States Gird for Worst as Congress Wrestles with Children’s Insurance Program


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Federal officials on Monday approved a $3.6 million emergency infusion for Minnesota after the state’s human services chief warned that pregnant women and some children were at imminent risk of losing health care coverage under the Children’s Health Insurance Program.

Utah, meantime, has formally requested authority to “eliminate eligibility and services under CHIP” if the state does not have enough money to continue coverage.

In statehouses around the country, officials are preparing for the worst as lawmakers in Washington struggle to find money for the popular Children’s Health Insurance Program, which insures nearly nine million children but lost its spending authority on Sunday, with the start of the new fiscal year.

Congress has known for two years that federal funds for the Children’s Health Insurance Program were expiring this fall. But only on Wednesday are two congressional panels — the Senate Finance Committee and the House Energy and Commerce Committee — tentatively scheduled to vote on legislation that would provide money for the program for another five years.

And the two chambers have not agreed on how to pay for the measures.

“We know that there is a desire in Congress to provide the funds, but we have heard that same sentiment all through the spring and the summer,” said Nathan Checketts, the deputy director of the Utah Health Department. “Congress needs to get this done as soon as possible, so states do not have to begin notifying people that their coverage may end.”

The Utah program covers 19,000 children.

Most states still have unspent funds that will last several months. But some are drafting contingency plans in case Congress does what it has done so often: fails to reach an agreement. A federal panel that advises Congress on the Children’s Health Insurance Program says that more than half the states are expected to exhaust all their CHIP funds within six months.

By the end of this year, Arizona, Minnesota and North Carolina are likely to run out of money for their programs, according to the panel, the Medicaid and CHIP Payment and Access Commission.

By March 2018, it said, CHIP funds will be exhausted in 27 additional states, including California, Colorado, Connecticut, Florida, Massachusetts, New York, Ohio, Oregon and Pennsylvania. Another 19 states are expected to use up their money from April to June 2018, with one state exhausting its funds from July to September 2018.

Gov. Andrew M. Cuomo of New York, a Democrat, said Tuesday that Congress’s failure to act jeopardized coverage for 330,000 children in the state.

Representative Pete Sessions, Republican of Texas, said the need was “not dire or urgent.” Republicans, he said, intend to provide the funds, so “the money that is necessary to keep this program going is not in jeopardy.”

But Democrats accused Republicans of willful inattention.

“If making sure that every child in America has access to health care, if that is not a priority, what is?” asked Representative Jan Schakowsky, Democrat of Illinois. “Families are waiting anxiously while their health security is hanging in the balance.”

Action in the Senate was delayed for several weeks as Republicans made repeated unsuccessful attempts, in July and September, to pass legislation that would have repealed much of the Affordable Care Act.

CHIP is for children in families that make too much to qualify for Medicaid but not enough to afford other coverage. Nearly 90 percent of children in the program had family incomes less than twice the poverty level (less than about $40,000 a year for a family of three).

Even if congressional committees can agree, it is not clear how soon legislation will emerge from Congress. The Senate plans to be in recess next week, and the House is expected to be in recess in the following week.

The Senate bill is a bipartisan measure, drafted by Senators Orrin G. Hatch, Republican of Utah, and Ron Wyden, Democrat of Oregon. Mr. Hatch, now the chairman of the Finance Committee, helped create the child health program in 1997 and says he is eager to extend it.

In the House, some Democrats have expressed concerns about the bill drafted by House Republicans because, they say, it would pay for continuation of the CHIP program by cutting other health spending. Some House Democrats have suggested offsets that would instead reduce payments to pharmaceutical companies.

Under federal law, states receive annual allotments of federal CHIP funds. They have two years to spend their allotments, and unspent money is then available for redistribution to other states. The money sent to Minnesota this week came from that pool of unspent funds.

The Senate and House bills would each provide a total of $118.5 billion over five years, but under arcane budget rules, Congress needs to offset less than 10 percent of that cost. The Congressional Budget Office assumes that if the program ended, some children would become uninsured, but the federal government would help provide coverage for others, through Medicaid or through private insurance subsidized under the Affordable Care Act.

The federal government and the states have historically shared the cost of CHIP, with Washington paying approximately 70 percent of the cost in a typical state. The Affordable Care Act increased the federal share by 23 percentage points, with the result that the federal government has been paying the entire cost in 11 states.

The Senate and House bills would continue the 23 percentage point bonus in 2018 and 2019, cut it in half in 2020 and eliminate it in 2021 and 2022.

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