Insurance coverage for more than 400,000 Texas children and pregnant women is in jeopardy after Congress failed to renew authorization for a federal program.
Congressional authorization for the Children's Health Insurance Program, which provides low-cost health insurance for children from low- and middle-income families, expired Sept. 30.
Without federal funding, Texas has enough money for CHIP to last until February 2018, according to estimates by the Texas Health and Human Services Commission. However, federal lawmakers say they're working on a plan to continue the program before funding runs out for Texas.
"States don't want to have to disenroll their kids," said Maureen Hensley-Quinn, senior program director at the National Academy for State Health Policy, a non-partisan group that advises states on health policy. But "there may come a time when [they] have to send families letters" letting them go.
The program, created in 1997 and adopted in Texas in 1999, has cut the percentage of uninsured children nationwide from 15 percent in 1997 to 5 percent in 2015. It also offers prenatal care to about 36,000 pregnant women in Texas. About 394,000 Texan children ineligible for Medicaid are covered under CHIP, and another 249,000 Texan children on Medicaid benefit from CHIP’s 92 percent matching rate. Together, Medicaid and CHIP cover about 45 percent of all children in the state.
Congress last renewed the program's approval in 2015 to last until the end of the 2017 fiscal year, which ended Sept. 30. Members of Congress had discussed voting to renew the program but did not do so in time for the new fiscal year. Why the program lapsed remains unclear outside of House GOP leadership. Even rank-and-file Republicans were unsure of why, a GOP Congressional aide told the Tribune.
Without CHIP, “there aren’t a lot of options” for children in low-income families, said Mimi Garcia, a spokesperson for the Texas Association of Community Health Centers. Community health centers, which often provide health care for uninsured Texans, also saw about 70 percent of federal funding expire on Sept. 30, Garcia said.
"Inaction by Congress so far has created a real threat to the stability of the infrastructure of health services for millions of Texans," Garcia said.
State officials are among those pressing Congress to re-up funding for the program.
"CHIP is a critical part of the health care safety net in Texas," wrote Cecile Erwin Young, chief deputy executive commissioner at the Texas Health and Human Services Commission, in a Sept. 26 letter. “CHIP has a proven track record of success, stemming from its adherence to the fundamental principles of state administrative flexibility, personal responsibility, and innovation aimed at enhancing health outcomes for beneficiaries.”
In the letter, sent to the Children’s Health Coverage Coalition, Young said her agency has coordinated with other organizations such as the National Association for Medical Doctors and the National Academy for State Health Policy to support CHIP nationally.
Hensley-Quinn said the National Academy for State Health Policy will work with states to create contingency plans if Congress does not vote to renew funding. Still, there is time for a renewal, she said, with many states not slated to run out of funding until winter or even spring.
Garcia said coverage remains available so long as people keep up with their renewals and funding for the program is found. Renewal dates for families in counties affected by Hurricane Harvey have been pushed back by 6 months, she said.
Garcia said her organization has been working with advocates at the national level to push for a renewal from Congress. She said they have “heard positive things from Congress that this will get renewed, but we also haven’t seen the action at the same time.”
Members of the two congressional committees overseeing the program, the Senate Finance Committee and the House Energy and Commerce Committee, are currently negotiating a deal on CHIP.
Sources on the House side say they are optimistic that both chambers will be able to strike a deal by Wednesday of this week, but as with all things on Capitol Hill in recent years, there are no guarantees.
The CHIP issue came up during a U.S. House Rules Committee hearing last week on another piece of legislation, a bill that addressed reauthorizing the Federal Aviation Administration and created tax breaks for victims of the recent spate of hurricanes striking the country.
Many House Democrats opposed that hodgepodge bill because it not include a CHIP reauthorization.
When leading Democrats raised those worries with U.S. Rep. Pete Sessions, R-Dallas, at a U.S. House Rules Committee hearing, he aimed to assuage their concerns.
"We don't intend to let them expire," he said. "We're going to have to do something."
Disclosure: The Texas Association of Community Health Centers has been a financial supporter of The Texas Tribune. A complete list of Tribune donors and sponsors is available here.
Correction: A previous version of this story incorrectly reported the number of children who don't qualify for Medicaid and receive CHIP benefits. That number is 394,000. The story also incorrectly stated the percentage of uninsured children nationwide in 1997. That number was 15 percent.