Medi-Cal Enrollment Among Immigrant Kids Stalls, Then Falls. Is Fear To Blame?

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Source: Kaiser Health News

As California prepares to expand Medicaid coverage to young adults living in the state illegally, the number of undocumented immigrant children in the program is slowly declining, new state data show.

Unauthorized immigrant children have been eligible for Medi-Cal, the state’s Medicaid program for low-income residents, since May 2016, and their enrollment peaked nearly a year later at 134,374, according to data from the state Department of Health Care Services.

Since then, enrollment has stayed mostly flat or fallen. Last February, the latest month for which data are available, 127,845 undocumented immigrant children through age 18 were enrolled in Medi-Cal, down about 5% from the April 2017 peak.

This drop mirrors statewide and national trends for all children enrolled in Medicaid and the Children’s Health Insurance Program, a separate public program that some states use to cover low-income children.

From December 2017 to December 2018, overall child enrollment in both programs dropped 2.2% nationally and 3% in California, according to a recent report from Georgetown University’s Health Policy Institute.

Some experts attribute the enrollment drop among all children to a strong economy because more people have jobs — and access to employer-sponsored health insurance. But Medicaid researchers say there are likely other factors at play for immigrant children.

The decline in their enrollment is more likely due to a shift in migration patterns and rising fear among their families in response to anti-immigrant rhetoric and federal crackdowns on unauthorized immigrants, said Edwin Park, a health policy research professor at Georgetown University.

“It’s likely the overall hostile environment for immigrant families is playing a critical role in enrollment,” Park said. “You should have seen a continued ramp-up” in sign-ups because the program is still relatively new. California along with Illinois, Massachusetts, New York, Oregon and Washington, plus the District of Columbia, provide public health coverage for undocumented immigrant children.

Last year, California allocated $365.2 million to cover these children. Even though Medicaid is a joint state-federal program, California must pay for the expanded benefits for unauthorized immigrants itself.

Starting next year, as part of the 2019-20 state budget signed last month by Gov. Gavin Newsom, the state will expand Medi-Cal coverage to young adult unauthorized immigrants ages 19 through 25. Officials estimate 90,000 young adults will join in the first year.

President Donald Trump criticized California’s move and threatened to “stop it.”

“The Democrats want to treat the illegals with health care and with other things, better than they treat the citizens of our country,” Trump said on July 1.

The state Department of Health Care Services, which administers Medi-Cal, said undocumented immigrant children might be leaving the program because they age out of eligibility when they turn 19 or move out of state.

Randy Capps, director of research at the Washington, D.C.-based Migration Policy Institute, said a shift in immigration patterns into and out of California could also affect their enrollment.

The number of people coming into the country illegally is down, especially from Mexico, according to a Pew Research Center report released in June. That is notable in California, where Mexican nationals make up the majority of the state’s undocumented immigrant population.

The report estimates there were 4.9 million unauthorized immigrants from Mexico in the U.S. in 2017, down from 6.9 million in 2007.

“All data suggest a downward trend on illegal immigration, especially of Mexican origin,” Capps said.

In California, “with the recent economic boom, that may be accelerating because the cost of living is escalating astronomically,” he said. “Housing is becoming prohibitively expensive for undocumented immigrants in large parts of the state.”

Although there have been an increasing number of Central American migrants trying to enter the U.S. at the southern border this year, most are claiming asylum and are not considered undocumented immigrants.

As a result, most of those children wouldn’t qualify for Medi-Cal under this program, explained Gabrielle Lessard, a staff attorney with the National Immigration Law Center.

But the rhetoric surrounding the Central American refugees has been heated, and Trump has made tough talk on immigration a centerpiece of his presidency.

Last month, Trump warned of “massive” deportation raids that would have targeted about 2,000 families — but they were postponed after he gave members of Congress time to make changes to asylum laws. He said the raids might begin this week.

His administration also has pursued policies targeting immigrants. For instance, last fall, the federal government introduced its “public charge” proposal, which would consider immigrants’ use of public benefit programs including Medi-Cal, CalFresh and Section 8 housing vouchers as a reason to deny lawful permanent residency — or green card status.

That proposed rule has not taken effect, and it’s not clear whether it will. If implemented, the policy would mostly affect legal immigrants, but it could also affect undocumented immigrants should they become eligible to seek legal status in the future.

In response, unauthorized immigrant families have been forgoing care, missing doctors’ appointments and asking whether they should disenroll from Medicaid coverage, health centers across California and the country have reported.

Lessard suspects that unauthorized immigrants could be pulling their children out of Medi-Cal or simply not renewing their coverage.

