Three weeks after the Children’s Health Insurance Program (CHIP) expired, states are trying to find stop-gap measures to provide coverage for children and pregnant women until Congress passes legislation to reauthorize the program.
Officials from six states and the District of Columbia fear they’ll run out of CHIP money by the end of the year. Twenty-five more states worry funds will dry up in the first quarter of 2018. In Virginia, officials are warning 65,000 children and 1,100 pregnant women that they may no longer have coverage in January.
The Congressional Budget Office (CBO) has released an analysis of a CHIP five-year extension bill. The CBO said extending the program through fiscal year 2022 and making changes to the program, including revamping the federal matching rate, would increase the deficit by $8.2 billion by 2027.
There was hope that Congress would approve a reauthorization bill quickly, but Capitol Hill’s glacial speed means states are now faced with trying to figure out how to keep children and pregnant women covered. The Medicaid and CHIP Payment and Access Commission (MACPAC) warned that Congress’ inaction will affect state budgets.
CHIP advocates and state leaders are hoping Congress will approve a five-year reauthorization bill. A bipartisan group of senators agreed on a bill in September, but the measure got derailed because of the Republican push to approve the Graham-Cassidy ACA replacement bill. Graham-Cassidy died without a floor vote. Lawmakers have predicted reauthorization timelines varying from later this week to the end of the year.
CHIP covers 8.4 million children and provides maternity coverage for about 370,000 women. Created 20 years ago as a way to provide more health insurance coverage to children of families with low and moderate incomes, the program costs the federal government about $14 billion annually.
Congress has reauthorized the program periodically since its creation. CHIP has bipartisan support, and studies have shown the program helps reduce hospitalizations and child mortality and increase quality of care. When the program was created, 15% of children were uninsured. That number is now about 5% because of CHIP, the Affordable Care Act (ACA) and Medicaid expansion.
The Commonwealth Fund recently reported that CHIP will be “virtually gone” by next summer without congressional action. “The 4.7 million children who receive CHIP coverage through Medicaid will remain entitled to coverage through 2019, but only at normal Medicaid federal matching rates. Among the 3.7 million children enrolled in separate programs, an estimated 1.1 million could lose coverage entirely, while the rest could face reduced coverage and significantly higher out-of-pocket costs,” according to the report.
Beyond children and women losing healthcare and states faced with tough budgetary decisions, not reauthorizing CHIP also affects hospitals and providers, especially children’s hospitals. Children's hospital leaders worry the demise of CHIP would lead to more uninsured children and bad debt for hospitals.