Uncertainty about the future of an insurance program for children is sparking panic at the state level as officials scramble to keep their coverage going.
Federal funding for the Children’s Health Insurance Program (CHIP) expired a month ago, and states are dipping into unspent money or asking for help from the Trump administration to maintain coverage until Congress reaches a deal to extend it.
“There’s a certain level of frustration with the uncertainty,” said Trish Riley, the executive director of the National Academy for State Health Policy, which met Monday with most state CHIP directors during the organization’s annual conference.
“These are folks who have to run programs, and there’s lots and lots of uncertainty about whether or when the financing will come through — and how.”
Some states, like Virginia and Utah, are considering sending notices out to enrollees saying they may lose coverage without action from Congress.
Advocates worry the notices could cause confusion among the families of the 9 million children who receive insurance through the program, potentially leading to a decline in enrollment.
It’s a catch-22 for the states. They don’t want consumers to panic unnecessarily, but they also want to ensure there’s time for enrollees to find new coverage, if it comes to that.
“The bottom line is, I don’t think any state wants to send notices because they know that it’s harmful,” said Joan Alker, executive director of Georgetown’s Center for Children and Families. “It needs to happen if it needs to happen, but it also is likely going to depress CHIP enrollment, so they’re really walking a tightrope on this one.”
State officials in Colorado and Utah told The Hill they could send out notices to enrollees warning about possible changes in coverage as soon as November.
In Washington state and Virginia, notices will be sent out Dec. 1 if Congress doesn’t act.
Meanwhile, five states and Washington, D.C., are estimating they could run out of funds by the end of this year or early January, according to a report from Georgetown’s Center for Children and Families.
Arizona expects its funds to last through November or December, while Minnesota currently has enough to last through next month. California has enough funding to last through late December or early January, while Ohio and Oregon expect to run out in December.
It’s hard for the states to know for sure how long the money will last, further stoking anxiety.
“Not only is it constantly changing when states will run out of money, as we say [in the report], it’s impossible to predict exactly when that’s going to be,” Alker said, adding she and her colleagues had to revise the report’s estimates “literally every single day” with new information.
The estimates are constantly updated because it takes time for claims to come through. Consumer behavior also has an impact because people tend to use their health insurance more if they fear it will end soon, Riley said.
Reauthorizing CHIP is usually a bipartisan affair, but the House is set to vote this week on a five-year, partisan bill. Democrats oppose how Republicans want to pay for the program — such as charging wealthy Medicare beneficiaries more and gutting ObamaCare’s public health fund. The parties reopened negotiations on the bill earlier this month, but couldn’t come to an agreement.
A Democratic leadership aide told The Hill that the expectation is most of the party will oppose the bill if the offsets don’t change. This could cause an issue in the Senate, where the bill needs bipartisan support to pass.
“By bringing a partisan bill to the floor, House Republicans are virtually guaranteeing that these essential programs will not be reauthorized until the end of the year,” said Rep. Frank Pallone Jr. (D-N.J.), the ranking member of the Energy and Commerce Committee.
“This delay causes unacceptable uncertainty for millions of kids and families who rely on CHIP and Community Health Centers for their health.”
On the other side of the Capitol, the Senate Finance Committee has passed a bipartisan five-year reauthorization of CHIP, but hasn’t yet determined how to pay for it. It’s unclear if the chamber will take up the House bill.
In Washington, most expect that CHIP will be funded before Congress breaks for the winter holidays. The funding could be included in a year-end spending bill, but a vote could also occur sooner. It doesn’t help that the Senate faces a jam-packed schedule in the coming months as lawmakers try to work on tax reform and to confirm judicial nominees.
“[CHIP] is available to do, but I suspect it may be part of the year-end legislation, but I don’t know,” said Senate Majority Whip John Cornyn (R-Texas.)
Cornyn blamed the Senate’s failure to reauthorize CHIP faster on Democrats, saying they are holding up judge nominations and, thus, requiring the Senate to burn time on the legislative clock.
“This is part of the pattern we’ve seen since the beginning of the Trump administration, of stringing things out, obstructing, dragging feet, and so unfortunately, popular bipartisan things like the Children’s Health Insurance Program reauthorization suffers as a result.”
The decision to schedule floor time for a CHIP bill is ultimately up to Senate Majority Leader Mitch McConnell (R-Ky.).
Some advocates are worried about CHIP being thrown into the end-of-year spending talks, given the potential for deadlock and delay as the parties battle over other priorities.
“End of the year is not exactly great news,” Riley said, adding, “the sense of urgency is palpable.”
“Ideally, CHIP would get done sooner rather than later because of the uncertainty and states being forced to act,” said Jane Sheehan, a senior government affairs manager at Families USA, a health-care advocacy nonprofit in D.C.
“It’s complicated because Congress has a lot to deal with in December. For it to get wrapped up in all the end of year stuff is concerning.”
Some states have been working with the Centers for Medicare and Medicaid Services (CMS) to obtain funds to hold them over until Congress passes a deal.
So far, CMS has awarded $230 million in unused funds available for redistribution to nine states and U.S. territories, and more could be awarded in the coming weeks.
Oregon was told by CMS it’s eligible for $51 million in funds to help the state until mid-December — past that, it would need to discuss other options with its state legislature, said a spokesperson with the state’s health authority.
Minnesota received $3.6 million to carry it through October and on Friday said it expects to receive an additional $1 million to carry it through November.
While helpful, these unused federal dollars only provide funding for another one to two months, according to the Georgetown Center for Children and Families’ report.