“This community has been so terrorized by the administration that people are afraid to show up to their appointments at health centers,” she said. “So the prospect of giving your information to the government, even though it’s the state government, is really terrifying to a lot of people.”

AHA Among Groups Opposing Price Transparency in Info-Blocking Rule

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Source: Modern Healthcare

Healthcare groups including the American Hospital Association came out strong against a suggestion that the Office of the National Coordinator for Health Information Technology require providers to disclose price information as part of its proposed rule.

The ONC in February released its long-awaited information-blocking proposal as a companion to the CMS’ interoperability proposed rule. The ONC’s rule outlines how regulators will require providers to share health data with patients, as well as steps to discourage healthcare organizations from creating barriers to data exchange.

But what data is included in that mandate has proved a point of contention.

In its proposal, the ONC asked stakeholders to weigh in on whether providers should offer patients information on how much they would be charged for certain services. “ONC has a unique role in setting the stage for such future actions by establishing the framework to prevent the blocking of price information,” the rule reads.

However, adding price information to the broader umbrella of health data that’s required to be shared with patients would go “well beyond what Congress intended and would seriously harm patients, hospitals and other healthcare providers,” the AHA wrote in a letter to the agency, arguing that the mandate extends past the goals of the 21st Century Cures Act. The data-blocking rule was a provision of the 21st Century Cures Act.

One of the AHA’s concerns is that publicly sharing price information would disrupt negotiations with payers.

Blue Shield of California raised a similar concern in a letter to the ONC, suggesting the agency should solely focus on providing patients with information on out-of-pocket costs, rather than on providers’ negotiated rates with health plans.

“We urge ONC to ensure any future proposals related to pricing information exclude plans’ proprietary pricing information and protect market negotiations between health plans and providers,” the health insurer wrote.

Other groups were more supportive of the idea, although they requested the ONC separate any rulemaking on price information from the information-blocking proposal.

The federal Health Information Technology Advisory Committee in May cautioned that tying price transparency to the information-blocking proposal would have an “unintended consequence of slowing down the finalization of the current ONC rule,” and recommended the ONC convene a price-transparency task force to consider the idea.

“As a task force, we absolutely agreed that we want to enable price transparency,” Andrew Truscott, co-chair of HITAC’s information-blocking task force and Accenture’s managing director for health and public service, said at the May meeting. “We believe that (price transparency) needs to be given a focus.”

Software company Wolters Kluwer voiced a similar sentiment in a letter to the ONC.

“We generally support including price information within the scope of (electronic health information) for purposes of information blocking, but not in the short-term,” the company wrote, noting price information is difficult to calculate, as it it requires knowing details of an individual patient’s insurance status.

“Factors such as insured status, in-network status, insurance deductibles, insurance co-pays and co-insurance add significant complexity to presenting usable information on price and until those factors are adequately addressed, it makes little sense to include price within the definition of EHI,” Wolters Kluwer wrote.

However, a review of individual comments submitted to the ONC—many of which come from patients sharing stories about expensive medical treatments—suggested there is demand for improving how providers share information on price. One submission from an anonymous commenter simply reads: “We want price transparency!”

Holy Name Medical Center in Teaneck, N.J., also expressed support for the inclusion of price information, arguing that current guidelines related to chargemaster prices are “woefully insufficient” as “the public should have the right to see which hospital systems and healthcare providers are driving higher costs.”

“The current healthcare market is a complex system of secret deals and discounts between insurance companies and healthcare providers,” the hospital wrote to the ONC. “In order to truly lower costs for consumers, we need greater transparency in the marketplace.”

As More California Kids Drop Medi-Cal Coverage, Experts Seek Answers

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Source: California Health Report

More than 150,000 California children dropped out of federally funded health insurance programs in 2018, a trend some experts blame on the Trump administration’s anti-immigrant policies and efforts to upend the Affordable Care Act.

Enrollment in California’s low-income health program, called Medi-Cal, and the low-cost Children’s Health Insurance Program (CHIP) dropped 3 percent in 2018, according to a report by the Georgetown University Center for Children and Families. That’s a total of 152,515 children leaving the two programs.

The enrollment drop follows stagnation in California’s uninsured rate among kids in 2017, reversing years of growth in health coverage rates following implementation of the Affordable Care Act.

It’s not yet clear whether these children have lost health insurance coverage altogether, or enrolled in private insurance plans. Health policy advocates and the report’s authors say it’s likely that at least some of decline is a result of wary immigrant families pulling eligible children out of government health insurance programs. Federal attempts to undermine Affordable Care Act reforms, such as by removing the individual mandate for people to enroll in health insurance, may also play a role, they said.

