While Congress has yet to come to an agreement on renewing long-term funding for the Children’s Health Insurance Program (CHIP), community health centers (CHCs), and several other health-related programs, states will have money to continue their CHIP programs through the end of December thanks to a provision of the two-week stopgap funding measure Congress passed last week. Funding for CHIP expired on September 30; according to the Washington Post, officials in nearly a dozen states are either already notifying families or are preparing to notify families that CHIP health insurance coverage may end soon due to lack of federal funding. States forced to end the program will need to determine whether enrolled children are eligible for the state Medicaid program or whether their family will need to seek insurance through a Patient Protection and Affordable Care Act marketplace plan.
Advocates fear this will cause confusion and undue stress for families, and ultimately, loss of coverage if Congress does not act soon. More than 9 million children currently receive health care coverage under CHIP. More than 26 million people visited CHCs at almost 10,000 locations nationwide. Failure to renew CHC funding could also lead to 161,000 jobs lost and $15.6 billion in reduced state economies, according to a new report.

The House passed (242-174) a bill to renew funding for CHIP, CHCs, and several other health-related programs on Nov. 3. While advocates were pleased that the bill included CHIP funding for five years, they disagree with how the House bill would pay for this funding, namely by cutting the Prevention and Public Health Fund by $6.35 billion over 10 years. Established by the Affordable Care Act, the fund provides vital support to state public health departments and the Centers for Disease Control and Prevention. The House bill also would increase Medicare premiums for higher-income enrollees.

According to Families USA, the House plan would also allow insurers under the Affordable Care Act to dramatically reduce “grace periods” for consumers who are late with a payment, and it would allow insurers to deny health care to pregnant women and children while back-office billing issues are being resolved. Advocates fear these changes would result in up to 500,000 people a year could lose coverage, and delays in care could lead to harmful birth outcomes and children’s developmental delays.

At present, the most likely path forward for long-term CHIP and CHC funding, as well funding for the Maternal, Infant and Early Childhood Home Visiting Program (MIECHV) and other health programs, looks to be as an add-on to a stopgap spending bill expected to be passed later this month to keep the government funded into January. Such a health package could also include legislation by Senators Alexander (R-TN) and Murray (D-WA) that would continue the payments to insurance companies (known as cost-sharing reductions, or CSRs) and legislation from Senators Collins (ME) and Nelson (FL) that would provide very modest funding for two years for states to set up reinsurance programs that help pay for high-cost patients. CSR payments cover the insurers’ costs of lowering deductibles and other out-of-pocket costs for lower-income marketplace enrollees. The Trump administration announced in October that it would halt CSR payments. Senator Collins made the enactment of these two bills a condition for her vote in favor of the Senate tax bill. However, the House has not agreed to their passage (see article on the tax bill elsewhere in this issue).

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