorado will shutter their programs Jan. 31 if funding doesn’t come through and will shift its CHIP kids to Medicaid or a qualified health plan on the exchanges.  Alabama will freeze CHIP enrollment starting Jan. 2 and would also need to close its program by Jan. 31, according to an official at the Alabama Children’s Hospital.

In a late-breaking twist, Texas will not immediately freeze enrollment.  The state, which was due to run out of its own funds in February, will get an additional $135 million in redistributed funds from CMS…

…Texas officials had sought $90 million in their original request.

Meanwhile… states like Minnesota and Arizona are out of money, and Oregon and California soon will be, according to the latest projections by the congressional Medicaid and CHIP advisers…

…Colorado, which runs its own state-based exchange, would run a 60-day special enrollment period set to start Jan. 31 when a child’s CHIP coverage ends.  The enrollment period would let kids start their new coverage on the first of the month following their application, says Luke Clarke, communications director at Connect for Health Colorado…

December 19, 2017: posted an article titled: “Alabama to end enrollment in children’s insurance program on New Year’s Day.”  The article was written by Amy Yurkanin.  From the article:

A program that provides insurance for the children of low-income families will stop enrollment on Jan. 1, 2018, and end completely a month later, according to the Alabama Department of Health.

If Congress does not renew funding for the Children’s Health Insurance Program (CHIP), which expired on Sept. 30, about 84,000 children in Alabama risk losing health insurance.  The state will have to find funding for another 77,000 children insured under Medicaid through the CHIP program.  Nationally, about 9 million children receive coverage through CHIP, and many states plan to shutter the program if funding runs out.

In Alabama, the program funded by CHIP is known as ALL Kids.  Families with incomes of up to 312 percent of the federal poverty limit can qualify if they don’t have access to affordable health insurance.  Families pay $52 or $104 a year to cover children under the age of 19, depending on income, plus small co-pays for sick visits.

“These are middle income working Alabama families,” said Cathy Caldwell, director of the Bureau of Children’s Health Insurance Programs for the Alabama Department of Public Health.

Caldwell said ALL Kids has existed in Alabama since 1998 and has proved to be a very popular and successful program. When the program started, about 20 percent of children in Alabama lacked health insurance.  That number is now 2.4 percent – the best in the South….

…Funding for CHIP emerged as a campaign issue in the recent special election, and Senator-elect Doug Jones urged Congress to act before the end of December. Jones will not be seated until the Alabama Secretary of State certifies the election results – which could happen within the next two weeks.

Officials at the Alabama Department of Public Health have not yet sent letters to families on ALL Kids, Caldwell said.  They are holding off until late next week to see if members of Congress act to fund the program. Caldwell said they have already received calls from parents worried about their children’s health coverage.

Some families may be able to enroll in insurance through the federal marketplace, Caldwell said.  Open enrollment ended on Dec. 15 this year, a month and a half earlier than the first few years of the Affordable Care Act.  Caldwell said the end of ALL Kids would allow parents to sign up for insurance outside of the open enrollment period.

However, she said that many families might not be able to afford private insurance – even with tax credits for low-income families…

December 19, 2017: Dr. V. Ram Krishnamoorthi, an assistant professor of medicine at the University of Chicago Pritzker School of Medicine; and Dr. Philip A. Verhoef, an assistant professor of medicine and pediatrics at UChicago Medicine, wrote an opinion piece for Crain’s Chicago Business.  It was titled “Playing the role of Scrooge tonight – it’s the U.S. Congress!”  From the piece:

…Prior to CHIP, more than 10 million children had no health insurance.  As a consequence, the health of these children was markedly poorer than patients with insurance, on every measure: the ability to access timely care, the presence of a medical home or primary care provider, measures of chronic disease control, and school functioning.

Most shockingly, these children were more likely to die for lack of insurance….

…Funding for CHIP expired without reauthorization on Sept. 30.  It didn’t have to.  After failing to pass any legislation on health care this year, Congress allowed federal support to be cut off for a program that covers 9 million children. Some states have already issued notices to families that their children may no longer be covered for their doctor’s visits and hospitalizations.  In Illinois, the CHIP program is estimated to run out of money midway through 2018.  But instead of passing a simple bill to reauthorize funding for the long term, congressional leaders are using CHIP as a bargaining tool by attaching it to unrelated spending bills, which themselves may not pass before the end of the year…

December 20, 2017: S. 1827 – KIDS Act of 2017 was reported to the Untied States Senate with amendments.  The new summary says:

Keep Kids’ Insurance Dependable and Secure Act of 2017 or the KIDS Act of 2017:

This bill extends funding through FY2022 for the Children’s Health Insurance Program (CHIP) and the Childhood Obesity Demonstration Project.

In addition, the bill reauthorizes through FY2022:

  • the qualifying-states option (which allows states that provided coverage to now CHIP-eligible children prior to CHIP’s enactment to continue to provide such coverage), and
  • the express-lane eligibility option (which allows states to use eligibility findings from other public benefit programs to determine children’s eligibility for Medicaid and CHIP).

Beginning in FY2020, the bill allows state child-health plans to adopt more restrictive eligibility standards with respect to children in families whose income exceeds 300% of the poverty line.

The bill extends funding through FY2022 for the Childhood Obesity Demonstration Project and the Pediatric Quality Measures Program.

The bill extend funding through FY2022 for specified outreach and enrollment grants.

Current law provides states with an enhanced Federal Matching Assistant Percentage (FMAP) for child-health assistance through FY2019.  The bill maintains the enhanced FMAP in FY2020, but halves the percentage-point increase.

The Senate did not vote on this bill.

December 20, 2017: PBS News Hour posted an article titled “Here’s when states could run out of money to fund the Children’s Health Insurance Program”.  It was written by Laura Santhanam.  From the article:

  • First quarter (October – December 2017) – Arizona and Minnesota
  • Second quarter (January – March 2018 ) – Alabama, Alaska, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Hawaii, Idaho, Kansas, Kentucky, Idaho, Kansas, Kentucky, Louisiana, Massachusetts, Montana, Nevada, New York, North Carolina, Ohio, Oregon, Pennsylvania, Rhode Island, South Dakota, Utah, Vermont, Virginia, and Washington
  • Third quarter (April – June 2018) – Arkansas, Indiana, Iowa, Maine, Maryland, Michigan, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New Mexico, North Dakota, Oklahoma, South Carolina, Tennessee, Texas, West Virginia, and Wisconsin
  • Fourth quarter (July – September 2018) – Illinois and Wyoming.

December 20, 2017: Gideon Resnick wrote an article on The Daily Beast titled “States’ Christmas Letter to Kids: No Health Care For You”.  From the article:

…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….

…The crisis unfolding in Alabama may be shocking to CHIP recipients.  But it should not be surprising to anyone who 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 soon be disenrolled soon….

…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.

December 20, 2017: A report done by the Georgetown University Health Policy Institute Center for Children and Families was released.  It was titled “New Report on CHIP Funding Delay Shows Nearly 2 Million Kids May Lose Coverage in January”.  From the report:

Funding for the Children’s Health Insurance Program (CHIP) expired on September 30.  Congress has not approved additional funding but provided a so-called “patch” as part of the short-term Continuing Resolution passed by Congress on December 7 and signed into law on December 8.

The patch reallocated the $2.9 billion in redistribution funds among states giving more money to 20 states with shortfalls in the first quarter 2018 (October – December 2017).  As no new money was added, the patch will actually cause 31 states to run out of money more quickly than previously estimated.  This outcome underscores the need for Congress to approve a long-term CHIP extension.

If Congress fails to approve long-term funding for CHIP, an estimated 1.9 million children in separate CHIP programs could lose coverage in January.  An additional 1 million children would also be at risk of losing coverage by the end of February….

…Does this create winners and losers?  Yes, the 20 emergency shortfall states (AZ, CA, CO, CT, DC, DE, FL, HI, ID, LA, MA, MN, MT, NV, NY, OH, OR, PA, UT and WA) will receive distribution funds to cover any shortfall.  But, in essence, the patch robs Peter to pay Paul.  The remaining 31 states will see their share of redistributed funds reduced, and thus the timeline by which they will run out of money is accelerated.

Despite the additional funds, the 20 “winner” states will only have sufficient funds to operate their programs through January.  All of them will come up short for February.  Given that the other 31 states will receive a smaller share of redistribution funds, five additional states (GA, KS, KY, RI and VA) will now only have adequate funding to run their programs through January 2018…

…By accelerating the redistribution through the patch, January becomes the last possible month that ALL states can cover their CHIP expenditures.  Twenty-five states are projected to have insufficient funds to cover children beyond January 2018.  In these states, some children may be protected by the Maintenance of Effort provision in Medicaid.  However, 1.9 million children enrolled in separate CHIP programs are at risk of losing coverage in January 2018.  By the end of February, this number grows by another million children….

…On Wednesday afternoon, Republican senators Susan Collins and Lamar Alexander confirmed that their party plans to take a vacation before giving working-class families some peace of mind about their children’s health coverage:

“We have asked Senator McConnell not to offer this week our legislation,” the senators, who are sponsoring a bill that provides funding intended to stabilize the individual insurance market, said in a statement.  “Instead, we will offer it after the first of the year when the Senate will consider the omnibus spending bill, the Children’s Health Insurance Program reauthorization, funding for Community Health Centers, and other legislation that was to have been enacted this week.”…

…So, why is the GOP inflicting needless harm on a popular program that most Republicans claim to support?  The deficit, of course.

While congressional Republicans were willing to add $1.5 trillion to the debt, so as to pay for corporate tax cuts, they have refused to appropriate the $75 billion required to reauthorize CHIP for five years.  Instead, they insist on financing children’s health care with cuts to other people’s medical benefits.  House Republicans have already passed a bill that raises money for CHIP by throwing an estimated 700,000 people off of Obamacare, for falling behind on their premium payments.  That legislation has (predictably) stalled in the Senate.  Democrats, for their part, have evinced little interest in transferring a few billion dollars from low-income adults to low-income children, while Republicans are transferring trillions of dollars to the wealthiest people in America…

December 21, 2017: David Leonhardt wrote an opinion piece for The New York Times titled “Taking Health Care From Kids”.  From the piece:

At the White House yesterday, Republicans celebrated their passage of a big tax cut.  Somehow, though, they still haven’t found the time or the money to protect health insurance for millions of low-income children…

…CHIP isn’t supposed to be controversial.  It enjoys bipartisan support, at least rhetorically.  Senator Orrin Hatch, the Utah Republican who helped create the program in the 1990s, said yesterday that Congress should remain in session until its funding is restored.

But the program has become a casualty of congressional leaders’ failure to agree on a plan to fund the government, largely because of an insistence on budget cuts from conservative Republican members.  Congress seems likely to push for an overall funding bill in January, creating uncertainty and anxiety for many families….

December 21, 2017: Cover Virginia posted an update regarding their FAMIS and FAMIS MOMS programs. FAMIS is a program for children, pregnant women, and adults.  Those programs are Virginia’s CHIP program.  The update said:

On December 21, the U.S. Congress approved short term additional funding to help states keep from closing their CHIP programs. The additional funding that congress has provided will allow Virginia to keep children and pregnant women covered by FAMIS through January and maybe longer.

Although Congress approved short term additional funding to help states keep from closing their CHIP programs, the Virginia Department of Medical Assistance Services (DMAS) must wait for the Centers for Medicaid and Medicare Services (CMS) to determine exactly how much funding will come to Virginia.  That decision will then determine how long Virginia can continue to operate FAMIS.  We hope to have that answer shortly after the holidays and will update this page as soon as we have that information.

December 21, 2017: KQED News posted an article titled “Are Tens of Thousands of California Kids About to Lose Their Health Care?” It was written by Elizabeth Aguilera.  From the article:

…She was referring to the question of whether Congress will reauthorize funding for CHIP, a program that covers more than 1.3 million California children, including hers, but now hangs in the balance.  Federal funding expired in September, and state officials are considering what to do if Congress doesn’t act soon – perhaps this week.  Coverage for about 32,000 residents is at risk most immediately….

…CHIP covers children and pregnant women in families that earn too much to qualify for Mede-Cal, the federal and state health care program for California’s lowest-income residents, but not enough to afford private insurance.  These families earn between 108 percent and 266 percent of the federal poverty level, up to about $65,000 for a family of four, depending on the children’s ages.

Without congressional action, California expects its federal funds to run out by early January, if not sooner, leaving state officials to figure out how to make up the difference, which could involve taking money from other programs….

…California received $3.1 billion from the federal government for the program for the last federal fiscal year, which ended Sept. 30.  Those funds make up 88 percent of the costs, said H.D. Palmer, spokesman for the Department of Finance.  The state picks up the rest, about $734 million….

…When California expanded Medi-Cal under the Affordable Care Act in 2014, it rolled in nearly all CHIP recipients for administrative purposes.  The state agreed with the federal government to keep them enrolled through September 2019.

The remaining 32,000 are in families with slightly higher incomes – $79,000 for four – and would no longer be eligible for any publicly funded coverage if CHIP, which in California used to be called Healthy Families, were eliminated.  This group includes recipients in three county programs, in San Francisco, Santa Clara, and San Mateo Counties, said Anthony Cava, spokesman for California’s Department of Health Care Services…

…The Legislature anticipated a cut in the federal funding and budgeted an extra $396 million for CHIP through June 30, which could also allow the program to limp along until the next budget is worked out in mid-2018, [Democratic state Sen. Ed] Hernandez said.  Gov. Jerry Brown will give the Legislature his proposal for that budget by January 10.  It is likely to contain other possibilities for CHIP funding, especially if Congress’ intentions remain murky, [H.D.] Palmer [spokesman for the Department of Finance] said…

Hernandez said that if the state has to fund the program, “then something else has to suffer.”