“The loss is alarming,” said Michael Odeh, health policy director for Children Now, a children’s health advocacy group. “We’ve seen an uptick in the number of uninsured kids from other data, so this declining enrolment and lowering of participation in Medi-Cal is truly concerning.”

California’s loss of young Medicaid and CHIP enrollees is part of a national trend. Across the country, more than 820,000 children left the programs last year, the Georgetown report found.

The California Department of Health Care Services attributed the decline to improvements in the economy and the state’s low unemployment rate. In a statement, department spokesman Anthony Cava said it’s likely more families are gaining job-based health insurance and earn too much to qualify for Medi-Cal.

“Medi-Cal enrollment is typically counter cyclical.  During economic downturns, enrollment rises as individuals may see declines in income and/or the loss of jobs that provide for health care coverage. This can create a demand for Medi-Cal coverage,” he wrote. “Conversely, during economic expansions, the demand for Medi-Cal coverage declines, as job opportunities and incomes increase.”

But report co-author Edwin Park, aresearch professor at Georgetown University’s McCourt School of Public Policy, said economic growth is not enough to explain the drop in enrollment. Although enrollment in Medi-Cal and CHIP typically slows during a strong economy, it’s unusual for it to go down, he said. What’s more, the loss of children in the programs is happening across the country, even in states where the unemployment rate is stagnant or has increased, Park added.

“There weren’t any particularly noteworthy changes in economic indicators in (2018) that could explain a sudden reduction in the number of people eligible or a big increase in alternative forms of coverage like employer-sponsored insurance,” he said.

Pending bills in the state legislature to reinstate the individual mandate and to make health insurance more affordable could help keep more children insured, Park said. The state should also double down on outreach to low-income and immigrant families to reassure them it’s safe to enroll their children in Medi-Cal and to educate them on the benefits of having health care, he and Odeh said.

Nevertheless, Park said the data shows California can “only do so much,” in the face of hostile federal policies.

“The national headwinds were hard and likely were contributing to the Medicaid and CHIP enrolment decline in 2018,” he said.

Kids without insurance “may end up in poor health, do worse in school and over the long term have poorer health and other life achievement outcomes than they would if they had health coverage,” he said. “These are all very troubling, worrisome signs.”

Government Shutdown Ends, CHIP Funded for 6 Years

Image result for CHIP Funding imagesSource: The New York Times

Congress brought an end to a three-day government shutdown on Monday as Senate Democrats buckled under pressure to adopt a short-term spending bill to fund government operations without first addressing the fate of young undocumented immigrants.

The House quickly approved the measure — which will fund the government through Feb. 8 and extend funding for the popular Children’s Health Insurance Program for six years — and President Trump signed it on Monday night.

The agreement also revealed fissures among Democrats, with about one-third of the party’s members in the Senate and a majority in the House voting against it.

The passage of the measure ended an ugly, if short-lived, impasse that threatened to give a black eye to both major political parties. The deal, reached after a bipartisan group of senators pushed their leaders to come to terms, enables hundreds of thousands of federal employees who had been facing furloughs to go back to work.

But a key part of the deal, a pledge by Senator Mitch McConnell, Republican of Kentucky and the majority leader, to allow an immigration vote in the coming weeks, sets the stage for a battle over the so-called Dreamers, young undocumented immigrants who were brought to the United States illegally as children.

Lawmakers in the House and Senate are offering drastically different visions of how to resolve their fate. But those on both sides of the debate, as well as advocates for immigrants’ rights, said that ultimately Mr. Trump would need to get involved for the immigration dispute to be settled.

Mr. Trump’s intentions were hard to discern, even as he took time to jab at the Democrats.

“Big win for Republicans as Democrats cave on Shutdown,” the president said on Twitter at 11:30 p.m.

The message continued: “Now I want a big win for everyone, including Republicans, Democrats and DACA,” referring to the Dreamers, “but especially for our Great Military and Border Security. Should be able to get there. See you at the negotiating table!”

The vote in the Senate was lopsided: 81 senators voted to end the shutdown while 18 — two Republicans and the rest of the Democrats and an independent who caucuses with them — sided against the measure. In the House, the vote was 266 to 150, with about three-quarters of Democrats opposed.

The measure also shored up the Children’s Health Insurance Program, known as CHIP, which insures nearly nine million children. States had warned that they were on the verge of having to end coverage after Congress allowed funding for the program, which had been created and sustained for two decades with bipartisan support, to expire in September.

