Today on a snowy day in DC, agreement was reached on the Senate health care bill making it likely that Senator Reid has enough votes to pass the bill before Christmas. The Senator also filed his Managers Amendment to the bill. The Congressional Budget Office followed soon after with the bill’s score.

Tucked between the more controversial provisions of the Manager’s Amendment are some noteworthy improvements to children’s coverage. This is good news for kids and due in large part to the efforts by children’s groups to raise the profile of these issues within the larger debate and the leadership of Senators Rockefeller and Casey. Some of the changes include:

• CHIP funding is continued for another two years (September 30, 2013 through September 30 2015). Originally, the bill provided funding only through September 30, 2013. This funding ensures that children can keep their CHIP coverage during a critical period when health reform is just getting off the ground.

• States will still need to maintain current Medicaid and CHIP eligibility and enrollment procedures for children above 133% of the FPL through fiscal year 2019. However, the amendment clarifies that states must meet this “maintenance of effort” requirement or lose their Medicaid funding.

• States will still receive the 23 percentage points increase in their CHIP match rate but its timing was delayed for two years. Now the increase will go into effect October 1, 2015. Since the bill assumes coverage will be maintained through 2019 but there is no funding after 2015, Congress will need to further revisit these funding issues.

• As before, if there is no federal funding children previously eligible for CHIP will be enrolled in the Exchange. The amendment strengthens this provision by requiring that children first be screened for Medicaid and, if eligible, enrolled. For children not eligible for Medicaid, the state must establish procedures to enroll the children in comparable coverage.

• The Secretary of HHS will be required to review and certify which plans in the Exchange provide CHIP-comparable benefits and cost sharing, but it is unclear what mechanism will be in place to ensure that these plans exist in the Exchange.

• Extends and increases funding provided in CHIPRA for Medicaid and CHIP enrollment and renewal activities. Now, $140 million (an increase of $40 million) will be available through 2015.

• Creates a new option for states to provide CHIP coverage to children of state employees eligible for health benefits. These children can now enroll in CHIP if the employee’s premiums and cost sharing exceeds 5 percent of the family’s income. To utilize this option, a state cannot have decreased its premium contribution for family coverage below 1997 levels (adjusted for inflation).

• Requires the Secretary of HHS to issue regulations to establish a more defined process for public input for section 1115 waivers in Medicaid and CHIP.

• Makes technical changes to tighten up the definition of cost-effectiveness in the new CHIPRA premium assistance option and removes the requirement that Medicaid programs do premium assistance as part of the Medicaid expansion in the underlying bill.

• Immediately prohibits insurers from denying coverage to children for pre-existing conditions. The new regulation would go into effect for adults with the rest of the legislation, in 2014.

We are still combing through the Manager’s Amendment and will keep you posted on other noteworthy changes.