Children’s Health Program in Jeopardy

Children’s Health Program in Jeopardy

More than 81,000 in District Could Lose Coverage

Stacy M. Brown, Washington Informer | 3/19/2014, 3 p.m.

Courtesy photo

Funding for a federally administered health insurance program for children could end next year and jeopardize about 8 million youngsters who depend upon it to visit their doctors, emergency rooms and other medical facilities.

“As states are adjusting to a variety of health system changes, it is essential that Congress secure the Children’s Health Insurance Program’s future so that states can operate their programs without interruption,” Bruce Lesley, president of the Northwest-based national bipartisan children’s advocacy organization First Focus, wrote in a letter dated March 13 to lawmakers and co-signed by more than 400 local, state and national organizations.

While about 8 million are enrolled nationwide in the program – known as CHIP – more than 81,000 D.C. residents rely on the insurance.

CHIP provides health coverage to children in families with incomes too high to qualify for Medicaid, but who cannot afford private coverage.

The program, which started in 1997, provides federal matching funds to states for the coverage and federal spending climbed to $13 billion in 2013, approximately 8 percent more than the previous year.

“If the CHIP funding cliff is not addressed, important gains in children’s coverage would be lost,” Lesley said.

“While the Affordable Care Act holds great promise for the millions of Americans who have lacked an affordable coverage option, especially uninsured adults, it will take time and experience to know how new coverage options, eligibility rules, enrollment systems, policies and procedures, benefits, plans and provider networks are working to meet the unique health and developmental needs of children,” he said.

The Affordable Care Act (ACA) of 2010 extends CHIP funding through Oct. 1, 2015 and it provides an additional $40 million in federal funding to continue efforts to promote enrollment in Medicaid and CHIP.

However, some lawmakers and others have questioned the need to continue the program because of the coverage available under the ACA.

“We don’t want to destroy anything, but it’s not something that can continue in perpetuity either,” said Donna Checkett, a commissioner and vice president of business development for Aetna’s Medicaid division in Hartford, Conn.

MedPageToday.com, a news service for physicians that provides a clinical perspective on breaking medical news, reported that it’s difficult for policymakers to know how best to handle CHIP beneficiaries, given the ACA’s insurance exchanges are in their relative infancy.

“Exchanges are not yet ready to function as a strong pediatric policy,” said Sara Rosenbaum, a Medicaid and CHIP Payment and Access Commission (MACPAC) member and health policy professor at George Washington University in Northwest.

“Is it a good idea to make a universal marketplace function more responsibly for children? Or is it a good idea to keep a separate pediatric financing arrangement? Because every time children get thrown in with adults, you worry that things will skew toward adults,” Rosenbaum said.

MACPAC commissioner Judy Moore, a health consultant in Annapolis, Md., said the organization should work to recommend some sort of transition between the current CHIP program and one where children are fully protected and covered through plans on the ACA’s health insurance exchanges.

“Now is a time of transition to a whole new world in health care coverage and access, and I don’t think we should be pushing things that we don’t really understand very much about, while the world is settling out around health plans, and benefit design, and exchanges,” Moore said.

MACPAC commissioners will likely make their recommendation to Congress in a June report to lawmakers and, while it’s unlikely Congress will address the issue this year, it will be an issue in 2015, and states will be forced to deal with it in their budgets starting next year as well.

Officials at the American Academy of Pediatrics in Northwest said earlier this year that CHIP should HYPERLINK "http://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/CHIPstatement.aspx" t "_blank" be fully funded through at least 2019.

Those most at risk of losing coverage are the more than 5 million children who live in states where the CHIP program operates separately from Medicaid.

The program works well and it’s a bipartisan program with a strong track record of successes, at a time when nearly one in five children lives in poverty, said Olivia Potter, a pediatrician and a member of the American Academy of Pediatrics.

“As we commemorate the five-year anniversary of the last time CHIP was renewed, I urge you to contact your congressman and discuss the need to once again extend CHIP and invest in children’s health,” she said.

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