The votes came after a weekend of fevered negotiations by a bipartisan group that eventually grew to include about 25 senators, who helped put together a framework in which Democrats would vote to reopen the government in exchange for the promise from Mr. McConnell.

An apparent turning point came when Mr. McConnell took the Senate floor on Monday morning to announce that he would ensure a “level playing field” on immigration — language that some Democrats interpreted as going further than he had before. Mr. McConnell said he would have the Senate take up immigration legislation by mid-February if the issue had not been resolved by then.

“I sat on the floor and listened to him very intently, somewhat holding my breath,” said Senator Angus King, independent of Maine, who caucuses with the Democrats. “I think the majority leader has made a public commitment that it would be very hard for him not to meet.”

But Senator Kamala Harris, Democrat of California, was unconvinced, and voted against the bill. She suggested that she did not trust Mr. McConnell.

“I refuse to put the lives of nearly 700,000 young people in the hands of someone who has repeatedly gone back on his word,” she said.

Immigrants’ rights activists were crushed.

“Last week, I was moved to tears of joy when Democrats stood up and fought for progressive values and for Dreamers,” said Frank Sharry, the executive director of America’s Voice, an immigrants’ rights group. “Today, I am moved to tears of disappointment and anger that Democrats blinked.”

Hundreds of thousands of young immigrants have been protected from deportation under an Obama-era initiative, Deferred Action for Childhood Arrivals, or DACA. Mr. Trump rescinded the program in September and gave Congress six months, until March 5, to come up with a replacement.

But the president has demanded that border security — including money for the “big, beautiful wall” he has promised at the southern border with Mexico — be included in any package. Mr. Trump also wants limits on what critics call “chain migration,” in which immigrants can sponsor their relatives, and an end to the diversity visa lottery, which fosters immigration from countries that are underrepresented.

A bipartisan group of six senators, led by Richard J. Durbin, Democrat of Illinois, and Lindsey Graham, Republican of South Carolina, has proposed the backbone of an immigration deal that backers hope could garner 60 votes, enough to break a filibuster.

But Mr. Trump has rejected that plan. And the measure is almost certainly a nonstarter in the House, where Speaker Paul D. Ryan has promised a vote on a conservative immigration measure championed by the chairmen of the Judiciary and Homeland Security Committees, if it has the support to pass.

“If we are hoping that Paul Ryan is going to have courage and that the House Republicans are going to be fair and decent and that a bill could emerge, we’re smoking something,” Mr. Sharry said.

Monday’s Senate vote exposed a rift between moderate Democrats who are up for re-election this year in states won by Mr. Trump and their more liberal counterparts.

One of those Trump-state Democrats, Senator Bill Nelson of Florida, characterized the vote as a “big win for the Dreamers,” adding that if the Senate passes a measure with more than 60 votes, it would “put a lot of pressure” on the House to act.

But more liberal Democrats, including Senator Richard Blumenthal of Connecticut, who voted against the spending measure, disagreed.

“The lesson to me is that a promise here is far less meaningful when there is no involvement by the House, not to mention the White House,” he said, adding that he has “no confidence, zero, that Paul Ryan will bring a measure to the floor, in fact on the contrary.”

Mr. Graham said it was critical that the Senate’s eventual immigration bill have the support of a broad bipartisan majority of perhaps 70 senators.

“A partisan product doesn’t get you to where you want to go,” he said. “If you’re going to make the play of trying to pick off a handful of the other side, it’s going to crash and burn.”

The shutdown crisis began Friday, after talks between Senator Chuck Schumer of New York, the Democratic leader, and Mr. Trump to keep the government open broke down when the president and his chief of staff demanded more concessions on immigration.

According to one person familiar with that day’s discussion, Mr. Schumer agreed to more military spending and discussed fully funding the president’s request for a border wall in exchange for an agreement from the president to support legalizing the Dreamers.

Late that night, an overwhelming majority of Democrats, joined by a handful of Republicans, voted to block consideration of a spending bill very much like the measure that passed Monday. The only difference is that the initial bill would have funded the government for four weeks, not three.

A round of partisan finger-pointing ensued, with Democrats calling the impasse the “Trump Shutdown” and Republicans branding it the “Schumer Shutdown.”

At the White House on Monday, Mr. Trump’s press secretary, Sarah Huckabee Sanders, insisted that Monday’s deal was not “drastically different” than what was discussed on Friday between the president and Mr. Schumer.

Despite what was characterized by both parties as Mr. Trump’s invisibility this weekend, Ms. Sanders insisted that he was responsible for making a deal happen.

“What the president did clearly worked,” she said, adding, “The president stayed firm, Republicans stayed firm, and Democrats, I think, realized that they had to move past that piece of legislation” to discuss immigration going forward.

