In the current negotiations to pass a spending bill and reopen the government, one of the biggest bargaining chips is CHIP — the Children's Health Insurance Program that provides insurance coverage to children from poor families across the country. As it stands, these CHIP enrollees could lose their health coverage as soon as the end of February in some 20 states and Washington, D.C. That means about 1.7 million children could be without insurance in about a month.
These numbers come from a study by the Georgetown University Health Policy Institute that considered what had happened since Sep. 30, 2017, when the federal government expired. First states could use money from a pool of unused money from prior years. That was expected to run out for some children now, in January. But then in December Congress passed a continuing resolution to keep the government open that included $2.85 billion "patch" for CHIP. That is what lengthened the timeframe from January to February.
The reason that different states will run out at different times is because they run their programs at the state level. This makes it very complicated and difficult to predict who will lose coverage and when because some states pay for the health care coverage in advance, others are billed after the fact by the medical providers. Some states also have set fees to the medical providers that include all medical care and other states pay per service.
As the report explains, "in small, fee-for-service CHIP programs," it would just take one expensive or "catastrophic" health event like a transplant or cancer treatment that would cause their spending to spike and money to run out.
The Georgetown study says there is a chance that all of February will be covered, but then what will happen next is anyone's guess:
It has become increasingly difficult to predict how long funds will last for any particular state. This uncertainty and the ongoing inaction by Congress increases the likelihood that states will take action to prepare families for the worst.
That means that parents will receive letters in the mail telling them that the coverage will cease. Some states, especially those who must pay in advance could start sending them soon. Back before the last extension in December, states had already begun to prepare letters and send them out, warning about lapses in coverage.
Not every child on CHIP's parents will receive one because of the way that different states provide the coverage. For anyone who receives CHIP through their state's Medicaid program, they don't have to worry about losing coverage thanks to a provision of the Affordable Care Act, or Obamacare. This doomsday scenario being discussed therefore only applies to CHIP-only programs that states have set up.
The emergency pool set up in December will be spent on a first-come, first-serve basis. So no states are guaranteed their own portion of the money if their traditional funding lasts longer.
The best option for CHIP is for Congress to pass a bill that would reauthorize it for this next fiscal year. Even better for advocates of the program would be a multi-year authorization, and some members of Congress are pushing for a bill that would reauthorize the program for as long as six years.
Paul Ryan, the Speaker of the House, has tried to use the budget stalemate to blame the lack of CHIP funding on Democrats, but it is the Republicans who control both houses that let the program's funding lapse by not holding a vote on the matter in the fall.
A total of 9 million children across the country are insured using the program. The longer CHIP is unfunded, the more likely more children will find themselves without insurance coverage.