As September drew to a close, so did funding for the Children’s Health Insurance Program, or CHIP.
In Montana the program that’s jointly funded by the federal and state governments covers about 23,000 children.
If federal funding isn’t restored by Congress, most of those kids could lose their health coverage by as soon as January, according to the Kaiser Family Foundation.
Watching the situation closely is Health O’Loughlin, co-director of the Montana Budget and Policy Center in Helena.
I asked her about what CHIP coverage means for Montana families, starting with what kinds of care it covers.
Heather O'Loughlin: That would include routine checkups, preventative care, some dental and vision coverage, and also coverage for serious health conditions.
Eric Whitney: And kids qualify for CHIP based on their family income, right? What are the income thresholds for kids to qualify for CHIP?
HO: For a family of four, that income level is about $64,000 a year.
EW: The money for CHIP comes from both the federal and the state government, right? What's the breakdown, and if federal funding went away, would the state of Montana be able to fund the program without it?
HO: The federal match for the CHIP program varies, depending on what part of the program we're talking about. In some instances, the state receives significant federal match, upwards of 96 percent of the cost of health services. And that encompasses roughly 7,000 children, who the state is receiving that higher match amount. For those that are in the traditional CHIP program, the feds are picking up about 67 percent of the cost.
So, if Congress doesn't act to re-authorize CHIP funding, the state could be looking at a significant cost shift, and in some instances the state will be required to cover a certain population of children, and we will see an increase in state costs.
But for a lot of children who access coverage under CHIP, the question will really be to the state of whether or not they can afford to continue that coverage, and those costs will be quite significant to the state.
EW: The federal government requires the state to provide CHIP coverage to a certain segment of the population, whether or not the federal funding is actually there. How many kids would the state be required to keep on CHIP?
HO: Almost 7,000 children. For that population the state is likely going to have to pick up the additional cost, to cover those children.
EW: If there's a reduction in the number of kids who are able to get CHIP as a result of these funding issues, what kind of options to families have if the CHIP coverage goes away?
HO: Some of these families may be able to shift their children onto their parents employer sponsored plans, or marketplace plans that they may be accessing. So in some instances this could be a pretty significant cost shift to not only families, but also employers. But the reality is that other children are likely to lose insurance altogether.
If you think about the demographics and income levels of many of those accessing CHIP, many of these parents are working at low wages, and oftentimes don't have health insurance coverage through their employer.
If Congress doesn't act, I think we do run the risk of facing coverage losses for children in Montana.
EW: If there are significant coverage losses, fewer children having CHIP insurance, will that have an impact on pediatricians and hospitals and health care providers who rely on billing CHIP for their services?
HO: Absolutely. I mean we have certainly seen the children's health insurance plan play an important role in children's access to health coverage. Montana now has roughly 92 percent of children covered, and Medicaid and CHIP play an important role. So for those who are losing coverage, it will have an impact on health providers who are providing those services that will no longer have the ability to bill Medicaid or CHIP for that those services.
EW: So now that the Graham-Cassidy proposal to repeal the Affordable Care Act is no longer on the table, can this bi-partisan agreement you talk about to re-authorize CHIP - is that likely to come up for a vote do you think?
HO: Well, we hope so. I think in many states including Montana folks are shocked at Congress' inaction on a program that previously has had strong bi-partisan support. We are hopeful that Congress will act, and hopefully act quickly to restore the program's funding. I mean, Montana is one state that is currently facing this, but many other states are expected to run out of CHIP funds relatively quickly, so I think the hope is Congress will take this up quick.
EW: What's your sense of the politics? Is this sort of a no-brainer that both parties are going to continue funding CHIP, or what makes you think that the funding might be in jeopardy.
HO: I don't necessarily think that it's a no-brainer. I think there have been some who've been worried about whether or not Congress was going to move before the end of the federal fiscal year. We're certainly not taking anything for granted. We recognize it has had bi-partisan support in the past, so we are hopeful. We also recognize that Congress has been intent in moving on to tax reform. I think there's a question of priorities, and we're hopeful that Congress will hear from constituents that states that CHIP is really a critical program for kids health, and hopefully we'll see them move on something quickly.
EW: And there's a real timing issue here for Montana, right? Montana is one of the states where CHIP funding would run out faster than other states, is that right?
HO: That's right. We're kind of middle of the pack I would say, there are a number of states that are expected to run out of funds quickly, within a month or two. Based off of a survey that was conducted by the Kaiser Family Foundation, Montana has said that it would likely run out of funds in early 2018, so time is really of the essence, in order to give families in Montana a sense of certainty that they'll have coverage, but also the state a sense of certainty that we'll be able to access federal dollars to continue this coverage.
One of the biggest concerns that we face right now in Montana is just the situation with our current state budget. This is going to add even additional pressure, and that's a big concern if Congress doesn't act.