But Ms. Sanders declined to clarify precisely what the parameters of an immigration deal would look like. That worried Democrats like Senator Robert Menendez of New Jersey.

“The problem with all of this is the problem it’s been from the beginning,” Mr. Menendez said. “You got no guarantees from the House. You got no guarantees from the president. So you have two-thirds of the equation that are just not there.”

Lawmakers Say They’re Close to Deal On CHIP Funding

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Source: The Hill

Lawmakers in both parties say that a long-running disagreement over children’s health funding has almost been resolved and that funding could be passed as soon as next week.

The reauthorization of the Children’s Health Insurance Program (CHIP) could be attached to a short-term government funding bill that must pass before Jan. 19, lawmakers say. Whether the reauthorization is ultimately tied to the bill, however, will depend on broader leadership negotiations.

Funding for the program, which covers 9 million children, has been stalled for months amid partisan fighting over how to pay for it.

But the Congressional Budget Office (CBO) issued a new cost estimate this week that now puts the cost of a five-year extension at just $800 million, down from $8 billion.

Finding an agreement on how to pay for that smaller sum won’t be an issue, said House Energy and Commerce Committee Chairman Greg Walden (R-Ore.). “I don’t think that will be a problem.”

He told reporters Wednesday it will be up to leadership, which is negotiating the larger spending package, whether CHIP gets added to a short-term spending bill (known as a continuing resolution) next week, but he said “it could” now that the dispute over how to pay for it is “minimized.”

Sen. John Cornyn (R-Texas) told Texas reporters Wednesday that a five-year CHIP bill is “highly likely to happen on or about the [Jan.] 19 when the current continuing resolution expires,” according to the Dallas Morning News.

The reason for the lower cost is that after Republicans repealed ObamaCare’s individual mandate, premiums are projected to rise for ObamaCare plans. If CHIP were not continued, some children would enroll in ObamaCare plans, which is now a more expensive option, making CHIP cheaper by comparison.

In fact, a 10-year CHIP extension would actually save money, $6 billion, according to CBO.

Rep. Frank Pallone Jr. (D-N.J.), the top Democrat on Energy and Commerce, is calling for a permanent extension.

But Walden said 10 years might be too long.

“Ten years is a long extension for something that important,” he said.

Asked about adding the CHIP funding to the funding bill next week, Rep. Gene Green (D-Texas) said, “I think it will be now that we know it doesn’t cost much.”

Budget Office Cuts Cost Estimate of Children’s Insurance

Image result for childrens health insurance imagesSource: U.S. News

Congress’ official budget analysts have eased one stumbling block to lawmakers’ fight over renewing a program that provides health insurance for nearly 9 million low-income children.

The Congressional Budget Office says a Senate bill adding five years of financing to the program would cost $800 million. Previously, the analysts estimated it would cost $8.2 billion.

That means lawmakers should find it much easier to agree to a way to pay for extending the program.

The lower cost projection doesn’t resolve the main barrier the bill faces. Extending the children’s health program has become enmeshed in a battle among President Donald Trump and lawmakers over how to protect hundreds of thousands of younger immigrants from deportation, and how much added money should be spent on defense and domestic programs.

Once those more heated disputes are resolved, the conflict over children’s health should end quickly.

Financing for the program expired last fall. Congress has temporarily extended its funding, but growing numbers of states have moved closer to exhausting their money. Members of both parties are eager to extend the health insurance program and avoid being blamed for causing millions of children to be uninsured.

Counterintuitively, the bill’s budget impact has shrunk because the Republican tax bill enacted last month eliminated the penalty President Barack Obama’s health care law imposes on people who don’t buy insurance. That move is expected to drive up the government’s costs of subsidizing people buying policies on insurance marketplaces.

That’s because ending those penalties is projected to result in fewer healthy people buying coverage on marketplaces, driving premiums higher for remaining consumers. Since government subsidies for people buying policies are linked to premiums, higher premiums mean higher federal costs.

The budget analysts say extending the children’s insurance program will encourage some parents to use that program and not the marketplaces. That would save the government money.

The new estimate was included in a letter the budget office sent Friday to Sen. Orrin Hatch, R-Utah.

What’s ahead for health care in 2018?

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From repeated attempts to repeal the Affordable Care Act to stopgap funding for the Children’s Health Insurance Program squeaking in just before the year ended, health care issues were prominent in American politics this year. In 2018, politicians are likely to tackle health issues including full CHIP funding, spending reductions to Medicare, drug prices and more.The Hill (12/28)

States Freeze CHIP Enrollment, Get Ready to Move Kids to New Plans

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Source: Modern Healthcare

As federal lawmakers continue to bicker over how to fund the Children’s Health Insurance Program moving forward, states across the country are freezing enrollment and preparing for the worst.

