Janet Allio, school nurse at Mary C. Snow West Side Elementary, remembers wishing she could do more to help families who made too much for Medicaid, but couldn’t afford private insurance, before the Children’s Health Insurance Program began.
“They’re able to have more preventative care, which means they lose less days of school and they’re healthier overall,” she said. “Healthy children are better learners.”
CHIP, which covers children whose parents make too much for Medicaid but make less than 300 percent of the federal poverty level, celebrated its 20th anniversary last month. Federal funding for the program is set to expire on Sept. 30, the end of the federal fiscal year, unless Congress acts.
A spokeswoman for the state Department of Health and Human Resources said thousands of kids would lose their current coverage if the program isn’t reauthorized.
All members of West Virginia’s Congressional delegation said they are in favor of reauthorizing the program, except for Congressman Alex Mooney, a Republican, whose spokesman had no response.
Allio, who is also a member of the state CHIP board, has been a school nurse for more than 25 years.
“From a personal perspective, it gave me a feeling of helplessness because I wanted to do everything I could to help the child, yet the parent had no recourse, especially for children with chronic illnesses such as asthma or diabetes, where their health care could be quite costly,” she said. “The child would be very ill and the parent would use the emergency room and hopefully be able to fall into the indigent program to receive care.”
If CHIP isn’t funded, children whose parents make more than 138 percent of the federal poverty level would have to turn to private plans for coverage.
“We even had parents that would give up their jobs and stop working so that their child would qualify for Medicaid,” Allio remembered. “So when CHIP was born, it filled that gap.”
CHIP was created by the Balanced Budget Act of 1997 and has been reauthorized for various lengths of time since then. Senator Jay Rockefeller, the former Democratic senator from West Virginia, was one of the leading proponents.
The U.S. Senate Committee on Finance held a hearing on CHIP funding Thursday. Sam Runyon, a spokesman for Democratic Senator Joe Manchin, said “We expect CHIP to move through in a bipartisan, non-controversial way” and that the senator supported the “vital program.”
In July, the Medicaid and CHIP Payment and Access Commissiom (MACPAC) warned that “Congressional action to renew CHIP funding is urgent to ensure the stability of children’s coverage during a time in which health insurance markets are expected to face substantial changes, and to provide budgetary certainty for states.” MACPAC has also called for a five-year reauthorization. Lawmakers have disagreed on the length.
The last two times the program was reauthorized, Congress allocated funding for two-year periods.
CHIP covered around 31,000 West Virginia kids during the federal fiscal year 2016, according to DHHR. That includes kids going on and off the program. It covered 17,000 kids on CHIP-Medicaid during the same time period, meaning kids who were on Medicaid plans funded with CHIP money. Some children moved to CHIP-Medicaid Expansion when more people became eligible for Medicaid under the Affordable Care Act, also known as Obamacare.
During the April, May and June time period, CHIP covered about 21,000 kids, according to DHHR. That doesn’t include CHIP-Medicaid.
Jessica Holstein, a spokeswoman for DHHR, said in an email that “more than 97 percent of West Virginia’s children have healthcare coverage, partly due to the success of CHIP.”
“However, this critical program is now facing uncertainty of federal funding post 2017,” she said. “Should the CHIP federal funding issue remain unresolved on the national level, West Virginia CHIP funding will be exhausted in March or April 2018.”
According to MACPAC, and an independent federal agency that advises Congress on Medicaid and CHIP policy, all states are expected to exhaust their CHIP funding by the end of 2017 or during fiscal year 2018 if funding is not extended.
“While we are hopeful that federal funding will be extended, further delays and the possibility of a curtailed CHIP match rate may put the program in jeopardy,” Holstein continued. “The thousands of children who rely on WVCHIP may lose access to healthcare for a variety of reasons, including coverage availability and cost issues.”
Sharon Carte, former director of CHIP in West Virginia, a member of the West Virginians for Affordable Healthcare Board, and a member of MACPAC, noted that parents would have no choice but to turn to private, more expensive plans with fewer benefits.
“They kind of fall off a cliff — a benefits cliff,” she said.
The Affordable Care Act increased federal funding for the program. The law increased the federal match rate to 23 percent. That resulted in the program being 100 percent federally funded in West Virginia. The state is one of just 12 states that are 100 percent federally funded, according to the Kaiser Family Foundation.
“Not extending funding or changing the match rate lower than the current rate will force the state to find approximately $4 million in state dollars during a budget deficit year to continue funding children who moved from the separate CHIP to Medicaid as mandated by the ACA,” Holstein said. “An additional $10 million is needed for the separate CHIP should the match rate be reduced — a total of $14 million in a budget deficit year. With no additional funding extended, the separate program would shut down.”
In West Virginia, families who make over 211 percent of the federal poverty level pay a monthly premium of $35 for one child and $71 for two or more. Parents who make below that pay no monthly premium.
A family of four that makes from $36,900 a year to $73,8000 a year is eligible. Families with two children and the lowest incomes pay a maximum $300 co-pay for medical services and $200 for prescriptions per year. Families with the highest incomes and two children pay a medical maximum of $400 and a prescription maximum of $250.