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The Clock Is Ticking Louder for the Children's Health Insurance Program

health-apple-blog-Getty.jpgBy Christina A. Samuels 

When the Sept. 30th deadline approached for reauthorizing the Children's Health Insurance Program, no one seriously thought that Congress would let the bipartisan-supported health plan expire. 

When the deadline passed, there was still little concern: States still had money available in their coffers to pay for the $14 billion program, which serves about 9 million children whose parents earn too much to qualify for Medicaid, but who can't afford insurance for their children on the open market. (CHIP also covers about 370,000 pregnant women.) 

But now, more than two months later, the program still has not been funded by Congress, and no funding plan is on the immediate horizon. Supporters hoped that long-term funding for the program might be appended to a short-term bill passed on Dec. 7 to keep the government running, but that didn't happen. 

Instead, that short-term bill allowed some reserve funds to be used by states whose CHIP funding is running out the soonest. That buys a little more time, but it doesn't help states, which are now wondering whether they should start notifying families that their child's health care program may be going away, or hold off on such notifications in hopes that Congress will come up with the money soon. 

Some states have decided not to wait. Colorado's CHIP funding, which serves about 75,000 children, runs out at the end of January. The state started notifying families at the end of November that they may need to start looking for other options.

"Everyone agrees it needs to get done," said Elisabeth Wright Burak, a senior fellow at Georgetown University's Center for Children and Families. "The fact that we can't get across the finish line is kind of mind-boggling." 

So how did we get here? Burak hypothesizes that the fact that the program is supported on both sides of the aisle may have, ironically, reduced lawmakers' sense of urgency.

Back in April, a federal advisory panel called the Medicaid and CHIP Payment and Access Commission estimated that only a few states would run out of CHIP money by the end of the year, giving lawmakers the idea that they had several more months to act. 

But it doesn't work that way, Burak said: States can't turn on a dime like that.

"Congress's inability to get this done has already created a lot of uncertainty for states and for families," she said. Faced with the signal that the program might be financially shaky, "they start to look for other options, or they just disenroll in the program. And it's hard to get them back in the door." 

There's not a lot of other options available for CHIP families, said Dr. Charles Pruitt, the president of the Utah chapter of the American Academy of Pediatrics, and an emergency room pediatrician in Salt Lake City. 

About 20,000 children in the state are covered through the program, Pruitt said, including a child whose uninsured family delayed bringing him to the hospital, only to find out that he had a brain tumor. He also spoke of a teen who was hit by a distracted driver; her family won't be bankrupted by her care because she is enrolled in the CHIP program.

"These are real people with real problems. These are not people on the dole, these are not the takers. These are people who are playing by the rules and doing the best they can," Pruitt said. 

Utah may be among the first states to freeze enrollment, Pruitt noted. That's because the state doesn't have an additional source of funds to tap once federal funding runs out for the state at the end of January. 

"Lives are in the balance while people debate the politics. If they worked with me, I think we'd have re-funded CHIP a long time ago," he said.

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