CHIP funding lapsed Sept. 30 and has yet to be renewed by Congress, leaving states to patch together funding with monies redistributed by the CMS. But most of those dollars will run out by March at the latest, and states will have to finish processing all claims by the end of January and find a new plan to cover CHIP-enrolled children.

Connecticut and Colorado will shutter their programs Jan. 31 if funding doesn’t come through and will shift its CHIP kids to Medicaid or a qualified health plan on the exchanges. Alabama will freeze CHIP enrollment starting Jan. 2 and would also need to close its program by Jan. 31, according to an official at the Alabama Children’s Hospital.

In a late-breaking twist, Texas will not immediately freeze enrollment. The state, which was due to run out of its own funds in February, will get an additional $135 million in redistributed funds from the CMS.

Bruce Lesley of the Washington-based advocacy group First Focus, said moves like this by the agency further muddy the prospects for other states, as the CMS hasn’t set out clear policies for how they allocate the redistributed money. Texas officials had sought $90 million in their original request.

Meanwhile, Lesley said, states like Minnesota and Arizona are out of money, and Oregon and California soon will be, according to the last projections by the congressional Medicaid and CHIP advisers.

The sudden end to CHIP programs would trigger a special enrollment period for kids who need to move to a qualified health plan. As of deadline, the CMS did not respond to a query about how the agency would manage the enrollment period for the federally facilitated marketplace.

CMS officials are planning to launch talks with children’s health policy experts to figure out the best way to transition kids out of CHIP if they need to, said one Washington-based children’s advocate who asked not to be identified.

Colorado, which runs its own state-based exchange, would run a 60-day special enrollment period set to start Jan. 31 when a child’s CHIP coverage ends. The enrollment period would let kids start their new coverage on the first of the month following their application, says Luke Clarke, communications director at Connect for Health Colorado.

Congress has five working days left to keep CHIP running, but the GOP tax overhaul will take up most of the week before lawmakers will finalize the continuing budget resolution to keep the government open past Dec. 22.

House lawmakers led by Rep. Tom Emmer (R-Minn.) and Rep. Ryan Costello (R-Pa.) arranged a stopgap measure to allow states to apply any surplus from last year to fund their programs through year-end.

This has mitigated the immediate crisis for Minnesota, which had run out of its own funds in October, but children’s healthcare advocates are skeptical of how much good this will do in the long run as Congress continues to delay.

“There are states that are out of money,” Lesley says. “There’s no kicking the can down the road.

He added: “It’s a crisis, and they’re pretending like it’s not.”

Children’s Health Bill Clears House as States Struggle to Keep Programs Afloat

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Source: New York Times

The House passed a bill on Friday that would provide five years of funds for the popular Children’s Health Insurance Program, over vehement objections from Democrats who opposed the way it would be financed.

The vote, 242 to 174, came a month after funds for the program expired.

The Senate plans major surgery on the legislation to avoid the partisan strife that split the House. But some states may have no choice but to freeze enrollment or start to shut down the program before Congress clears legislation to renew funding. No new funds have been available since Oct. 1.

In the House, 15 Democrats joined 227 Republicans in voting for the measure on Friday. Only three Republicans voted against it.

The bill would provide money for the Children’s Health Insurance Program and clinics known as community health centers, which care for low- and moderate-income people around the country. Both programs have enthusiastic support across the political spectrum.

But lawmakers clashed over how to pay for them. To offset the cost, the House bill would increase premiums for Medicare beneficiaries with income of more than $500,000 a year, remove some lottery winners from the Medicaid rolls, and cut $6.35 billion over 10 years from a fund established by the Affordable Care Act to pay for public health initiatives such as preventing diabetes, heart disease, cancer and opioid abuse.

In addition, the bill would end insurance coverage for several hundred thousand people who fail to pay their share of premiums for insurance purchased in marketplaces under the 2010 health care law.

Most people who buy insurance through the Affordable Care Act marketplace receive subsidies to help pay their monthly premiums. Under the law, if they do not pay their share of premiums, insurers must give them a three-month grace period before terminating their coverage. The House bill would reduce the grace period to one month unless a state specified a different period.

The Congressional Budget Office estimates that the government would save nearly $5 billion over a decade because fewer people would have government-subsidized coverage.