December 21, 2017: The official website for Governor John Hickenlooper (Colorado) posted an announcement titled “Joint Budget Committee Approves Gov. Hickenlooper’s Request for Emergency CHP+ Funding”.  From the announcement:

The Joint Budget Committee (JBC) today approved Gov. John Hickenlooper’s request for emergency funding to continue Colorado’s Child Health Plan Plus (CHP+) program through Feb. 28, 2018.  This supplemental funding provides additional time for Congress to authorize federal funding and prevents cancellation notices being sent to Colorado CHP+ members next week…

…Funding for the emergency CHP+ budget request will come from the Children’s Basic Health Plan Trust which was created using monies from the 1998 Tobacco Master Settlement.  No General Funds will be used in this request.  Congress can act at any time.  If they act quickly and reauthorize the federal Child Health Insurance Program in January – and barring any further gap in federal funding – it is expected today’s emergency funding will not be needed…

Prior to today’s JBC budget action, Colorado only had sufficient funding to operate the CHP+ program through Jan. 31, 2018.  The JBC can make spending decisions when the legislature is not in session for extraordinary items at the request of the Executive Branch.

December 22, 2017: New York Magazine posted an article titled “Congress Will Not Renew the Children’s Health Insurance Program This Year”.  It was written by Eric Levitz. From the article:

On September 30, federal funding for the Children’s Health Insurance Program (CHIP) expired. Congressional Republicans claimed that they didn’t want this to happen.  The GOP had always supported CHIP, which provides insurance to the children of families who earn too much for Medicaid, but do not receive insurance through their employers.  Republicans just got so caught up with trying to repeal Obamacare (a.k.a. trying to take health care away from millions of adults) that they forgot to preserve access to basic medical care for 9 million low-income children.  Regardless, the public had no need to worry: States had enough money to keep CHIP running for the rest of the year, and Republicans would authorize the program with all due haste.

Nearly three months later, congressional Republicans got so caught up trying to cut taxes on corporations (while taking health care away from millions of adults), they haven’t quite found the time to renew CHIP…

December 21, 2017: posted an article titled “Facing government shutdown, what happens to local CHIP kids?”  It was written by Raychel Vendetti. From the article:

…Congress failed to authorize funding in September, so Pennsylvania’s CHIP may only last until March if federal lawmakers don’t act soon.  Some reports show that up to 20 states will run short of money in the first quarter of 2018.  David González, MS Chief Executive Officer St. Martin Center, Inc., says, “without that, it instantaneously will create a crisis that an individual will need additional income, or they are not going to be able to work and they are going to have to access the welfare rules to be able to access healthcare so its a healthcare tool and economic development.”

Craig Ulmer, the Interim CEO of Community Health Net says they treat several patients covered under CHIP, but the organization also has a discounted services plan so if they were to lose coverage, health care is still available.  He tells us, “that is where Community Health Net comes in.  The family does not have to make that decision of health care versus the bills and food for the family; Community Health Net will be there.”

This is now considered the longest lapse in funding in the program’s history.  CHIP has bipartisan support.  It is exactly how to pay for the $15.6 billion a year program where the disagreement remains.  Families just hoping to continue to have coverage for their families into the new year.

December 22, 2017: Georgetown University Health Policy Institute Center for Children and Families posted an update. It was written by Associate Professor of the Practice at the Center for Children and Families, Kelly Whitener.  Here are some key points:

…Congress passed a short-term continuing resolution (CR) today that will keep the government funded through January 19 2018.  The bill also includes a small amount of additional funding for CHIP, but falls woefully short.

…this CR adds $2.85 billion.  Crisis averted?  I wish. While some have said the CR funds CHIP for 6 months – from October 1, 2017 through March 31, 2018 – the numbers tell a different story.

The federal government spends about $14.5 billion on CHIP each year.  So half a year’s funding would be in the neighborhood of $7.25 billion.  I’m no math whiz, but I can see that $2.85 billion is not enough.  States will continue to spend their time and money planning for the end of CHIP. And families will continue to question whether their children’s coverage will end this month or next…

December 22, 2017: The Alabama Public Health website posted a notice about the Alabama ALL Kids program (which is the name of Alabama’s CHIP program).  It said:

Important Update: With the continuing resolution passed by Congress on December 21, 2017, ALL Kids will not freeze enrollment on January 1, 2018 nor terminate coverage on February 1, 2018.  Further updates to come as Congress needs to pass full, long term funding for the Children’s Health Insurance Program.

December 22, 2017: Bloomberg Politics updated an article that was posted the day before.  The article is titled “Children’s Health Insurance Program Still in Limbo After Yet Another Patch”.  It was written by Anna Edney and Natasha Rausch.  From the article:

A critical government program that provides health-care coverage to 9 million low-income kids received yet another patch to help stretch it out a few more months — with still no long term fix in sight.

Congress passed short-term legislation Tuesday night that includes $2.85 billion to help fund the program, known as CHIP, through the end of March.  The measure will help cover the estimated 1.9 million children across 24 states and Washington D.C., that stood to lose coverage for care such as doctors visits and hospitalizations in January as states dipped into reserve funds.  But the temporary relief leaves CHIP and families that rely on it in a state of uncertainty…

…Funding for CHIP — which also covers dental care and prescriptions, among other services — amounts to almost $16 billion, with more than 90 percent coming from the federal government…

…Democrats have opposed a House GOP proposal to reauthorize CHIP for five years because it would be paid for by taking money from a fund set up under Obamacare to invest in prevention efforts.  Bipartisan talks with the Senate and White House on other funding offsets are “well down the road” said House Minority Leader Nancy Pelosi, a California Democrat.

December 22, 2017: The Iowa Department of Human Services posted an announcement about its CHIP program.  It said:

CHIP Funding Update: The department is closely monitoring developments related to the Children’s Health Insurance Program, or CHIP, funding.  Iowa expects to have sufficient funding to cover CHIP costs through at least March 2018.

Under current law, federal funds for CHIP are only approved through federal fiscal year (FFY) 2017.  In FFY18, states may continue to use unspent prior year allotments and Iowa expects to have sufficient funding to cover CHIP costs through at least March 2018.  Based on current estimates, absent any new allotments, federal CHIP funding will be exhausted sometime during the quarter-ending June 30, 2018.  There is still time for CHIP funding to be reauthorized.

December 22, 2017:The Connecticut Mirror posted an article titled “CT reviewing lifeline Congress throws children’s health program”.  From the article:

…Before leaving for holiday break, Congress approved a stopgap spending bill that provides $2.85 billion to states like Connecticut that were running out of money for a health program that covers 17,000 children in the state.

But the short-term extension of the Children’s Health Insurance Program, known as CHIP, or HUSKY B in Connecticut, does not provide the certainty some states have been seeking….

…Connecticut officials said Friday they were unsure what the lifeline would mean for the state.

“Fiscal review will determine exactly what this means for Connecticut,” said Connecticut Department of Social Services spokesman David Dearborn.  “Right now, we are extended out through January 31, so there is not imminent closure, as some states may be facing.  The overall funding problem isn’t necessarily resolved.”.

December 22, 2017: CBS News posted an article titled “How states are dealing with the uncertainty behind children’s health insurance” It was written by Ross D. Franklin.  From the article:

  • Arizona – Could shift children to Medicaid, the health insurance program for the poor, which reimburses states at a lower rate than the children’s health program.  Republican Governor Doug Ducey hinted he could use state funds to continue coverage, perhaps costing $80 million.
  • California – Plans to sift many of the 1.3 million covered children and pregnant women to Medicaid.  This would cost California hundreds of millions of dollars and could put 32,000 at risk of losing coverage.
  • Colorado: Colorado legislators approved Democratic Governor John Hickenlooper’s request for $9.6 minion in state funds to finance CHIP through February of 2018.
  • Connecticut: Has been notifying thousands of families that the program could run out of money by Jan. 31 unless congress reauthorizes federal funding. The letters urge parents to enroll their children in new health coverage for Feb. 1.
  • Minnesota: Will use more of its own money to cover recipients if federal money halts
  • Oregon: Federal money ran out this month for 120,000 children and 1,700 pregnant women, but coverage continued with added state money.  One-third of the children would be shifted to Medicaid.  The rest would continue in CHIP.
  • Texas: About 400,000 children covered, expected to have enough money through February.  Texas has not sent warning letters to families.
  • Washington state: Their CHIP has been functioning with money redistributed from other states

December 22, 2017: Public Radio Tulsa posted an article titled “New Federal CHIP Funding Could Get Oklahoma’s Program Through FY2018”.  It was written by Matt Trotter.  From the article:

Oklahoma has learned its share of nearly $3 billion for the Children’s Health Insurance Program included in a short-term spending bill signed by the president today.

The Oklahoma Health Care Authority’s allotment is $44.4 million.

“We have begun to recalculate our state fiscal year 2018 budget, and we believe we are close to being able to sufficiently fund our CHIP program through June of this year,” said OHCA CEO Becky Pasternick-Ikard.

Oklahoma’s CHIP program was set to lose $49 million this fiscal year after Congress missed a funding deadline in September. OHCA was considering delaying provider payments to get through the fiscal year.

Federal CHIP funding is guaranteed only through March through the short-term spending bill…

December 24, 2017: KSFY ABC posted an article titled “SD: More than 15,000 kids could lose health insurance in March”. The article was written by Erika Leigh.  From the article:

Congress approved a short-term solution for CHIP, the Children’s Health Insurance Program in a spending bill that helped avoid a government shutdown, but funding is set to run out in March, unless it acts fast.

The South Dakota Department of Social Services said approximate 15,570 kids in state are eligible for CHIP each month.  It provides access to free health insurance for low-income families…

…Congress just approved a spending bill that pumped $3 billion into CHIP, but the funding is only through March 2018.  South Dakota DSS said it estimates its funding for those approximately 15,570 kids will run out in March too…

…If those folks elect not to buy health insurance in 2018, they will still have to pay a penalty under the individual mandate ordered under Obamacare for not having insurance.  The recent tax reform bill does away with the mandate but not until 2019, so anyone without health insurance will have to pay the penalty when they pay their 2019 taxes.

December 24, 2017: The Spokesman posted an article titled “Health insurance funding for children running low as Congress stays deadlocked on reauthorizing CHIP”. It was written by Rachel Alexander.  From the article:

A federal health insurance program covering 52,000 kids in Washington is running out of money as partisan disagreements keep Congress from reauthorizing funding…

…In Washington, the state program for both Medicaid and CHIP is called Apple Health, and the coverage is identical. The only difference is a small premium CHIP families pay: $20 or $30 per child, depending on income level, with a maximum of two premiums per family…

…CHIP was created in 1997 and has enjoyed bipartisan support since, with the federal government spending about $14 billion a year on the program.  But federal funding expired Sept. 30, and since then, Democrats and Republicans have yet to agree on funding going forward.

The House passed a bill on Nov. 3 to fund CHIP for five years, which also raised Medicare premiums on people making $500,000 or more a year, cut funds from the Affordable Care Act’s public health fund, and shortened the grace period for people who fail to pay their share of individual health insurance premiums…

…All but 15 Democrats voted against the measure, saying Republicans were using the renewal of a program with bipartisan support as a way to undermine the Affordable Care Act.

The Senate considered a bill that would renew CHIP funding for five years without other provisions, but it failed to make it to the Senate for a vote….

…As Congress fails to act, Washington is watching its reserves dwindle.  Mary Wood, the director for the state’s program, said federal government funds for CHIP are about $242 billion a year, a total of 88 percent of the program cost.  The state pays the rest out of the general fund.

Since funding expired, Washington has gotten temporary federal funding of $10.3 million a month to offset some CHIP costs, but can’t continue running the program indefinitely at a deficit…

December 24, 2017: posted an article titled “The current state of CHIP: What happens next as the children’s health program runs low on funds”.  It was written by Alison Durkee.  From the article:

…Congress passed short-term funding for CHIP on Dec. 21 as part of a spending bill that averted a federal shutdown, the program’s long-term outlook still remains unclear – and children covered by the health care program may soon face the consequences…

…The short-term legislation includes an additional $2.9 billion in funding for states to use on children’s health insurance.  States can also use any unspent funds from 2017 to fund their 2018 coverage; the Medicaid and CHIP Payment and Access Commission noted in October that there was an estimated $4.1 billion in unspent 2017 funding available for spending in the 2018 fiscal year, which began in October.

Prior to the most recent funding bill, Congress had approved a “patch” to the program as part of a Continuing Resolution passed Dec. 7, a study conducted by the Georgetown University Health Policy Institute noted.

The patch, however, did not provide additional funding, but rather redistributed existing unused CHIP funds to cover states that were running out of funding the fastest…

…Twenty-five states were expected to run out of funding by the end of January 2018 under the prior Congressional plan, the Georgetown study noted, leaving 1.9 million children at risk of losing health care coverage.  An additional million children would then be at risk of losing coverage by the end of February.

The new short-term influx of funding includes continued authorization to redirect state funds in addition to the $2.9 billion in federal funds, the Tribune noted.  It is currently unclear what the timeline for individuals states’ funding will be under the new plan….

…If funding runs out, the consequences for those covered by CHIP would depend on their state.  States have established their CHIP programs in several ways, either setting it up as a separate program in conjunction with a state’s Medicaid expansion or some combination of the two.

The 5.6 million children who are covered under Medicaid-expansion CHIP, MACPAC noted, will continued to be covered through Medicaid, as the Maintenance of Effort provision in the Affordable Care Act requires states to keep the same eligibility levels for those in Medicaid and CHIP through 2019.  The move to Medicaid will come at a higher cost to states, however, as they will no receive a lower Medicaid match rate from the federal government for the coverage, according to the Kaiser Family Foundation.

Separate CHIP programs, on the other hand, are permitted to terminate coverage entirely if the federal funding runs out.  The separate CHIP programs cover 3.7 million children, 1.2 million of whom are expected to become uninsured because other sources of health care coverage would be unaffordable, according to MACPAC.

