Children's health funding hangs...

Children's health funding hangs in the balance as Congress leaves town

Families and governors wonder what's next after Congress approves enough funding for children's health insurance through March.

By JENNIFER HABERKORN and RACHANA PRADHAN

Congress is likely to depart Washington this week approving just enough money for children’s health insurance through March and leaving families and governors wondering what's next.

Only days after clearing a massive tax reform bill along party lines, Republicans are still trying to figure out how to keep the government open past Friday, with hopes of including funding for the Children’s Health Insurance Program, which covers roughly 9 million low- and middle-income kids. So far, Republican and Democratic sources say they don’t expect to be able to attach more than six months of CHIP funding, with three of those months retroactive to when Congress let funding lapse, on Sept. 30.

States would welcome the patch but warn that they still could be forced to shut down their CHIP programs or freeze enrollment in the near future without a more permanent source of dollars.

Republican and Democratic lawmakers have pledged to renew money for the popular bipartisan program. But CHIP has been caught up in partisan squabbling over how to pay for it, and the issue was pushed to the back burner as Republicans tried to repeal Obamacare and worked on tax reform.

Congressional leaders have used CHIP funding as a bargaining ploy to gather votes, by attaching it to more controversial measures.

"The problem you’ve got is that CHIP is so popular that there is this thought process that well, anybody who has another bill that they’d like to get through, if they can get it attached to CHIP, they have a better chance of getting it through, which causes problems for CHIP," said Sen. Mike Rounds (R-S.D.).

Sen. Rob Portman (R-Ohio) blamed the lack of a long-term solution on “leaders on both sides” and said GOP leadership told him CHIP won’t be fully funded “unless they do all this other stuff,” referring to more controversial measures.

Republican lawmakers were visibly frustrated that a permanent solution had not emerged but weren't threatening to withhold their votes on the spending bill and risk a government shutdown.

“We’ve got to get this done and it will happen next month for sure, no question about it,” said Rep. Fred Upton (R-Mich.), former chairman of the House Energy and Commerce Committee, which oversees the program. “I have no doubt — you can remind me of those words next month.”

Democrats are blaming Republicans for the dire state of funding, saying the GOP controls both chambers and could have made time for the matter.

Republicans “were so determined to spend all their time on a bill giving tax breaks to wealthy people, they’ve ignored the basics,” said Sen. Dick Durbin (D-Ill.).

House Republicans late on Wednesday introduced a bill to fund CHIP for six months as well as allow the federal government to extend emergency funding to states whose programs are on the brink of running out of money. House and Senate leaders are still negotiating a broader government spending package and the CHIP funding levels could change.

It's unclear whether the $2.85 billion in the House bill plus federal emergency funding would adequately cover CHIP's costs through March. States and Democratic aides say the CHIP money in the stopgap funding bill will be depleted before then. CMS has also provided guidance that states are spending money faster than originally projected.

CMS also had roughly $3 billion in leftover CHIP funds from prior years to give to states, but as of early December the agency had already distributed nearly $1.2 billion to keep programs open in 16 states and the District of Columbia.

The House plan calls for funding the government until Jan. 19. At that time, lawmakers expect to enact a long-term spending plan and revisit a host of other issues, possibly including a longer-term CHIP reauthorization.

A six-month patch is likely to give some breathing room to several states that were set to freeze enrollment next month or shut down their programs altogether at the end of January absent congressional action. Virginia, Colorado, Utah, Alabama and Connecticut were among the states that were planning to close their programs on Jan. 31.

“I think it would keep programs open in January. I don’t know that it would keep programs open through February," said Maureen Hensley-Quinn with the National Academy for State Health Policy, which is in regular touch with state CHIP officials. “I think it’s giving them some hope that they will have a bit more time."

In Virginia, the top official overseeing that state's CHIP program says the short-term funding patch will solve the state's budget problem for January. But officials have to see whether it will be enough to sustain the program through February, Linda Nablo, chief deputy director of Virginia's Department of Medical Assistance Services, wrote in an email Thursday.

Virginia earlier this month sent notices to children and pregnant women that their coverage could end on Jan. 31.

Alabama has confirmed that the state won't freeze enrollment on Jan. 1 should Congress pass the new CHIP funds, Hensley-Quinn said. Several states will delay sending notices warning enrollees they could be dropped, reasoning they could cause unnecessary alarm.

But the reprieve won't last for long if Congress doesn't come through with a long-term funding extension, and states are likely to still plan for program shutdowns in the near future. The National Governors Association on Thursday again called for Congress to pass a five-year funding bill before Congress leaves town for the year.

“I don't think it’s an exaggeration to say they’re feeling a little chaotic right now," Hensley-Quinn said.

The House bill would also provide $550 million in funding to community health centers by cutting Obamacare’s Prevention and Public Health Fund. Funding for Community Health Centers also expired on Sept. 30.