The House and Senate finally passed a continuing resolution that extends the Children’s Health Insurance Program for six years incorporating the policy language that is essentially the same as the deal that Senators Hatch and Wyden agreed to back in September. The fact that CHIP was extended 114 days after funding expired is unprecedented and not something to be proud of. Nor it is it a good advertisement for those who wish to bring block grant funding to the Medicaid .
While a six-year extension is extremely welcome news for the millions of families who rely on CHIP for their child’s coverage, and for states who have been walking a tightrope for months now, the fact that it took so long should never be repeated. One state, Connecticut, actually closed enrollment for the week after Christmas, and a handful of others sent or posted notices about the possible loss of coverage. Never before has CHIP found itself in such chaos.
We will post additional blogs and reports unpacking the language but here are a few toplines – the deal extends CHIP through federal fiscal year 2023 and required no offsets or “payfors” because of a new CBO score post repeal of the individual mandate. The current enhanced CHIP match rate continues “as is” for FFY18 and FFY19 and is then reduced by 11.5% in FFY20 (i.e. the enhancement is cut in half). In FFY21, states go back to CHIP’s regular match rate. Another important issue is the “maintenance of effort” which requires states to continue income eligibility levels that were in place as of the date of enactment of the ACA. This important provision which ensures that kids have a stable source of coverage remains, though states that are above 300% of the poverty line may roll coverage back to that level beginning in FFY 20.
Also, no offsets like those that were included in the House passed bill to take money out of the Public Health Prevention Fund were necessary due to CBO’s new scoring post repeal of the individual mandate. As my colleague Kelly Whitener blogged about, it would make more sense to do a ten-year extension which would actually save money. If Congress is feeling sensible, they could come back and add another four years.
Families have experienced needless anxiety. And we may see a chilling effect on enrollment from the many stories reporting on the expiration of CHIP funding not to mention states that sent notices about the possible loss of coverage. As one of my favorite CHIP directors once said, “Bad news travels fast.” We have been worrying all year that the combination of ACA repeal efforts and delays in funding CHIP may lead to fewer parents signing up their kids for coverage. Moreover, the current heightened fear of government being experienced in immigrant communities may also depress enrollment of children in “mixed-status” families – where a child is a citizen but the parent is not. All of this adds up to an “unwelcome mat” effect if you will, which may stagnate or reverse children’s coverage levels overall.
 There is an additional provision related to CHIP buy-ins that comes from the House passed version that we will talk about more in a future blog – we don’t think it is all that important because we believe that states could already do this…