December 25, 2017: The Hill posted an article titled “How about health care as a gift for kids – let’s pass CHIP this season”.  It was written by Angira Paten, MD, MPH, who is assistant professor of pediatrics and medical education and a member of the Center for Bioethics and Medical Humanities, both at Northwestern University Fienberg School of Medicine, a pediatric cardiologist at Ann & Robert H. Lurie Children’s Hospital of Chicago, and a Public Voice Fellow throught The OpEd Project.

It was also written by Nana Matoba, M.D, who is an assistant professor of pediatrics in Northwestern University’s Feinberg School of Medicine, a neonatologist at Ann & Robert H. Lurie Children’s Hospital of Chicago, and a Public Voice Fellow through The OpEd Project.

There were also other contributors to the article.  From the article:

…Nearly three months after the lapse of federal funding for the Children’s Health Insurance Program (CHIP), Congress hurriedly voted to extend its funding and to avert government shutdown.

As physicians, we cannot let this recent last minute bill reassure us.  It is a temporary fix to a major crisis to a state and federally funded program for children whose families don’t qualify for Medicaid or private insurance.

Several states had already notified families that they may lose coverage,  In a few weeks, these families will again face the uncertainty – an unnecessary and unfair financial burden of losing insurance for sick children,

In the neonatology units, we provide care for up to 100 infants per day with life-threatening conditions who require intensive medical support as soon as they are born.

Working at a major referral center and source of specialized health care, we see firsthand the effects of the CHIP program expiration on families of sick children.  The infants we care for in the hospital face many challenges, but fortunately, have excellent access to specialized pediatric care, and many are covered by CHIP.

In Illinois, where we practice, CHIP falls under the program Illinois All Kids and has enrollment of over 325,000 children.  Without federal action, the funds for these children will run out.  That number is equal to the populations of Tampa, Florida, or Arlington, Texas…

…Children do not account for the majority of the health care costs in the United States.  CHIP represents $16 billion of the $553 billion of Medicaid spending, a mere 3 percent of the total expenditure.

A 2014 Kaiser Family Foundation study shows that this investment has led to meaningful gains in access to care and the quality of care for low-income children.  It has provided a safety net for children in working families during economic downturns.

A National Bureau of Economic Research study in 2014 shows that expanding health care coverage through CHIP has had a spill-over effect including increasing rates of high school completion and college completion.

To be sure, everything that a society chooses to provide as a basic right or a safety net has a cost that must be met by generation of revenue.  Some might argue that if children don’t qualify for CHIP, they can go on to Medicaid.  This is not true, as CHIP provides health care to children whose families do not qualify forMedicaid.

Institutions like St. Jude’s Children’s Research Hospital provide free care to 8,500 children a year, but this is a rarity in pediatrics and could not absorb all our patients.

…All aspects of children’s health care are at stake when we talk about ending CHIP care.  It will affect children with rare and complex diseases.  Some children will receive insufficient care, or no care and some will die.

We have simply postponed solving the problem to three months from now.  But we have time to act….

December 29, 2017: The Modesto Bee posted an opinion piece that was written by The Modesto Bee Editorial Board.  From the editorial:

Republican leaders and President Donald Trump rushed to deliver tax cuts that mostly benefit the wealthy and corporations.  But somehow they couldn’t find the time to rescue programs that help vulnerable children and young people before heading home for the holidays.

So when Congress reconvenes Wednesday, lawmakers should waste no time before acting to extend the Children’s Health Insurance Program and the Deferred Action for Childhood Arrivals program.  While both programs have a respite for a few months, waiting until the last minute is how bad deals and mistakes get made.

California has much at stake, so the state’s delegation – Republicans and Democrats alike – ought to play a leading role in getting this done.

Our state is home to more than 200,000 of the nearly 800,000 undocumented immigrants brought to the U.S. illegally and protected from deportation under DACA.  They go to school, work, and contribute to their communities in many other ways, and very few get into trouble.

California is also home to about 2 million of the 9 million children who get health services under CHIP, a bipartisan success passed 20 years ago.  The program builds on Medi-Cal by expanding coverage to children in working poor families who earn too much to qualify for Med-Cal, but too little to afford private insurance on their own.  California gets about $2.7 billion a year from the feds, covering nearly 90 percent of the program’s costs.

The program expired Sept. 30, but instead of a five-year reauthorization, Congress has only approved temporary funding, most recently in the stopgap bill to avoid a government shutdown just before Christmas.

That extended through March, but all the uncertainty is causing concern for parents and state officials alike.  If Congress and the president don’t act, officials could be forced to find funding elsewhere in the state budget, cut back health service, or both…

…Still, with the new year comes hope for more cooperation in Washington D.C. The fates of CHIP and DACA are a huge test.  These are disasters happening in slow motion.  There’s no excuse for Congress and the White House not to prevent them.

December 29, 2017: The Hill posted an article titled: “Connecticut CHIP to last an extra month unless it gets more money from Congress”.  It was written by Rachel Rubein.  From the article:

Connecticut is extending its program to provide health insurance to low- and middle-income children another month, after lawmakers appropriated $2.85 billion to keep states’ programs to keep states’ programs temporarily afloat.

In mid-December, a notice on Connecticut’s website alerted families that the state’s Children’s Health Insurance Program (CHIP) would end Jan. 31 unless Congress provided new federal funding.  Before leaving town for the holidays, lawmakers passed a stopgap spending bill with additional funds for CHIP lasting through March 31.

Connecticut announced Friday that the new money has meant its program, called Husky B, won’t shutter on Jan. 31, but warned the additional dollars from Congress are only enough to last through Feb. 28.  More funding or a full reauthorization of CHIP is needed to keep the program running longer.

“Please note that if Congress does vote to provide further funding for the CHIP program, services received and coverage in HUSKY B will continue past February”, according to a new notice on the state’s website. Advocates and state officials have pushed Congress to reauthorize CHIP for five years after Congress let the program lapse Sept. 30.  CHIP enjoys bipartisan support, but Democrats and Republicans have argued this year over how to pay for it.

States have been getting by with leftover federal dollars while they examined how much longer they could keep their children’s health programs up and running…

January 2, 2018: The Boston Globe posted an editorial written by the Boston Globe.  It was titled “It’s time for Congress to act on CHIP and DACA.”  From the article:

In their rush to wrap their tax cut presents and get out of Washington for Christmas, lawmakers took two issues where there’s supposedly bipartisan support for action and kicked them down the road into 2018.

One is the Children’s Health Insurance Program, or CHIP, which provides affordable health coverage for almost 9 million children in families who earn too much to qualify for Medicaid but still have relatively modest incomes; regular federal funding for that program expired at the end of September…

…The stop-gap funding measure passed just before Christmas does avert the immediate crisis for CHIP.  Otherwise, according to the Kaiser Family Foundation, 16 states would have run out of funding for their CHIP programs in January, with another 21 arriving at that point in February and March…

January 2, 2018: CNBC posted an article titled “Funding child health care and ducking government shutdown are just 2 of Congress’ pressing January duties”. It was written by John W. Schoen and Jacob Pramuk.  From the article:

Just back from a year-end break, Congress returns to a busy calendar with tight January deadlines on pressing issues ranging from children’s health care to avoiding a government shutdown…

…Just before heading home last month, Congress approved a stop-gap extension of existing spending levels, known as a continuing resolution, which runs out Jan. 19. Unless extended, a series of mandatory furloughs and service cuts would kick in…

…Some 9 million children will be left without health insurance unless Congress votes to renew funding for the Children’s Health Insurance Program. Last year, Congress blew past a Sept. 30 deadline to reauthorize funding for the federally funded, state-administered program.

Before leaving for the holidays, lawmakers added $3 billion in funding to the federal program to keep it running out of money.  Without those funds, about a third of the states would have been suspending coverage this month, according to the Kaiser Family Foundation.

While the temporary fix buys the program a little more time, some states have already started notifying families that they may soon lose coverage…

January 3, 2018: Forbes posted an article titled “Half of U.S. Kids 3 And Under Await Congress On Children’s Health Funding”.  It was written by Bruce Japsen.  From the article:

As Congress begins to address the long-term future of the Children’s Health Insurance Program and entitlement cuts, the medical care of almost half of U.S. children three years old and younger is in limbo…

…”Because young children and their parents rely on Medicaid at higher rates than older children and their parents, contractions of Medicaid funding would have outsize effects on families with young children,” Urban Institute researchers wrote in the report.

Such “contractions” in CHIP and Medicaid spending became more real before the holidays when the Republican-led Congress passed a temporary budget that only extended CHIP through the end of March, leaving long-term funding up in the air.  Furthermore, U.S. House Speaker Paul Ryan says he wants to consider entitlement reforms in healthcare that could lead to reduced spending on Medicaid, CHIP and other healthcare programs.  He hasn’t been specific in what he wants to “reform” but several media reports say he’s got health insurance in his sights…

…Cutting CHIP would be unusual if Speaker Ryan considered it ripe for spending reductions.  Since the CHIP program was created as part of the Balanced Budget Act of 1997 signed into law by then President Bill Clinton, there has typically been bipartisan consensus in Congress to renew it every five years…

…But the Donald Trump White House and the Republican-led Congress were instead focused at the end of last year on passing a massive tax cut.  Meanwhile, the CHIP program won an extension of just three months for about 9 million children of low-income families…

January 3, 2018: The VT Digger posted an article titled “State could take $36 million hit with federal health care cuts”.  It was written by Elizabeth Hewitt.  From the article:

…Congress has not approved long-term funding for federal qualified community heath centers and the children’s health insurance program, known as CHIP.

Both programs expired at the end of the federal fiscal year in September. Congress passed a short-term extension through March for both as part of a spending resolution in December.

Vermont’s 12 health centers stand to lose $14 million in federal funding if Congress doesn’t renew funding.  About 25 percent of the state’s population uses the centers for primary care services.

CHIP funding, along with Medicaid, supports the state’s Dr. Dynasaur program.  According to estimates from the legislative Joint Fiscal Office, the state would be left with a $1.9 million budget shortfall in the current fiscal year, and a $21.6 million in the next year if the federal program ends.  Currently, the federal government pays 90 percent of the cost of health care for children through the Medicaid program under CHIP.  If the program is not reauthorized, children would be picked up by the general Medicaid program, which has a much higher state match….

January 5, 2018: NPR posted an article titled “CHIP Funding Could Run Out on Jan. 19 For Some States”. It was written by Phil Galewitz. From the article:

Some states are facing a mid-January loss of funding for their Children’s Health Insurance Program despite spending approved by Congress in late December that was expected to keep the program running for three months, federal health officials said Friday.

The $2.85 billion was supposed to fund state’s CHIP programs through March 31. But some states will start running out of money after Jan. 19, according to the Centers for Medicare & Medicaid Services. CMS did not say which states are likely to be affected first.

The latest estimates for when federal funding runs out could cause states to soon freeze enrollment and alert parents that the program could soon shut down…

…CMS says the agency is in discussions with states to help deal with the funding shortfall.

“The funding…should carry all the states through January 19, based on best estimates of state expenditures to day, says CMS spokesman Johnathan Monroe. “However, due to a number of variables relating to state expenditure rates and reporting, we are unable to say with certainty whether there is enough funding for every state to continue its CHIP program through March 31, 2018.”…

January 5, 2018: posted an editorial titled “Restore long-term funding for children’s health programs: editorial”.  It was written by the Editorial Board of  From the editorial:

Last month’s congressional funding Band-Aid to keep the federal government in business included $2.85 billion in stopgap money for the Children’s Health Insurance Program.  That’s far short of the five-year $8 billion CHIP extensions advocates had sought.

Even more worrying, after partisan squabbles allowed the program to lapse Sept. 30, is the “it’s unclear how long [that funding] will actually allow all states to continue operating their CHIP programs,” warns the National Academy for State Health Policy.

Before Congress acted last month, the Medicaid and CHIP Payment and Access Commission, which advises Congress, had projected that Arizona, the District of Columbia, Minnesota, and North Carolina would exhaust CHIP funding by Dec. 31.

And CHIP is just one piece of federal health assistance programs aimed at at-risk families and children who need a long-term funding solution.

Last month’s temporary budget fix, H.R. 1370, also provide $550 million for community health centers that serve more than 25 million, many in struggling communities — enough to last only through March 31….

…CHIP needs to regain long-term funding.  It works to safeguard the health of children, and long has enjoyed bipartisan support…

…In Ohio, covering the 200,000 children enrolled in CHIP costs about $45 million a month — a cost Ohio funds via Medicaid.  For Ohio’s vulnerable children, that’s a upside of sorts, since the program will continue even if CHIP money runs out.  The downside: Federal reimbursement for Ohio Medicaid costs is 63 cents per dollar: CHIP reimbursement is 97 cents per dollar.  So, if Congress doesn’t fully fund CHIP, Ohio’s percentage share of CHIP costs would rise steeply…

January 5, 2018: WHYY posted an article titled: “Congress to sick kids in Delaware: Drop dead, maybe”. It was written by Rob Tornoe.  From the article:

A couple of days ago, 2017 came and went, and with it hope that Congress would come to the aid of millions of kids in Delaware and all across the country depending on them for their health care.

Congress did offer the equivalent of a fiscal Band-Aid for the Children’s Health Insurance Program (CHIP) by including some stopgap funding that extending the program in Delaware through January – but well short of the $14 billion a year the program requires…

…It’s mind boggling how we’ve gotten to this point.  CHIP has been a popular program among members of both political parties since its introduction in 1997, so the fact that it has become a victim to the rabid partisanship that has enveloped Washington is troubling, to say the least.  Bipartisan support exists here in Delaware, too – all 14 members of the Delaware House Health Committee (made up of both Republicans and Democrats) urged Congress to reauthorize CHIP funding.

