Last week I attended and spoke at a wonderful child health symposium at West Virginia University’s John D. Rockefeller IV School of Policy and Politics. Senator Rockefeller was there sharing his inspiration and wisdom and emphasizing the bipartisan spirit in which the Children’s Health Insurance Program (CHIP) was born 20 years ago. Today, thanks to Medicaid and CHIP, West Virginia has brought its child uninsured rate down to just 3 percent.
As I returned to Washington, I felt frustrated and angry that it is September 12 and Congress has not yet taken action to extend CHIP’s funding — which expires on September 30. It’s encouraging to see the bipartisan support for CHIP on display at the Senate Finance Committee hearing last week, but words must be translated into deeds. At a time of great national instability, and after a yearlong debate in which Congress contemplated substantial cuts to publicly funded coverage, families and states need to be reassured that they can rely on the federal government to back up its commitment to keeping kids covered by funding CHIP ASAP.
Some complacency may exist because most states will likely have some carryover funding to tide them over for a few weeks or months according to estimates from MACPAC. A new report from the Kaiser Family Foundation found that more states (10) are expected to run out of funds by December. And virtually all states have included federal funding for CHIP in their already mostly completed state budgets.
Relying on carryover funds to allow Congress to delay needed action is completely unacceptable in my view. There are many wild cards here which all put children’s coverage at risk.
First, states may experience a quicker rate of spending for an unforeseen reason, such as Hurricane Harvey or Hurricane Irma. We know from past experience, such as Hurricane Katrina, that demand for Medicaid and CHIP increases in such disasters, and I would be very surprised if Texas and Florida (two of the largest separate CHIP programs in the country) don’t experience an increase in their CHIP costs as a result of these devastating storms. Both Texas and Florida have assumed full federal funding in their state budgets at CHIP’s current enhanced match rate.
Second, some states may have state statutory triggers that result in enrollment freezes or worse – West Virginia, for example, has a state statutory provision that the program will be shut down when “The effective date of any reduction in annual federal funding levels below the amounts allocated and/or projected in Title XXI of the Social Security Act of 1997.” The West Virginians I spoke to while I was in the state last week said it was unclear what the impact of allotments not being allocated by September 30 would mean. Arizona has an explicit trigger in state statute that directs the state to freeze enrollment if federal funding is reduced.
And as Sen. Heller (R- NV) explained at last week’s hearing, CHIP has helped Nevada achieve historic gains in child health coverage – an accomplishment of which both he and Governor Sandoval are justifiably proud. The improvement in health coverage for Nevada’s children will quickly change course if Congress fails to promptly fund CHIP.
Senator Heller has good reason to be concerned about the lack of action to extend CHIP funding. Nevada anticipates it will run out of federal funding by the end of November or early December. If funding is not extended soon, Nevada would potentially freeze enrollment on November 1 and end coverage on November 30. In order to give families at least 30 days’ notice of these changes, the state would need to send notifications to families by the beginning of October. The state has included federal funding for CHIP in its budget so a special state legislative session would be required if the federal funding were to change so policy makers could determine how to address the funding shortfall. This scenario will play out in Nevada and other states if Congress fails to extend CHIP by September 30.
My colleague Tricia Brooks, the former Director of New Hampshire’s CHIP program, has explained why states can’t just turn on a dime.
During these uncertain times, Congress should reassure families and states that they can rely on the federal government to back up its commitment to children’s health care by extending CHIP for five years. We have blogged before about how to do this, and as I have repeatedly said, this could be an easy, bipartisan victory of which Congress can feel proud.
[Editor’s Note: Senate Finance Committee leaders announced a bipartisan agreement to renew CHIP funding after this blog was published. The Senate and House of Representatives have not taken action yet.]