Republicans said some people were abusing the longer grace period to skip out of their financial obligations. But Representative Diana DeGette, Democrat of Colorado, said, “Nobody should have to lose coverage in order for others to keep it.”

“Colorado is likely to run out of CHIP funding in January, with termination notices going out to worried families in the next few weeks,” Ms. DeGette said. “Yet here we are with a partisan bill that asks us to pay for low-income children’s insurance on the backs of seniors and the most vulnerable.”

Republicans defended their path to pay for the children’s health program, especially the higher Medicare premiums. It was reasonable to require wealthy people to help defray the cost of care for children from families of modest means, they said.

“When you are making a half-million dollars a year, you can pay a little bit more,” said Representative Tom Cole, Republican of Oklahoma. “Warren Buffett and Donald Trump don’t need the same Medicare program that Ma and Pa Kettle living on Social Security do.”

Democrats, who often seek higher taxes on high-income people, denounced the proposal.

“I’m not worried about whether wealthy families can afford to pay increased Medicare premiums,” said Representative Debbie Dingell, Democrat of Michigan. “But I’m worried that these changes will result in wealthy people abandoning the program in large numbers, which would worsen the risk pool and ultimately increase the cost for middle- and lower-income seniors. It would fracture the universal nature of Medicare and put the entire program at risk.”

AARP, the lobby for older Americans, strongly supports the children’s insurance program, but tried to block the increase in Medicare premiums.

“Higher-income Medicare beneficiaries already pay more in monthly premiums,” Nancy LeaMond, an executive vice president of AARP, said in a letter to House members. In addition, she said, “higher-income seniors have been paying more into the Medicare program throughout their working lives.”

But Representative Greg Walden, Republican of Oregon and the chief author of the bill, said, “We are just asking the wealthiest seniors in America, those making $40,000 a month — not a year, a month — to pay about $135 a month more for their Medicare, so we can fund children’s health insurance for five years.”

Five states — Arizona, California, Minnesota, Oregon and Washington — have received emergency infusions of federal cash to prevent an interruption in coverage of children. But the amount of unused funds available for that purpose is far less than the expected need, and an independent commission that advises Congress warned this week that 29 states “will exhaust all available federal funds” by March unless Congress passed legislation to provide more money.

In the Senate, work on CHIP legislation has been bipartisan from the start. The Senate Finance Committee has voted to provide five years of funds for the program, but it has not specified a way to cover the cost.

The committee chairman, Senator Orrin G. Hatch of Utah, and Senator Ron Wyden of Oregon, the senior Democrat on the panel, have been discussing ways to pay for the bill. They have not reported much progress toward an agreement, but their talks hold more promise than negotiations between Republicans and Democrats in the House.

The Senate is unlikely to take up a free-standing CHIP bill. Funds could be included in a larger piece of legislation, perhaps a sprawling spending bill in December to keep the government open, senators say.

The House bill would send $1 billion in additional Medicaid funds to Puerto Rico as it tries to cope with damage from Hurricane Maria, and the island’s delegate in Congress, Jenniffer González-Colón, a Republican, endorsed the legislation.

Representative Frank Pallone Jr., Democrat of New Jersey, said Republicans had missed the deadline for renewing the children’s insurance program because they “chose to spend the first nine months of this year trying to repeal the Affordable Care Act.”

But Mr. Walden said Democrats were partly responsible because they had requested delays in hopes of finding other ways to pay for the legislation.

“We cannot wait any longer,” Mr. Walden said Friday. “Patients cannot wait any longer. Patients need care. These critical programs need funding. And we must move forward.”

States Running Out of Cash for Children’s Health Insurance

Image result for childrens health insurance imagesSource: The Hill

Uncertainty about the future of an insurance program for children is sparking panic at the state level as officials scramble to keep their coverage going.

Federal funding for the Children’s Health Insurance Program (CHIP) expired a month ago, and states are dipping into unspent money or asking for help from the Trump administration to maintain coverage until Congress reaches a deal to extend it.

“There’s a certain level of frustration with the uncertainty,” said Trish Riley, the executive director of the National Academy for State Health Policy, which met Monday with most state CHIP directors during the organization’s annual conference.

“These are folks who have to run programs, and there’s lots and lots of uncertainty about whether or when the financing will come through — and how.”

Some states, like Virginia and Utah, are considering sending notices out to enrollees saying they may lose coverage without action from Congress.

Advocates worry the notices could cause confusion among the families of the 9 million children who receive insurance through the program, potentially leading to a decline in enrollment.

It’s a catch-22 for the states. They don’t want consumers to panic unnecessarily, but they also want to ensure there’s time for enrollees to find new coverage, if it comes to that.