The squabbling has left parents and pediatricians across the country shaking their heads in disgust, while here in Delaware, 8,300 children nervously wait t see if they’ll be able to receive the basic medical care they could suddenly lose, through no fault of their own…

…Even someone as cynical as myself never thought we’d get to the point where the health care of children was threatened by the dysfunction and outright neglect of our elected officials in Washington, who managed to roll up their sleeves and pass tax cuts that overwhelmingly favors the most fortunate in our country while leaving needy kids out in the cold…

January 5, 2018: The Hill posted an opinion piece titled: “Congress should protect children and families in poverty in 2018.”  It was written by John Bouman.  From the opinion piece:

…The tax legislation delivers huge giveaways to our country’s wealthiest households and largest corporations, strips health care coverage from some 13 million people, and ultimately raises taxes on millions of low-and moderate-income families.  On top of that, the legislation sets the stage for a massive assault on various programs that ensure decent living standards and provide upward mobility for people living in or near poverty…

…But enacting a deeply unfair tax agenda wasn’t the only way that Congress failed low-income families just ahead of the new year.  Federal lawmakers also failed to come together on a long-term extension of the Children’s Health Insurance Program (CHIP) – a popular program that provides healthcare to roughly 9 million low-income children and pregnant women.

CHIP has produced historic progress on children’s health.  Since it was established in 1997, CHIP has worked hand-in-hand with Medicaid to drive the uninsured rate among kids to an all-time low of just 4.5 percent. What’s more, a large body of research shows that children who have access to publicly-funded healthcare enjoy longer, healthier lives, are more likely to graduate high school, and tend to have higher earnings as adults…

…CHIP has also long enjoyed strong bipartisan support.  Indeed, since CHIP’s inception, lawmakers on both sides of the aisle have recognized the importance of ensuring that our nation’s children have access to quality healthcare.

That is, until this year.

During their hyper-partisan pushes to repeal the Affordable Care Act (ACA), gut Medicaid, and cut taxes for the ultra-rich, Congressional Republicans have let CHIP fall by the wayside. Senators Orrin Hatch (R-UT) and Ron Wyden (D-OR) struck a bipartisan deal early in September, but their plan has stalled in the Senate ever since.  And while House Republicans have passed their own version of an extension, it pays for CHIP through partisan attacks on the ACA and by taking coverage away from low-income adults.

As a result, funding for CHIP expired on September 30th, touching off months of panic among state officials, health providers, and – not least of all – children and families.  Nearly 2 million kids were set to lose insurance by the end of January, with millions more to follow soon thereafter…

…If federal lawmakers are truly committed to ensuring that all children can grow up healthy, thrive, and achieve economic security, they will move swiftly to renew funding for CHIP for five full years.

Furthermore, they must do so without attacking other key anti-poverty efforts.  Programs such as SNAP (formerly known as food stamps), Medicaid, and housing assistance also improve the short- and long-term health of families; restricting access to them, whether through funding cuts or harmful policies like work requirements, promises to undermine the quality of life of tens of millions of low-income men, women, and children…

January 5, 2018: The Congressional Budget Office (CBO) sent a letter to Senator Orrin Hatch (Republican – Utah).  Senator Hatch is the Chairman of the Senate Committee on Finance.  The letter was sent by Director Keith Hall.  From the letter:

The Congressional Budget Office and the staff of the Joint Committee on Taxation (JCT) have updated their estimate of S. 1827, the Keep Kids’ Insurance Dependable and Secure Act of 2017, to account for the enactment of Public Law 115-97, which repealed the penalties related to the individual health insurance mandate starting in 2019, and to account for administrative action. The agencies now estimate that enacting this legislation would increase the deficit by $0.8 billion over the 2018-2027 period.

S. 1827 would extend federal funding for the Children’s Health Insurance Program (CHIP) for five years through fiscal year 2022.  The bill also would make several other changes to CHIP, including a change in the federal matching rate for the program and extension of the requirement that states maintain eligibility level as they were in 2010.

Compared with the October 20, 2017, cost estimate for the legislation, this cost estimate shows a cost over the next 10 years that is smaller by $7.5 billion.  The net change in the deficit is significantly smaller than the agencies’ prior estimate because the offset to the cost of funding CHIP for five years is larger.  That offset, which reduces direct spending related to the marketplaces, is higher for three main reasons:

CBO and JCT expect that premiums for coverage through the marketplaces will be higher in the absence of the mandate penalties than they would otherwise have been.  As a result, the federal cost of enrolling a child in coverage through the marketplaces will be higher.  Thus, funding CHIP for five additional years – causing some children to be covered in that program rather than through the marketplaces – would result in a larger reduction in spending related to the marketplaces than in the prior estimate.

The agencies estimate that, without the penalties related to the individual mandate, a larger share of parents would be uninsured.  When funding for CHIP is reduced under current law, some parents would seek to preserve coverage for their children and enroll them in a family policy through the marketplaces.  Some of those parents would otherwise be insured and could add their children to their coverage, while other parents would be uninsured and enroll both themselves and their children, resulting in higher costs to the federal government relative to insured parents. In the revised estimate, more parents would fall into the latter category.  Thus, funding CHIP for five additional years would result in a larger reduction in spending related to the marketplaces.

The agencies now incorporate into their estimate final regulations related to how premiums differ by age that increase premiums for children’s coverage through the marketplaces.  Those regulations cause federal spending per child in the marketplaces to be higher.  Thus, funding CHIP for five additional years – reducing the number of children covered through the marketplaces – would result in a larger reduction in spending related to the marketplaces than in the prior estimate…

January 7, 2018: Valley Star posted an article titled: “Texas can keep CHIP running until end of March”.  It was written by Marissa Evans.  From the article:

Texas now has enough federal money to keep alive its health insurance program for more than 450,000 uninsured kids and pregnant women through the end of March, a state official said on Friday.

That’s true even though the Children’s Health Insurance Program technically expired on Sept. 30 after Congress failed to renew funding.

Carrie Williams, a spokesman for the state Health and Human Services Commission, said Texas can keep the program afloat thanks to $248 million in funding allocated through a short-term spending bill passed by Congress last month.

The news, first reported by the Dallas Morning News, comes less than a month after Texas Health and Human Services Commission officials announced that the federal Centers for Medicare and Medicaid Services was giving the state $135 million to continue the program through February.

Williams said in her email that the $135 million now won’t be immediately needed because of the December spending bill….

January 7, 2018: The St. Louis Post-Dispatch posted an editorial titled: “Editorial: If GOP leaders really care about kids, now’s the time to prove it.”  I was written by the St. Louis Post-Dispatch Editorial Board.  From the article:

For a party that champions a “pro-life” agenda, the GOP routinely turns its back on children once they leave the womb. The question isn’t just about abortion rights; it’s about making sure that all children have access to a quality life, growing up safe, healthy, and well-educated.

On Sept. 30, the Republican-controlled House and Senate allowed funding to expire for the Children’s Health Insurance Program, known as CHIP, which provided coverage for 8.9 million kids across the country whose parents earn too much to qualify for Medicaid.

Regardless of how anyone judges adults for their employment and financial-management choices, no child should be made to suffer just to make a political point.  The parents of CHIP-eligible kids are not welfare bums, as some portray them. They are hard-working individuals whose jobs don’t pay them enough to afford private health coverage.

Until now, states have been able to sustain CHIP by dipping into reserve funds. But by the end of this month, 16 states – including California, Texas and Florida – will run out.  Another 21 states’ funds will be exhausted between February and March, according to the Kaiser Family Foundation.  Missouri’s funding is expected to last through the year.

Congressional Democrats now are drawing a hard line in negotiations with Republicans over funding to keep the federal government running past Jan. 19, when the current spending authority expires. Unless GOP leaders agree to long-term funding for CHIP, Democrats are threatening to shut down the government.  The Democrats, in this case, are the ones fighting for kids’ lives….

January 10, 2018: Michigan Radio (an NPR station) posted an article titled: “State says there’s enough money to keep Children’s Health Insurance Plan running until summer.”  From the article:

It’s been a worrisome few months for the families of 116,000 lower-income kids in our state, the ones who rely on the Children’s Health Insurance Program for their health care…

…Now we hear that CHIP funds will last a little longer than first thought…

…”The CHIP program allotment for Michigan will last longer than for some states”, said [Kathy] Stiffler [of Michigan’s Department of Health and Human Services]. While other families in other states have been notified of the program’s end, that isn’t quite the case in Michigan, at least at the moment. “Our allotment should get us through at least June or July, based on the current continuing resolution” she added…

January 10, 2018: Georgetown University Health Policy Institute Center for Children and Families posted a January 2018 Update. The update was written by Tricia Brooks and Joan Alker.  From the summary of the update:

A new report by the Georgetown University Center for Children and Families estimates that if Congress does not approve funding for the Children’s Health Insurance Program (CHIP) in January, an estimated 24 states (including D.C.) could face CHIP funding shortfalls. Coverage beyond February is most at risk for approximately 1.7 million children in 21 of the 24 states with separate CHIP programs.  These states, in the order of size of enrollment are: NY, PA, FL, GA, CA, VA, AL, CO, WA, NV, MO, KY, MT, UT, ID, CT, AZ, LA, SD, MN and DC.

Here are some facts from the January 2018 Update:

  • Funding for the Children’s Health Insurance Program (CHIP) expired on September 30, 2017. States were able to continue to operate their programs in the short term with leftover CHIP allotment funds from fiscal year 2017. If these funs ran out, they were supplemented by a proportional share of unused funds from prior fiscal years received in a “redistribution” pool.
  • Just before the December recess, Congress approved $2.85 billion in CHIP funding in a so-called “patch” as part of the Continuing Resolution (CR) that expires January 19. The CR also changed the way that redistribution funds are awarded to states, no longer guaranteeing a specific share of these emergency shortfall funds to any state.

January 10, 2018: The American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American College of Physicians, American College of Obstetricians and Gynecologists, American Osteopathic Association, and the American Psychiatric Association sent a letter to specific members of Congress. The letter was written on behalf of the more than 560,000 physicians and medical students represented by the combined memberships of those groups.

The letter was sent to House Majority Leader Mitch McConnell, House Minority Leader Chuck Schumer, Speaker of the House Paul Ryan, Senate Minority Leader Nancy Pelosi, Chairman Orrin Hatch, Ranking Member Ron Wyden, and Ranking Frank Pallone.  From the letter:

…Since its inception in 1997, CHIP, together with Medicaid, has helped to reduce the number of uninsured children by a remarkable 68 percent. CHIP has a proven track record of providing high-quality, cost-effective for low income children and pregnant women in working families. CHIP was a smart, bipartisan solution to a real problem facing American children and families when it was adopted in 1997 and its importance and impact in securing a healthy future for children in low-income families has only increased…

…More than three months since the September 30th deadline to extend federal funding for CHIP, Congress has failed to pass a long-term extension. States have already started to notify families that they may not have a source of coverage should Congress fail to enact a long-term extension of CHIP funding, and several states have started to use funds meant to operate the program to start shutting it down. The short-term CHIP and other health program funding included in the late-December Continuing Resolution (CR) is not enough to prevent states from continuing these actions, and only causes more chaos and confusion on the ground. We urge Congress to honor CHIP’s 20 years of success by enacting a five-year extension of CHIP funding so that this critical source of health coverage for the children and pregnant women we treat every day will be maintained into the future.

In addition to CHIP, funding lapsed on October 1st for several other health care programs critical to millions of low-income, working Americans and others who face financial challenges, including: Community Health Center Programs (CHCs); Medicaid disproportionate share hospital payments (DSH); the National Health Service Corps (NHCS); Maternal Infant, and Early Childhood Home Visiting Program (MIECHV); and the Teaching Health Center Graduate Medical Education Program (THCGME)…

…Our members are the foundation of the U.S. health system and include the front-line physicians who care for families, adults, adolescents, women and children in rural, urban, wealth, and low-income communities. As such, our groups are united in asking for an immediate extension of these programs, which enjoy widespread support among both chambers and both political parties, in a bicameral, bipartisan fashion. There is no excuse for further delays on extending these critical, bipartisan health programs, and we urge Congress to include a long-term funding solution ahead of the January 19th deadline.

January 11, 2018: The Congressional Budget Office (CBO) posted a “Cost Estimate of Extending Funding for the Children’s Health Insurance Program for 10 Years”. From the Summary of the estimate:

CBO and the staff of the Joint Committee on Taxation (JCT) have completed a preliminary estimate of the budgetary effects of extending funding for the Children’s Health Insurance Program (CHIP) for 10 years using specifications provided by your staff. Under those specifications, the provisions of S. 1827, the Keep Kids’ Insurance Dependable and Secure Act of 2017 (KIDS Act), would be extended. In particular, all of the provisions that would be in place in 2022, the final year of funding under that Act, would continue unchanged for the remainder of the 2023-2027 period. The agencies estimate that enacting such legislation would decrease the deficit by $6.0 billion over the 2018-2027 period.

On January 5, 2018, CBO and JCT estimated that S. 1827 would increase the deficit by $0.8 billion over the next ten years, after accounting for the enactment of Public Law 115-97, which repealed the penalties related to the individual health insurance mandate starting in 2019, and for administrative action.

Extending funding for CHIP for 10 years yields net savings to the federal government because the federal costs of the alternatives to providing coverage through CHIP (primarily Medicaid, subsidized coverage in the marketplaces, and employment-based insurance) are larger than the costs of providing coverage through CHIP during that period. The extension would increase the deficit in each year between 2018 and 2020 and reduce the deficit each year thereafter. The change from annual increases in the deficit over the 2021-2027 period primarily occurs because the federal matching rate for CHIP would decline relative to its level in prior years – from an average of 93 percent in 2019 to 81.5 percent in 2020 and 70 percent in 2021 and subsequent years – lowering the federal costs of coverage through CHIP as states become more responsible for the program’s costs.

January 11, 2018: Delaware Online posted an article titled: “Health Secretary: Funding for CHIP will last until February in Delaware” It was written by Meredith Newman. From the article:

Health Secretary Kara Odom Walker said Thursday that funding for the Children’s Health Insurance Program in Delaware will last until the end of February, delaying the chance of 8,300 children losing their health insurance for another month…

…In Delaware, the state adds $2.9 million to the federal $30 million to fund the Delaware Healthy Children Program, which provides low-cost health insurance to children whose parents don’t qualify for Medicaid. Funding for CHIP, which usually garners bipartisan support, has been in limbo since its federal funds ran out on Sept. 30.

In December, state officials believed Delaware would run out of funding by Jan. 31. But officials recently heard from the Centers for Medicare and Medicaid Services that Delaware will now be able to last until Feb 28…

…There is bipartisan support for CHIP in Delaware. This fall, all 14 members of the Delaware House Health Committee – Republican and Democrat – wrote to the congressional delegation about fighting for the re-authorization of CHIP…

…Officials at Nemurs/A.I. Dupont Hospital for Children said the hospital saw about 6,00 children on CHIP in the last year for issues ranging from asthma to terminal illnesses, and many of them have special health care needs.

Doctors fear the elimination of CHIP will worsen the treatment some children receive in Delaware.

January 11, 2018: Mother Jones posted an article titled: “Congress Could Reduce the Deficit by Billions by Extending Children’s Insurance Program”. It was written by Megan Jula. From the article:

Extending a program that provides health insurance to nearly 9 million children could save the government $6 billion over the next 10 years, according to a new estimate by the nonpartisan Congressional Budget Office…

…When Congress let CHIP funding expire on September 30, states continued to operate the program using any leftover funds from fiscal year 2017. And just before December, Congress approved $2.85 billion in CHIP funding as a “patch” until they could agree on a longer-term fix. However, the Centers for Medicare & Medicaid Services warned last week that money could run out for some states after January 19, the same deadline for Congress to pass a spending bill in order to avert a government shutdown.

The projected cost of extending CHIP has continually fallen since Congress initially failed to fund the program last fall. In October, CBO estimated that CHIP would cost $8.2 billion over the next decade. But last Friday, CBO updated its estimate because of changes in the tax bill Republicans passed in December. The new cost projection for a five-year extension: $800 million… The GOP tax bill repealed Obamacare’s individual mandate.  Without the mandate, the government’s cost to help children buy insurance on Obamacare’s marketplaces becomes much more expensive, making CHIP a cheaper deal for the government.

According to the CBO’s latest estimate, extending CHIP would increase the deficit each year between 2018 and 2020 and then reduce the deficit each year after, primarily because the federal match rate for CHIP would decline – from an average of 93 percent in 2019 to 70 percent in 2021 and after – making states responsible for more of the program’s costs. But time is ticking for Congress to pass an extension. A new report by the Georgetown University Center for Children and Families estimate that if Congress does not approve funding for CHIP this month, 23 states and DC “will have insufficient funds to fully cover all children beyond February 2018.”…

January 11, 2018: Center for American Progress posted an article titled: “While Congress Cuts Taxes, Children and Families are Left Without Health Insurance and Support Services”. It was written by Cristina Novoa, a policy analysis for Early Childhood Policy at the Center for American Progress, and Theresa Chaloub, a senior policy analyst for the Women’s Health and Rights Program and Health Policy at the Center.

…While Congress was focused on the tax bill it neglected to fund important programs such as the Children’s Health Insurance Program (CHIP) and the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. Both programs expired on September 30 despite clear evidence and several warnings that if Congress did not take action, children and families would lose access to health coverage and necessary home visiting services.

CHIP, a bipartisan program, provides quality, affordable health coverage to nearly 9 million children and thousands of pregnant women and includes services such as hospital services, well-child check-ups, and immunizations. Along with Medicaid, it is an essential source of health coverage for children of color: Almost 60 percent of the children enrolled in these programs are African American or Hispanic.

MIECHV funds voluntary evidence-based home visiting services for families living in poverty, first-time parents, single mothers, and other families who may benefit from additional support. Many of these families are families of color; nearly one-third of children served are African American, and another one-third are Hispanic or Latino. Programs pair parents with a nurse, a social worker, or an early childhood professional who provides coaching and education throughout pregnancy and a child’s early years. Home visits empower parents, helping them create a safe and healthy home environment that supports positive maternal and child health outcomes. Home visits can include lessons on positive parenting, proper nutrition, stress management, and child development; breastfeeding assistance; referral to programs that promote family economic security; and much more…

January 12, 2018: NPR posted an article titled: “Scramble Is On To Care For Kids If Insurance Coverage Lapses”. It was written by Phil Galewitz and Emmarie Huetteman. The story was produced by Kaiser Health News, an editorially independent program of the Kaiser Family Foundation.  NPR is one of several websites that published this story.  From the article:

Dr. Mahendra Patel, a pediatric cancer doctor, has begun giving away medications to some of his young patients, determined not to disrupt their treatments for serious illnesses like leukemia. He’s worried Congress will fail to renew funding soon for a health program that pays for the care of millions of children across the country…

…The months-long failure on Capitol Hill to pass a long-term extension to CHIP, which provides health coverage to 9 million lower-income children, portends serious health consequences for many of them.

About 1.7 million children in 20 states and the District of Columbia could be at risk of losing their CHIP coverage in February because of the funding shortfall, according to a report released Wednesday by the Georgetown University Center for Children and Families.

Treatment plans for serious diseases can span months, leaving some doctors, like Patel, to jury-rig solutions in case CHIP falls through. The challenges are particularly great for kids with chronic or ongoing illnesses like asthma or cancer.

Dr. Joanne Hilden, a pediatric cancer physician in Aurora, Colo., and past president of the American Society of Pediatric Hematology-Oncology, said the families of cancer patients who depend on CHIP are in a difficult position because they can’t schedule care to be finished before the program funding runs out.

A San Antonio pediatrician, Dr.Carmen Garza, is advising parents to be sure to keep their children’s asthma medications and other prescriptions current and to fill any refills they can so that they have vital medicines if CHIP expires…

..The Centers for Medicare and Medicaid Services last week said it couldn’t guarantee funding to all states past Jan. 19.

A few states, including Louisiana and Colorado, plan to use state funds to make up for the lack of federal money. It’s a drastic step, since the federal government pays, on average, nearly 90 percent of CHIP costs.

Most states can’t afford to make up the difference and will have to freeze enrollment or terminate coverage when their federal funding runs dry. Virginia and Connecticut, for instance, can promise to keep their CHIP program running only through February, officials said.

The largest states seem to be in the best shape, though even that can guarantee only a few months of care. Florida, California and Texas officials said they have enough CHIP funding to last through March. New York officials said they have enough money to last until at least Mid-March…

…Alabama and Utah are among the states unsure how long their federal CHIP funding will last, according to interviews with state officials. Part of the problem is they haven’t bene told by CMS how it will distribute money from the agency’s so-called redistribution pool. Under the pool’s restrictions, states with extra money would have to give it to states that are running low…

…Pennsylvania officials notified CHIP providers in late December – who then informed enrollees – that the state would have to end the program in March unless Congress acts…

January 12, 2018: The Inquirer posted an article titled: “Growing inequality in health-care coverage through work creates urgency for CHIP reauthorization”.

It was written by Kathleen Noonan, the senior legal advisor of PolicyLab at Children’s Hospital of Philadelphia. It was also written by David Rubin, MD, MSCE, director of PolicyLab and medical director of Population Health at CHOP.  From the article:

As the 100-day mark since Congress let the Children’s Health Insurance Program’s (CHIP) funding lapse has passed, and as families nationwide begin to receive letters that they may soon lose their children’s health insurance, we have been reflecting on how and why CHIP has become so important in the health-care debate.

It used to be that health insurance offered through an employer was a great workplace equalizer; the CEO and a line worker in the same company were likely to be covered by the same insurance plan. There was something quite unifying and democratic about that idea when it came to illness, at least for people who worked together, everyone had access to the same benefits. And whether you had a spouse or children, work would cover them, too. This is no longer our reality…

…Companies now typically offer health plans that are vastly different from what they offered before. Today’s plans have higher premiums, charge more for family coverage (if family coverage is provided at all), often require a very high deductible before coverage even begins, and make patients pay a portion of any doctor’s bill. The result is that seemingly less expensive plans can have out-of-pocket costs that may exceed $10,000 before any insurance kicks in, crating a financial barrier to seeking care. In fact, over the last decade, teh number of plans with deductibles has dramatically increased, from 55 percent in 2006 to 83 percent today, with average deductibles for those plans increasing by $1,100 in just 10 years…

…So, how are families in America reacting? Until recently, this growing inequality in the affordability of health care through work has been tempered by growth in public insurance options for families. No longer offered affordable family coverage – or any family coverage – through their employer, low- and moderate-income working families have been increasingly covering their children through Medicaid and CHIP. According to a PolicyLab study published in Health Affairs, between 2008 and 2013 there was more than a 30 percent increase in the proportion of low-income working parents who themselves had insurance through work, but whose children were insured through Medicaid or CHIP…

…All of this puts the importance of the CHIP program in a different light. If the trend we documented – and we see no reason why it will not – employer-sponsored coverage will become a less affordable option for working families. This means that beyond arguing just CHIP’s continuation, we should be looking at ways to ensure all family scan cover their children through a program like CHIP with its pediatric-specific, comprehensive health care. And then we’d be having a real discussion about equity again.

January 15, 2018: Forbes posted an article titled: “Hospitals, Doctors Brace For Loss of Children’s Health Funds” It was written by Bruce Japsen. From the article:

Providers of medical care are once again bracing for the loss of federal funding under the Children’s Health Insurance Program with the Republican-led Congress still unable to come up with a plan to fund it beyond March of this year.

A new report last week indicates that more than 20 states face CHIP funding shortfalls if Congress doesn’t act this month. And that’s beginning to worry hospitals and doctors who see a loss of 9 million children from low-income families who gain coverage from CHIP…

…The GOP-led Congress passed a temporary budget a month ago that only extended CHIP through the end of March, putting children’s hospitals at a particular risk to lose money, analysis say. CHIP accounts for more than $15B in annual spending and more than 90% of it comes from the federal government with states picking up the rest.

“Much of the high complexity and high cost of care provided to children in the U.S. occurs at dedicated children’s hospitals,” The Chartis Group’s pediatric services leader Brian Thygesen said. “Any reductions in utilization or funding from CHIP will immediately impact the bottom line of nation’s children’s hospitals, not to mention the families who will feel the pain first.”…

January 16, 2018: Cosmopolitan posted an article titled: “More Than 100 Days after CHIP Expired Republicans Still Aren’t Making It a Priority.” It was written by Joe and Lauren Kennedy.

Joe Kennedy represents the 4th congressional district of Massachusetts.  Lauren Birchfield Kennedy is the co-founder of Neighborhood Villages, a nonprofit that seeks to improve access to high-quality, affordable childcare. From the article:

…Few monsters terrify a parent more than illness, particularly when our children are young and small of body. That’s why few issues have united families in America more consistently than the cause of ensuring that all children have access to high-quality medical care. For twenty years, the Children’s Health Insurance Program (CHIP) has been the anchor of that effort; it covers children and pregnancy women who cannot afford private insurance but who do not qualify for traditional Medicaid. CHIP has been a tremendously successful program, reducing the uninsured rate among our nation’s children from nearly 14 percent in 1997 to less than 5 percent today. A modest investment for the federal government, CHIP nearly 9 million children and hundreds of pregnant women.

Up until now, this success fortified bipartisan support for the program and ensured it reflected something more powerful than our divided politics: CHIP was a demonstration of our collective decency. This is what makes the refusal of Republican leaders in the White House and Congress to prioritize a full reauthorization of CHOP all the more devastating (And no, the short-term funding extension passed in December doesn’t come close to covering what states need beyond a couple months). It’s more than irresponsible governance; it’s an abdication of a collective moral duty to protect the youngest among us – not just our own children, but any child who calls this country home.

Families are panicked. And they should be. Known deadlines have come and gone; states have sounded the alarm; and parents from Colorado to Virginia have received letters notifying them that their health coverage is in jeopardy. Today, 108 days after CHIP formally expired, millions of children and their parents one again woke up wondering how much longer they would have health insurance and access to the medical care they need…

January 16, 2018: Politico posted an article titled: “House GOP leaders may target Obamacare to avoid shutdown”. It was written by Rachel Bade and Jennifer Haberkorn. From the article:

House GOP leaders may load up a temporary government funding bill with Obamacare tax delays in a bid to win over Republicans and avoid a shutdown at week’s end.

Speaker Paul Ryan and his team will huddle with rank-and-file GOP lawmakers in what’s expected to be a contentious conference meeting Thursday night. Senior Republican sources say GOP leaders will float several options to try and secure Republican votes on what will be the fourth spending stopgap since September – an embarrassing practice that Republicans say puts the military at risk.

Leaders will pitch a delay of the medical device tax, a loathed Obamacare levy on equipment such as defibrillators and surgical tools. The tax has been delayed for two years but when back into effect on Jan. 1. They’ll also discuss again delaying the law’s health insurance tax, which is now going into effect after a one-year delay.

A third tax potentially in the crosshairs: the so-called Cadillac tax on high-cost health insurance plans favored by labor unions…

…Facing GOP resistance, Republican leaders are also expected to also discuss another option: adding six years of funding for the Children’s Health Insurance Program designed to draw Democratic votes.

January 16, 2018: The Hill posted an article titled: “Week ahead: Lawmakers near deal on children’s health funding”. It was written by Peter Sullivan. From the article:

…The coming week could finally see lawmakers agree on extending the Children’s Health Insurance Program (CHIP), after months of partisan bickering over how to pay for it.

The breakthrough came when the Congressional Budget Office drastically lowered its cost estimate for the measure, so that it will actually save money if extended for long enough.

“If we go to six years, it may have no cost,” House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) told reporters Wednesday. “The good news is you can do six years and it costs you nothing.”

Members in both parties say the change means the extension could move next week, though it depends on broader leadership negotiations over a spending package. There is still some uncertainty over what legislation CHIP reauthorization will be attached to and how long the extension will be.