“The bottom line is, I don’t think any state wants to send notices because they know that it’s harmful,” said Joan Alker, executive director of Georgetown’s Center for Children and Families. “It needs to happen if it needs to happen, but it also is likely going to depress CHIP enrollment, so they’re really walking a tightrope on this one.”

State officials in Colorado and Utah told The Hill they could send out notices to enrollees warning about possible changes in coverage as soon as November.

In Washington state and Virginia, notices will be sent out Dec. 1 if Congress doesn’t act.

Meanwhile, five states and Washington, D.C., are estimating they could run out of funds by the end of this year or early January, according to a report from Georgetown’s Center for Children and Families.

Arizona expects its funds to last through November or December, while Minnesota currently has enough to last through next month. California has enough funding to last through late December or early January, while Ohio and Oregon expect to run out in December.

It’s hard for the states to know for sure how long the money will last, further stoking anxiety.

“Not only is it constantly changing when states will run out of money, as we say [in the report], it’s impossible to predict exactly when that’s going to be,” Alker said, adding she and her colleagues had to revise the report’s estimates “literally every single day” with new information.

The estimates are constantly updated because it takes time for claims to come through. Consumer behavior also has an impact because people tend to use their health insurance more if they fear it will end soon, Riley said.

Reauthorizing CHIP is usually a bipartisan affair, but the House is set to vote this week on a five-year, partisan bill. Democrats oppose how Republicans want to pay for the program — such as charging wealthy Medicare beneficiaries more and gutting ObamaCare’s public health fund. The parties reopened negotiations on the bill earlier this month, but couldn’t come to an agreement.

A Democratic leadership aide told The Hill that the expectation is most of the party will oppose the bill if the offsets don’t change. This could cause an issue in the Senate, where the bill needs bipartisan support to pass.

“By bringing a partisan bill to the floor, House Republicans are virtually guaranteeing that these essential programs will not be reauthorized until the end of the year,” said Rep. Frank Pallone Jr. (D-N.J.), the ranking member of the Energy and Commerce Committee.

“This delay causes unacceptable uncertainty for millions of kids and families who rely on CHIP and Community Health Centers for their health.”

On the other side of the Capitol, the Senate Finance Committee has passed a bipartisan five-year reauthorization of CHIP, but hasn’t yet determined how to pay for it. It’s unclear if the chamber will take up the House bill.

In Washington, most expect that CHIP will be funded before Congress breaks for the winter holidays. The funding could be included in a year-end spending bill, but a vote could also occur sooner. It doesn’t help that the Senate faces a jam-packed schedule in the coming months as lawmakers try to work on tax reform and to confirm judicial nominees.

“[CHIP] is available to do, but I suspect it may be part of the year-end legislation, but I don’t know,” said Senate Majority Whip John Cornyn (R-Texas.)

Cornyn blamed the Senate’s failure to reauthorize CHIP faster on Democrats, saying they are holding up judge nominations and, thus, requiring the Senate to burn time on the legislative clock.

“This is part of the pattern we’ve seen since the beginning of the Trump administration, of stringing things out, obstructing, dragging feet, and so unfortunately, popular bipartisan things like the Children’s Health Insurance Program reauthorization suffers as a result.”

The decision to schedule floor time for a CHIP bill is ultimately up to Senate Majority Leader Mitch McConnell (R-Ky.).

Some advocates are worried about CHIP being thrown into the end-of-year spending talks, given the potential for deadlock and delay as the parties battle over other priorities.

“End of the year is not exactly great news,” Riley said, adding, “the sense of urgency is palpable.”

“Ideally, CHIP would get done sooner rather than later because of the uncertainty and states being forced to act,” said Jane Sheehan, a senior government affairs manager at Families USA, a health-care advocacy nonprofit in D.C.

“It’s complicated because Congress has a lot to deal with in December. For it to get wrapped up in all the end of year stuff is concerning.”

Some states have been working with the Centers for Medicare and Medicaid Services (CMS) to obtain funds to hold them over until Congress passes a deal.

So far, CMS has awarded $230 million in unused funds available for redistribution to nine states and U.S. territories, and more could be awarded in the coming weeks.

Oregon was told by CMS it’s eligible for $51 million in funds to help the state until mid-December — past that, it would need to discuss other options with its state legislature, said a spokesperson with the state’s health authority.

Minnesota received $3.6 million to carry it through October and on Friday said it expects to receive an additional $1 million to carry it through November.

While helpful, these unused federal dollars only provide funding for another one to two months, according to the Georgetown Center for Children and Families’ report.

Last Updated 11/18/2020

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