Walden has proposed a six-year extension, while Democrats are pushing for a longer period, even floating a permanent extension…

January 16, 2018: WOSU Public Media posted an article titled “Ohio Hospital Groups Urge Government To Renew CHIP Funding” It was written by Marlene Harris-Taylor. From the article:

A coalition of Ohio hospital groups and state agencies are urging passage of the federal Children’s Health Insurance Program or CHIP.

Additional funding for the program has been stalled in Congress for months and Ohio will face millions in budget shortfalls if CHIP is not renewed, said Greg Moody, director of the Ohio Office of Health Transformation during a conference call with journalists.

The CHIP program covers low-income kids whose families earn too much to qualify for Medicaid but don’t have employer-provided insurance or private insurance. In Ohio, about 220,000 children get health insurance through the program.

CHIP is administered by the state-run Medicaid program. The State covers the cost of children in the program and then the federal government reimburses those costs at a rate of nearly 97 percent.

Federal funding for the health insurance program expired last September and despite some temporary money allocated by Congress, it will soon run out of federal matching dollars in Ohio.

Then, Medicaid money will kick in, but at a lower reimbursement rate from the federal government, Moody said…

…Moody and several hospital groups, including Cleveland’s University Hospital, held a teleconference with reporters to push for federal renewal of CHIP…

January 18, 2018: The United States House of Representatives voted on H R 195 “Federal Register Printing Savings Act”.  The vote was 230 YEA to 197 NAY. The bill passed the U.S. House of Representatives.  The next step is for the bill to pass the United States Senate.

What’s in the bill?  That information was NOT published on the U.S. House of Representatives website on January 18, 2018.  This is likely because the House did not finish voting on the bill until the evening.  Here’s what I could glean from various news websites:

From The Washington Post:

…For one, Republicans attached a long-term extension of the Children’s Health Insurance Program and delays to several unpopular health-care taxes. The bill does not include protections for “dreamers”, immigrants brought to the United States illegally as children or who overstayed their visas as children, a top Democratic priority…

From Reuters India:

…House passage came only after conservatives secured a promise from [Speaker of the House Paul] Ryan that he would soon advance some type of legislation to bolster U.S. military readiness, satisfying their desire for increased defense spending, said Republican Mark Meadows, head of the House Freedom Caucus…

…Besides extending government funding for a month to give negotiators more time to work on a longer deal, the House’s temporary spending bill would extend the Children’s Health Insurance Program (CHIP) for low-income families for six years…

January 18, 2018: Vox posted an article titled “There are just days of CHIP funding left” It was written by Dylan Fox. From the article:

The Children’s Health Insurance Program, lacking long-term authorization since October, is starting to run out of money.

The program, which covers 9 million American children, is at the center of Congress’s government shutdown showdown this week. Republicans are attaching a six-year CHIP extension to a short-term spending bill in a gambit to deter Democrats from shutting down the government over an immigration impasse. Democrats are furious, given that the Republican majority has allowed the program to go without long-term funding for this long.

The Trump administration has said state reserves for CHIP could start to dry up as soon as Friday – maybe, at best, the current funding could last through the end of the month. But after that, without congressional action, kids could be frozen out of health coverage or dropped off the rolls.

Congress has been courting disaster with CHIP, failing to extend funding long-term when it ran out in September. States have begged them to act, and Congress approved a package in December to help states keep running their programs through March. But the short-term relief is insufficient to last that long….

…Based on the administration’s estimates, the short-term CHIP money should be enough to fund all states through January 19 or possibly the end of the month…

…But, Republicans have dithered on CHIP for months, prioritizing a last-ditch run at Obamacare repeal and their tax overhaul. An extension that did pass the House in November was loaded with cuts to ACA and Medicare, which made it untenable for Democrats.

But now, with Democrats threatening to shut down the federal government until a solution is found for the Deferred Action for Childhood Arrivals program, Republicans have decided to attach a six-year extension – with no spending cuts attached – to a short-term spending bill. They are transparently using a CHIP extension as leverage to avert a government shutdown….

January 18, 2018: Jimmy Kimmel posted a video on the Jimmy Kimmel Live YouTube account titled: “Jimmy Kimmel on Government Shutdown and Funding CHIP.” It provides an incredibly easy to understand explanation of what is going in in Congress with CHIP funding:

January 19, 2018: CNN posted an article titled: “Who’s affected by a shutdown: By the numbers” It was written by Daniella Diaz.  Here is the portion of the article that is about CHIP funding:

If Congress can’t agree on a plan to fund the federal government before time runs out, a shutdown is expected to affect millions of Americans.

For starters, the continuing resolution proposed by House Republicans would include a six-year reauthorization of the Children’s Health Insurance Program – but if it doesn’t pass the Senate, CHIP will be funded only through March…

January 19, 2018: US News & World Report posted an article titled: “Montana Can Continue Funding CHIP Through Mid-March”. It appears to come from the Associated Press.  From the article:

Montana has enough money to continue funding the Children’s Health Insurance Program through mid-March.

Marie Matthews, manager of the health department’s Medicaid and Health Services Branch, told a legislative interim committee on Friday the funding would run out in two months without congressional action.

About 27,000 Montana children receive health insurance through CHIP or Medicaid expansion. Matthews says more than 23,000 Montana children would be at risk of losing coverage if CHIP isn’t re-authorized…

January 19, 2017: Lancaster Online posted an article titled: “To our elected representatives: For our children’s sake, save CHIP”. It was written by Damaris Rau, superintendent of the School District of Lancaster.  It was also written by Edith Gallagher, school board president.  From the article:

It should not be necessary for the citizens of our great nation to have to write letters to get the attention of our elected officials over the pending expiration and collapse of the Children’s Health Insurance Plan, or CHIP. We, the superintendent and the board of directors of the School District of Lancaster, are alarmed this plea is not only necessary, but that it is urgent. It is urgent because it concerns the health and well-being of our children, and it seems our representatives don’t feel that urgency.

The proposed six-year extension of CHIP is needed right now. Pennsylvania is one of 16 states whose federal dollars for this program will be exhausted at the end of January.  When that happens, the futures of millions of families and their children will be at risk.

Before CHIP’s enactment in 1997, more then 23 percent of low-income children were uninsured. Today only 5 percent remain uninsured nationally. The health plans offered through CHIP are specifically designed for children and include regular checkups, screenings and immunizations, among other essential services. Currently, CHIP provides medical coverage for 8.9 million children in working families who earn too much to qualify for Medicaid but cannot afford or access private coverage. Some 181,000 of those children are in Pennsylvania, 10,161 are here in Lancaster County. Many of these children need ongoing treatment for things like asthma, allergies, diabetes and childhood cancer.  If CHIP is allowed to collapse, many children will suffer and possibly die because their families cannot afford medical treatment…

…The U.S. House and Senate measures now on the table would extend CHIP funding for six years, and both sides are in agreement on the proper federal funding level. Unfortunately, in the face of Congressional inaction, many states have started to notify families that their children’s benefits may end.

We know a great many difficult decisions lie before our legislators. The health of our children – our collective future – should not be one of those difficult decisions. Indeed, it is an easy decision….

January 19, 2018: Arizona Public Media posted an article titled: “Legislators Using Health Care for Children as a Bargaining Chip”. It was written by Nancy Montoya. From the article:

The Children’s Health Insurance Program, known as CHIP, is being used by more than 9 million children across the country.

Funding for the program officially expired in October of last year. Funding for another six years of the program is part of a proposal to temporarily fund the government.

Republicans have included CHIP in the funding package as an incentive for Democrats to vote to extend government funding for another month. Congress has passed the extension, but Democrats in the U.S. Senate say they want DACA, the Deferred Action for Childhood Arrivals program, included in that package For now it is a standoff.

In Arizona, CHIP is known as KidsCare. It is the safety net for working families that make too much to be on Medicaid, but not enough to afford market health insurance.

In Arizona, there are more than 25,000 children using KidsCare. El Rio Health is the largest provider of Kids Care in Pima County, serving around 6,000 children. CEO Nancy Johnson said KidsCare in Pima County, serving around 6,000 children. CEO Nancy Johnson says KidsCare covers regular health checkups for children…

…Without KidsCare, Johnson said, a working family of four making around $33,000 a year, would have little choice but to use the emergency room when a child is seriously injured or very sick. And there would be no preventative care.

January 19, 2018: Press of Atlantic City posted an article titled: “CHIP funding ‘held hostage’ as Congress debates how to avoid shutdown”. It was written by Nicole Leonard. From the article:

Long-term funding for a crucial children’s health care coverage program hangs in the balance amid a potential federal government shutdown, and New Jersey health experts say the delay in taking action is unacceptable.

The Children’s Health Insurance Program has been without permanent funding since October. An estimated 113,000 or more kids in New Jersey are at risk of becoming uninsured if the money runs out…

…Eligible children in New Jersey get coverage through NJ FamilyCare, which also covers Medicaid enrollees and residents who qualify through the state’s Medicaid expansion…

…CHIP coverage in New Jersey will cost the federal government an estimated $490.7 million in fiscal year 2018, according to the Medicaid and CHIP Payment and Access Commission, a nonpartisan legislative branch agency that provides Congress and other departments with analysis, data and recommendations.

Although that may seem like a lot, a report earlier this month from the Congressional Budget Office said CHIP would actually save the federal government $6 billion in the next decade.

Some states, such as Connecticut, Colorado and Virginia have already sent parents letters about how their children may lose health insurance next month as funding runs out. Other states nearing that point are also expected to send out letters soon.

New Jersey’s CHIP funding is not at that level yet, [Mary] Coogan [attorney and head of Advocates for Children of New Jersey’s Kidlaw Legal Resource Center] said, as reported estimate the state’s money could last as late as April, but that doesn’t lessen the feeling of alarm, she said….

…If CHIP funding is not restored and New Jersey makes efforts to cover those children using state funds, health policy experts like Katherine Hempstead, senior advisor at the Robert Wood Johnson Foundation, said the responsibility to provide that type of coverage would be too much for states to shoulder.

Transitioning those kids into marketplace plans would likely raise the cost-sharing burdens considerably.

[Cathleen] Bennett [New Jersey Hospital Association president and CEO and former state commissioner of the Department of Health] said New Jersey hospitals are prepared to treat children with limited or no insurance who may have no other choice but to go to an emergency room for care, but it is no replacement for being able to regularly see a primary-care doctor for wellness.

She also warned that passing CHIP funding while other health care initiatives and programs undergo cuts could also lead to problems down the road….

January 19, 2018: The CT Mirror posted an article titled: “CT extends HUSKY B coverage for kids again, now through March” It was written by Makenzie Rigg. From the article:

Connecticut officials have again extended health care coverage for more than 17,000 children and teenagers in the Children’s Health Insurance Program (CHIP), this time through March…

…Initially, in Connecticut, that money was projected to run out on Jan. 31. But Congress approved a stopgap spending bill in December that provided $2.85 billion to states that were running out of CHIP money, Connecticut officials announced that the termination date was extended to Feb. 28.

This week, state officials once again pushed back the deadline – to March 31 – if Congress does not act….

…State officials will send out another round of letters to affected families.

GOP leaders proposed a six-year extension of the CHIP program in a short-term spending bill that would keep the government from shutting down shortly after midnight Friday.

The House approved that spending bill, known as a continuing resolution, on a largely party line vote Thursday – without the support of any of Connecticut’s House members.

But that bill is stalled in the Senate and reauthorization of the CHIP program is still uncertain…

January 19, 2018: The News Journal posted an editorial titled: “Congress’ dysfunction has real consequences for Delaware: Editorial” It was written by the News Journal editorial board.  From the editorial:

If you need a reminder that dysfunction in Congress has real consequences, ask the families of 8,300 Delaware children who could lose health insurance next month.

The Children’s Health Insurance Program provides medical care for children whose families don’t qualify for Medicaid but still the trouble affording health insurance. Because of CHIP, some 1.9 million American kids can get treatment for everything from asthma to childhood leukemia…

…State officials say Delaware may be able to support CHIP through the end of February. But, sooner or later, the money runs out.

That would mean sick kids won’t get medical treatment. If the program ends permanently, it might mean some would die.

The lack of reauthorization for CHIP is particularly infuriating because nobody seems to have an actual policy argument for ending it. The program only costs $800 million, at a time when Congress is handing out trillion-dollar tax cuts and considering growing military spending by billions of dollars.

No, CHIP is in legislative purgatory because it is being used as a bargaining chip in unrelated political negotiations, like immigration reform of the federal budget.

CHIP should not be a pawn in anybody’s political chess game. It deserves an up or down vote on its own.

Stop playing chicken with children’s health at stake….

January 19, 2018: The United States Senate voted on H.R. 195 “Federal Register Printing Savings Act of 2017”. They began voting at 10:14 P.M. Eastern Time.  This bill required at least 60 votes to end debate and move to a final vote.

The vote was 50 YEAS to 49 NAYS (and 1 person who did not vote at all). The vote was mostly – but not entirely – along party lines.

  • 45 Republican Senators voted YAY
  • 5 Republican Senators voted NAY
  • 44 Democratic Senators voted NAY
  • 5 Democratic Senators voted YAY
  • 1 Senator did not vote. That Senator was John McCain (Republican – Arizona). He is absent from Congress because he has a brain cancer called glioblastoma and he needed to recover from some side effects of the treatment.

The New York Times reported that the Senate adjourned for the night around 1:30 Eastern Time. Shortly before adjourning, Senate Majority Leader Mitch McConnell (Republican – Kentucky) proposed a measure that would keep the government open for another three weeks. The Senate planned to return the next day, Saturday, January 20, 2018, at noon.

Reuters reported that the United States government shut down at midnight, January 20, 2018, after Congress failed to reach a last-minute deal to fund its operations.  The date is significant.  January 20, 2018, is the one-year anniversary of when Donald Trump was sworn in as President of the United States.

January 20, 2018: The Washington Post posted an article titled: “Congressional leaders refuse to budge on shutdown’s first day, but negotiations continue” It was written by Robert Costa, Paul Kane, Ed O’Keefe and Karoun Demirjian From the article:

Congressional leaders in both parties refused to budge publicly from their political corners Saturday on the first day of the government shutdown, avoiding direct negotiations and bitterly blaming each other for the impasse in speeches. President Trump joined the fray with a series of charged tweets.

But private glimmers of a breakthrough were evident by late Saturday, as moderate Democrats and Republicans began to rally behind a new short-term funding proposal to reopen the government through early February.

That plan could include funding for storm-ravaged states, reauthorization of the Children’s Health Insurance Program – and an implicit agreement to hold votes at some point in the coming weeks on a bipartisan immigration deal, according to senators involved in the discussions…

…Lawmakers in both chambers were scheduled to return to work Sunday afternoon…

January 20, 2018: CBS News posted an article titled: “McConnell: Senate will be back Sunday and “as long as it takes – live updates” From the article:

Senate Majority Leader Mitch McConnell, R-Kentucky, announced plans to vote at 1 a.m. Monday on a three-week continuing resolution to fund the government after a day of lawmakers playing the blame game on Capitol Hill for the shutdown. The Senate adjourned Saturday evening and will reconvene Sunday and “as long as it takes.”…

January 21, 2018: Daily Miner posted an article titled: “Arizona could be liable for millions in insurance costs”. It was written by Howard Fischer, Capitol Media Services. From the article:

State lawmakers took the first steps Thursday to preserving a health care program for children of needy families if Congress scales back federal dollars.

HB 2127 would repeal a provision of the 2016 law that restored the Kids Care program, but only if Washington picks up the entire cost. Instead, it would require the head of Arizona’s Medicaid program to inform the Legislature of any shortfall and give lawmakers the option of keeping the program in place with state dollars.

That creates the chance for the nearly 25,000 youngsters already enrolled – and potentially an equal number who are eligible – to keep getting nearly free care, even if federal lawmakers no longer pick up the full tab. But it also means the state’s Medicaid program, where participation is capped at nearly $28,700 for a family of tree.

Eligibility for CHIP funds up to $41,560 for a family of three; larger families can earn more and still qualify…

…But that 2016 law contains a trigger; If federal dollars drop below 100 percent, new enrollments would again be shut down….

[Rep. Regina] Cobb [R-Kingman, sponsor of HB 2127] however, assured [Rep. Jay] Lawrence [R-Scottsdale] that nothing in HB 2127 allocates any money. She said it just sets up a method for the Legislature to make the funding decision when the time comes.

She acknowledged, though, that her legislation, which now goes to the full House, will be meaningless if Congress provides no dollars to restore the CHIP program…

January 22, 2018: CBS News (who was doing live-update reporting on the shutdown) posted the following:

The government shutdown will remain in effect going into Monday, after senators failed to come to an agreement to end it late Sunday night. A vote is scheduled for noon Monday that would end the shutdown with a short-term spending bill the would last three weeks. Majority Leader Sen. Mitch McConnell attempted to schedule a vote Sunday night that would end the shutdown, but Minority Leader Sen. Chuck Schumer objected…

January 22, 2018: The United States Senate voted at 12:30 PM (Eastern Time) on a motion to invoke Cloture on H.R. 195 “A bill to amend title 44, United States Code, to restrict the distribution of free printed copies of the Federal Register to Members of Congress and other officers and employees of the United States, and for other purposes”.

In “plain English”, the Senate voted on whether or not they should close debate on the budget bill.  The bill needed 60 votes in order for it to pass.  The vote was 81 YEAs to 18 NAYS.  Senator John McCain did not vote. He is absent from Congress because he has a brain cancer called glioblastoma and he needed to recover from some side effects of the treatment.

To be clear, the Senate passed a procedural bill.  They still had to hold a vote on the budget bill itself.

January 22, 2018: Vox posted an article titled “CHIP is finally getting funded – after 114 days without a budget” It was written by Sarah Kliff.  From the article:

The Senate is expected to pass Monday a bill extending the Children’s Health Insurance Program for an additional six years, likely ending a funding crisis that has plagued the state-run health plan for the last four months.

Congress let CHIP’s long-term funding lapse 114 days ago. The program became a bargaining chip in larger negotiations over the federal budget and immigration.

But things changed early Monday afternoon, as the Senate began a series of votes to a bill extending the federal government for an additional three weeks – and CHIP’s budget for an additional six years.

Both the House and the President are expected to support the Senate bill, meaning that CHIP may no longer be part of the congressional budget fight, and that state programs won’t have to worry about running out of money as soon as Monday evening…

January 22, 2018: The United States Senate voted at 4:05 PM (Eastern Time) on H.R. 195.  This time, they were voting on the actual budget bill.  This bill required at least half of all Senators to vote for it in order to pass.

The vote was 81 YEAS to 18 NAYS.  Senator John McCain was still absent and, therefore, could not cast a vote. This total means that the budget bill has passed the Senate.

But, that doesn’t mean things are immediately fixed.  Next, the bill goes back to the House of Representatives, who must vote on it.  This is necessary because the Senate added an Amendment to the budget bill that came to them from the House of Representatives.  When the Senate makes a change on a bill, it has to go back to the House for a vote that includes that change.

January 22, 2018: The United States House of Representatives voted on H.R. 195  – with the Amendment that was added earlier that day by the United States Senate. The House voted at 7:36 PM (Eastern Time).

The vote was 266 YEAS to 150 NAYS.  A total of fourteen Representatives did not vote.  This means H.R. 295 has passed both the Senate and the House.  The final step is to send the bill to the President.  He can choose to sign it, or to veto it.

What happens if the President signs the bill?  CBS News reported:

…The bill funds the government through Feb. 8, extends the Children’s Health Insurance Program (CHIP) for six years, and delays three Obamacare taxes. The House also concurred with a Senate resolution to pay federal workers through the shutdown…

To be clear, if the President signs the bill, CHIP would be funded for six years.  Congress would still have to scramble to create a budget bill that can pass both the Senate and the House before Feb. 8, 2018.  No matter what the final budget bill contains – CHIP funding would be secure.

January 22, 2018: Business Insider posted a blog titled: “OPEN FOR BUSINESS: Trump signs temporary funding bill to end government shutdown”. It was written by Bob Bryan. From the article:

President Donald Trump signed a short-term funding bill Congress passed on Monday, officially ending the three-day federal government shutdown…

…The deal will keep the government funded until February 8, eight days earlier than the date in the House-passed funding bill that the Senate rejected on Friday…

…The Senate funding bill will also extend funding for the Children’s Health Insurance Program for six years. CHIP funding technically expired in September.

January 22, 2018: WNYC News posted an article titled: “Patients, Hospitals Breathe Easy as Congress Restores CHIP Funding. From the article:

The vote by Congress to re-open the government is good news for families with kids on CHIP – the Children’s Health Insurance Program – and for the hospitals, clinics and lawmakers that serve them. As part of Monday’s deal on Capitol Hill, lawmakers have pledged to renew CHIP for another six years…

…More than 100,000 children get health coverage through CHIP in New Jersey, and about three times that number do in New York. To qualify, children must come from households earning from one to four times the federal poverty level, depending on their ages.

New York also faces a cut of around $800 million in federal finding to safety-net hospitals that serve low-income communities…

January 23, 2018: 47 ABC posted a short article titled: “CHIP reauthorization provides funding until 2023”. It was written by Dani Bozzini.  The key point of the article is:

…After months of uncertainty, Congress reauthorized the Children’s Health Insurance Program, better known as CHIP, as part of the short-term spending bill passed by Congress Monday night.

In Delaware alone, that means 8,300 children will continue to get health insurance coverage…

January 23, 2018: HPPR posted an article titled: “Children’s Health Insurance Program Lives to See Another Day in Colorado”. It was written by Angie Haflich. From the article:

The national Children’s Health Insurance Program, or CHIP, will live to see another day, meaning 800 pregnant women and over 75,000 kids in Colorado will keep health coverage…

…On Monday, in voting to approve a measure to end the federal government shutdown, Congress approved a six-year extension of funding for the program. Since October,when CHIP funding lapsed, Colorado had been keeping the program going with residual funds and some state money.

Had funding not been renewed by Congress, Colorado could have ended its program as early as March,

Colorado spends about $185 million per year on the Child Health Plan Plus, with 90 percent of that coming from federal dollars.

January 23, 2018: The CT Mirror posted an article titled: “Congress funds children’s health program, but not health clinics. It was written b Ana Radelat. From the article:

While the three-day government shutdown has ended, the fate of many federal programs is still up in the air – but a children’s health program that serves about 17,000 kids in Connecticut has come out a winner in the partisan fight over the federal budget.

The stopgap funding bill that was approved by Congress and signed by President Trump Monday funds most of the federal government for three weeks but the Children’s Health Insurance Program, or CHIP, for six years…

…On Tuesday, the day after Congress acted, the Connecticut Department of Social Services announced “great news for families of more than 17,000 children enrolled in HUSKY B.”

“The Children’s Health Insurance Program (known in Connecticut as HUSKY B) has been extended for six years.”…

..The CR funds the federal government at last year’s level for another three weeks. But new programs or additional money to help hurricane victims and those addicted to opioids, are not funded in the CR. Nor is there any funding for community health care centers, which serve many HUSKY B children…

…Community health centers in the state receive about $54 million in federal funding each year and 70 percent of that, or about $37 million, is at risk…

January 23, 2018: WIBW posted an article titled: “Shutdown bill will keep Kansas’ CHIP program funded for years to come” It was written by Nick Viviani. From the article:

While most Americans welcomed the end of the federal government shutdown, the news meant even more to tens of thousands of Kansas’ poorer children. Tucked into the bill President Donald Trump signed Monday night was six-year re-authorization of the Children’s Health Insurance Program, otherwise known as CHIP.

The state only had enough money to fund the program, which provides insurance for low-income children who do not qualify for Medicaid, for a little more than a month, according to the Kansas Dept. of Health and Environment (KDHE)….

…Now, with the extension, KDHE says they will be able to continue to provide services without interruption. The agency added they will “responsibly administer” the funding provided by the federal government that allows a buffer should the program expire six years from now and isn’t immediately reauthorized.

The original CHIP authorization expired in October 2017. At the time, KDHE said the agency had set aside enough funding to last until the first quarter of the year. More than 8 million children nationwide rely on CHIP for medical services. KDHE says 37,647 of them are in Kansas.

January 24, 2018: Jefferson Public Radio posted an article titled: “Deal To End Shutdown Funds Health Care for 2 Million Californians”. It was written by Ben Bradford. From the article:

About two-million California children will continue to receive health care through the federal-state Children’s Health Insurance Program.

The federal budget deal that ended the government reauthorizes the CHIP program for six years.

H.D. Palmer of the California Department of Finance says Governor Jerry Brown’s budget had planned for federal subsidies to taper off in March, with the state picking up the tab…

…The federal government will continue to cover almost 90 percent of the program’s cost for the next two years, at about 3 billion dollars per year. After that, the federal share decreases, ultimately to 65 percent, with the state paying the rest through the Medi-Cal budget…

January 24, 2018: WHSV 3 posted an article titled: “Virginia begins notifying CHIP recipients that coverage will continue”. From the article:

As part of the deal that ended the shutdown of the federal government, the Children’s Health Insurance Program, or CHIP, was reauthorized for six years.

That means families in Virginia that rely on CHIP for coverage for their children will not lose their coverage at the end of the month, as many feared.

The Virginia Department of Medical Assistance Services is expected to begin notifying families that use the Family Access to Medical Insurance Security, or FAMIS, program that they will see uninterrupted coverage…

January 24, 2018: The Times-Picayune posted an editorial titled: “Check children’s health insurance funding off the worry list”. It was written by the Times-Picayune Editorial Board.  From the editorial:

At least one good thing came out of the short-lived government shutdown: The spending agreement approved by Congress Monday (Jan. 22) extends the Children’s Health Insurance Program for six years…

…The agreement reached Monday provides $124 billion through 2023. The first two years will be at the current level of funding, with the federal government providing at least 88 percent of the cost. Then over the two years after that, funding will decrease by 23 percent to the level it was before the Affordable Care Act.

For Louisiana, the federal government has been picking up 96.55 percent of the cost of LaCHIP, as the state program is known. The state will have to figure out how to make up the difference when the match is rolled back…

January 24, 2018: Alabama Today posted an article titled: “Alabama kids no longer in danger of losing coverage after CHIP, All Kids funding restored.” It was written by Elizabeth Lauten.  From the article:

Due to a lapse in federal funding the Children’s Health Insurance Plan (CHIP), known as ALL Kids in Alabama, recently found itself in jeopardy.

The program, which acts as a safety net for roughly 15,000 children across the state became an important bargaining chip in the government shutdown when it came to negotiations over the federal budget and immigration. Bu the tide turned in CHIP’s favor early Monday afternoon, when members of the U.S. Senate agreed to pass a bill extending the federal budget for an additional three weeks – and CHIP’s budget for an additional six years…

…More than 83,000 children in the state are covered by All Kids program. Meanwhile, another 75,000 are covered by an Alabama Medicaid component of CHIP…

…But ALL Kids future isn’t set in stone. While Congress has funded the program through 2023, the funding rates will decrease over time. For the first two years, federal money will pay at least 88 percent of the program’s expenses in the state. In 2020, the federal share will decrease and the state will have to pick up some of the costs.

January 24, 2018: Georgetown University Health Policy Institute Center for Children and Families posted an article titled: “HEALTHY KIDS ACT (Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act)”. It was written by Kelly Whitener. From the article:

As we have noted in earlier posts, the Continuing Resolution (CR) passed on January 22 includes six years of funding for CHIP and other CHIP-releated provisions that we’ll unpack here…

…CHIP is now funded through federal fiscal year 2023, or September 30, 2023. Though the Secretary will have to determine the allotment amount for each state, the overall appropriations are as follows:

  • FFY 2018: $12.5B
  • FFY 2019: $22.6B
  • FFY 2020: $23.7B
  • FFY 2021: $24.8B
  • FFY 2022: $25.9B
  • FFY 2023: $25.9B

Based on current spending levels and projections for future spending, the funding is expected to be sufficient to cover the costs in all states. Because this funding comes part way through FFY 2018, there is also a provision to prevent duplicate appropriations. States will not have to pay back any money they have already received, but the next installment in their FFY 2018 allotment will be reduced to reflect these earlier, partial payments. Money that CMS has recieved but has not paid out to states will be sent back to the treasury.

The HEALTHY KIDS ACT also extends the child enrollment contingency fund… and the qualifying states option … through FFY 2023….

…CHIP Look-Alke Plans. Some states operate CHIP look-alike or buy-in programs whereby families with income above the CHIP eligibility threshold are able to purchase CHIP coverage for their children. Because the buy-in prorams are not federally funded, they are not under the purview of Congress or CMS. However, the HEALTHY KIDS Act includes two policies related to CHIP buy-in programs. First, it clarifies that states may ise a blended risk pool – combining CHIP and buy-in enrollees. Second, it adds buy-in programs to the list of programs that automatically meet the minimum essential coverage requirements under the ACA as long as the benefits in the buy-in are identical to the benefits in the state’s CHIP plan…

January 30, 2018: Health Affairs posted an article titled: “CHIP Funding Has Been Extended, What’s Next For Children’s Health Coverage?” It was written by Tricia Brooks. From the article:

After allowing funding for the Children’s Health Insruance Program (CHIP) to lapse for an unprecedented 114 days, Congress extended CHIP funding through federal fiscal year (FYY) 2023. On January 22, 2018, the President signed a continuing resolution approved by Congress that would end the 3-day government shutdown and adopt the Healthy Ensure Access for Little Ones, Toddlers and Hopeful Youth by Keeping Insurance Delivery Stable Act (HEALTHY KIDS Act). The delay in long term federal financing for what has been long touted as a popular bipartisan program had put families, state officials, and other stakeholders on edge, in some states more than others. What happened and what’s next for CHIP?…

…How Did States Handle The Funding Lapse?

The design of state CHIP programs was a key factor in what actions states could take in response to the lapse in CHIP funding. This is largely attributed to the Affordale Care Act (ACA)’s “Maintenance of Effort (MOE) provision which required states to maintain their eligibility levels an enrollment procedures through FFY 2019 for children in both Medicaid and CHIP. The provision was intended to stabilize children’s health coverage before and after implementation of the ACA, a period of significant change in the health care system. However, federal law allowed an exception for separate CHIP programs in the even that federal allotments were insufficient to maintain CHIP coverage. In federal guidance, issued on November 9, 2017, the Centers for Medicare and Medicaid (CMS) affirmed that Medicaid MOE would continue to protect coverage for children enrolled in CHIP-funded Medicaid expansion or M-CHIP programs. States would recieve federal Medicaid funds for these children but state budgets would be hit by the reduction in federal financial participation from the enhanced CHIP rate to the Medicaid rate.

On the other hand, separate CHIP programs had options, including transitioning children to Medicaid or closing their programs. States tried to anticipate when they would exhaust federal CHIP funding and contimplated what actions they would take in the face of continuing inaction by Congress. A few states, like New York and Louisiana, were consdiering permanently transitioning CHIP children to Medicaid, while other states, like Arizona and Oregon, decided to use otehr state funds temporarily to cover shortfalls with the hope of recouping CHIP funding retroactively. But some states came to the difficult realization that they lacked the resources to maintain coverage without federal funding. A number of states, including Alabama, Colorado, Connecticut, Oklahoma, Utah, Virginia, Washington, and West Virginia, postd website announcements or sent notices to families indicating that CHIP coverage could end on a specific date if Congress failed to act. Connecticut implemented an enrollment freeze on new applications during the last week of December 2017, and Alabama planned to freeze enrollment as of February 2018.

Families in these states and elsewhere were alarmed at the potential loss of CHIP coverage. As the funding crisis continued with increasing media coverage, more families became aware that their children were at risk of becoming uninsured. During this time, some states encouraged enrollees to schedule any needed preventive or routine health and dental care while their coverage was still active…

…What’s Next for CHIP?

…But it’s critical to recognize that CHIP sits on the shoulders of Medicaid. For every child that relies on CHIP, four children are enrolled in Medicaid. As such, CHIP and Medicaid must work in tandem to advance coverage and improve access and the quality of care…

…But there is reason for concern as some states and the federal government take steps to chip away at Medicaid for low-income families. These efforts will undoubtedly spill over to negatively impact children by reversing the welcome mat effect that Medicaid expansion has had on children’s enrollment, not to mention improving parent health and family economic security. If the foundation of Medicaid that CHIP rests on is weakened, there is little doubt that the nation’s success in covering children will be at risk…

June 7, 2018: The Hill posted an article titled: “House passes Trump’s plan to claw back $15 billion in spending”. It was written by JulieGrace Brufke and Niv Elis. From the article:

The House voted along party lines late Thursday to pass a White House proposal that would claw back nearly $15 billion in previously approved government funding.

The House approved the measure in a vote of 210 – 206, with conservatives calling ti a step in the right direction after they ripped into the price tag of the $13 trillion spending bill President Trump signed earlier this year…

…Trump had pushed lawmakers earlier this week to vote in favor of the clawback plan, known as the Spending Cuts to Expired and Unnecessary Programs Act, which GOP leaders have been working on for two months…

…While the move was welcomed by fiscal hawks, Democrats and a handful of moderates argued it could hinder future budget negotiations and drain unused funds that may prove necessary for programs down the road.

Opponents blasted the administration’s decisions to target unobligated funds within the Children’s Health Insurance Program (CHIP) – which make up nearly half of the $14.7 billion in rollbacks – alleging the cuts could lead to a loss of coverage that is higher than expected…

…The CBO analysis supported Republican arguments that the plan would not affect children’s health. Its analysis found that the recessions would not affect any spending on children’s health, and would not affect any coverage.

But it also showed that the move would have little impact on spending.

Because the funds in question were unobligated or associated with expired programs, canceling the budget authority to spend them would do little to affect the actual spending…

…Whether the Senate will move on the measure remains unclear…

June 20, 2018: The Press Herald posted an article titled: “Senate rejects billions in Trump spending cuts as 2 Republicans, including Collins, vote ‘no'”. It was written by Erica Werner. From the article:

The Senate on Wednesday rejected billions in spending cuts proposed by the Trump administration as two Republicans joined all Democrats in voting “no”.

The 48-50 vote rebuffed a White House plan to claw back some $15 billion in spending previously approved by Congress – a show of fiscal responsibility that was encouraged by conservative lawmakers outraged over a $1.3 trillion spending bill in March.

The House had approved the so-called “recessions” package earlier this month. But passage had never been assured in the Senate, where a number of Republicans had been cool to the idea from the start.

Nevertheless, Wednesday’s outcome was startling because one of the “no” votes came from Sen. Richard Burr (R-NC), who does not normally buck the White House or leadership. Burr’s office had no immediate comment.

Sen. Susan Collins (R-Maine), a moderate who is one of the Republicans who most frequently sides with the Democrats, cast the other ‘no’.

The cuts in the recessions package included $7 billion from the Children’s Health Insurance Program, mostly from an expired account that can no longer be used; $5 billion from Energy Department programs, including a little-used loan program for advanced technology vehicle manufacturing; and smaller amounts from a variety of other programs ranging from Forest Service land acquisition to the Millennium Challenge Corp…

January 16, 2020: Oregon Health Authority posted news titled: “Oregon Health Authority awarded up to $16 million to improve child health”. From the news:

Oregon will receive millions in new federal funding to develop better ways to reduce risks for children and prevent unnecessary hospital visits and foster care replacements.

The Oregon Health Authority (OHA) has been awarded $16 million over seven years from the Centers for Medicare and Medicaid Services (CMS) Integrated Care for Kids (InCK) Model to improve health for children and youth covered by Medicaid and the Children’s Health Insurance Program (CHIP) in five Oregon counties.

OHA will partner with the Oregon Pediatric Improvement Partnership (OPIP) at Oregon Health & Science University and local communities to better integrate services across behavioral health, physical health, and other family supports to meet the triple aim of better health, better care, and lower costs. OHA is one of eight awardees selected from across the country…

…The model will focus on supporting children and youth ages 0 to 21 who are covered by Medicaid and CHIP in Marion, Polk, Crook, Deschutes and Jefferson counties. The ultimate goal of the model is to provide effective child- and family-centered care in order to reduce hospital stays and out-of-home placements from children and youth such as foster care and residential behavioral health.

Research shows that many of the factors that determine health outcomes are related to social determinants of health and health equity. This funding aims to help health care providers align with other public programs such as child welfare, education, housing, nutrition, and maternal and child health to expand access to care for children and youth.

The funding includes up to $3 million for the first two years for planning and partnership development and up to $2 million for each of the five implementation years, with some funding contingent on performance…

November 11, 2020: Georgetown University Health Policy Institute Center for Children and Families posted a blog post titled: “What the Proposed “SUNSET” Regulation Means for Medicaid and CHIP”. It was written by Andy Schneider. From the blog post:

On November 4, the Department of Health and Human Services proposed to require itself to review almost every regulation it has ever issued, including those affecting Medicaid and CHIP. It did so by proposing a new regulation, which has the misleading acronym “SUNSET” (Securing Updated and Necessary Statutory Evaluations Timely). A more appropriate acryonym would be “JAMS” (Just Another Means of Sabotage). It’s a thinly-veiled effort to put the Department in a procedural straight jacked and “JAM up the works just in time for the onboarding of a new administration.

Under this proposal, almost all regulations that the Department does not review within certain periods of time will automatically expire. The public has until December 4 to comment (in the case of Medicare regulations, until January 4).

This proposal is not subtle. Nor is it random. It pairs nicely with the ironically-captioned “Good Guidance” proposal the Department published on August 20 targeting subregulatory guidance like Medicaid Director letters. Under the proposal, SMDs would not “have the force and effect of law” because they are not issued using notice-and-comment rulemaking process that produces regulations. Under last week’s proposal, regulations that have been issued through the notice-and-comment process would automatically expire unless the Department reviews the regulation before the expiration date…

…The Department is the Executive Branch agency responsible for implementing the Medicaid and CHIP statutes that Congress has enacted. To carry out this responsibility, the Department has, since the creation of these programs, relied on regulations and subregulatory guidance to inform states, providers, managed care plans, and beneficiaries about their duties and opportunities under these laws. Over the past three and a half years, the Department has used these same communications  tools, along with section 1115 waiver authority, to try to “transform” Medicaid. Having failed to do so, the Trump Administration is now trying to undercut the ability of the incoming Biden Administration to make the Department, and the programs it administers, work.

The proposal  would require the Department to conduct a retrospective review of almost all of its regulations, including those for Medicaid and CHIP, under penalty of expiration. It provides that Medicaid and CHIP regulations will expire at the later of: (1) two years after the proposal takes effect, (2) ten years after the regulation was originally promulgated (following notice-and-comment rulemaking procedures), or (3) ten years after the Department “assesses” and, if necessary, “reviews,” the regulation…

…How can a regulation that has been in effect for decades qualify for a ten-year reprieve?  First the Department would have to conduct an “assessment” to determine whether the regulation “currently has a significant economic impact upon a substantial number of small entities.” If the Department determines there is such an impact, it would have to “review” the regulation to determine whether it should be “continued without change, or should be amended or rescinded.”  If the Department determines the regulation should remain in place without any change, the regulation would continue. If the Department determines the regulation should be amended or rescinded, it has two years to do so (this can be extended one year at a time for up to five years). The proposal exempts some regulations, including itself, but few if any Medicaid or CHIP regulations would qualify.

Under this proposal, a “regulation” is not what most people think of as a “regulation”—i.e., the Access Rule or the Managed Care Rule. Instead, it’s defined as a section of the Code of Federal Regulations (CFR). For example, in the Managed Care Rule, at 42 CFR Part 438, there are 91 different sections of the CFR.  When its time comes, each section of the Managed Care Rule will need to be “assessed” and, if that section is found to have a significant economic impact upon a substantial number of small entities, it will need to be “reviewed.” This is true even though the Department has just amended the Rule.

…Of course, if the Department didn’t have the bandwidth to conduct these “assessments” and “reviews” for each “regulation” every 10 years, it could simply pick and choose which “regulations” it didn’t like and allow them to expire automatically. Easy peasy.

The Department argues that its proposal is authorized by the Regulatory Flexibility Act (RFA), which has been on the books since 1980. Now, forty years later—and three years and nine months into the Trump Administration’s term in office—the Department has discovered that the RFA requires that almost all of its regulations be put on an expiration clock…

…It turns out that the provision the Department cites—5 U.S.C. 610(a)—says no such thing. Instead, it requires each federal agency to “publish a plan for the periodic review of the rules issued by the agency which have or will have a significant economic impact upon a substantial number of small entities.” “Periodic” means a review every 10 years unless that is not feasible, in which case the review period can extend up to five more years.  The purpose of the review is “to determine whether such rules should be continued without change, or should be amended or rescinded, consistent with the stated objectives of the applicable statutes, to minimize any significant economic impact of the rules upon a substantial number of such small entities.”

The RFA does not provide for regulations to automatically expire if the issuing agency does not review them. Nor does it authorize agencies to impose such a regime on themselves. Nor does it even suggest that the Department can compress the “review” process for most Medicaid and CHIP regulations (as well as most other regulations issued by the Department) into the next two years…

What Happened After Congress Failed to Renew CHIP Funding is a post written by Jen Thorpe on Book of Jen and is not allowed to be copied to other sites.

If you enjoyed this blog post please consider supporting me Ko-fi. Thank you!


Leave a Reply

Your email address will not be published. Required fields are marked *