Assessing the New House Republican CHIP Bill
On
Extension of CHIP Funding
With no additional federal CHIP funding, states will start exhausting their remaining CHIP funds.
Altogether, a
The HEALTHY KIDS Act largely mirrors the bipartisan CHIP provisions in the Hatch-Wyden bill, which the
The bill would also continue through 2019 the ACA's maintenance-of-eligibility requirement, which prohibits states from cutting children's eligibility for Medicaid and CHIP or making it harder for eligible children to enroll. It would then extend that requirement through 2022 for all children in families with incomes below 300 percent of the federal poverty line. That would protect nearly all Medicaid- and CHIP-covered children from eligibility cuts or restrictive enrollment and renewal procedures.
Finally, the HEALTHY KIDS Act would extend for five years the Express Lane Eligibility (ELE) option, which makes it easier for eligible children to enroll in (and renew) Medicaid and CHIP coverage. ELE allows a state to use information for Medicaid and CHIP that it has already obtained and verified when determining the family's eligibility for another program, like SNAP (formerly food stamps). As a result, these families no longer have to submit the same information twice and state workers do not have to duplicate their effort, which reduces states' administrative costs. Nine states use ELE in their Medicaid and/or CHIP programs:
Aid to
The HEALTHY KIDS Act includes up to
Under Medicaid today, the federal government picks up a fixed share of Medicaid costs for states, but
The ACA provided an additional
An additional
Instead, for the short term, the block grants for
To ensure fiscal stability over the long run, federal policymakers should eventually eliminate the cap on federal funding for
Several provisions of the House bill are intended to produce Medicaid and Medicare savings to offset the cost of the rest of the bill. These provisions, however, raise some substantial concerns. Medicaid Third-Party Liability
When Medicaid beneficiaries have other insurance that may be liable to pay for their health care, states generally must ensure that the other insurer is billed before Medicaid.[11] In this way Medicaid avoids paying for services that are the responsibility of another payor. However, special rules apply to prenatal and pediatric care and situations where a child support order requires a parent to maintain health coverage for a child. States must pay claims for furnishing prenatal or pediatric care when a third party such as a private insurer is responsible, then recover the amount from the liable third party. For child support situations, states must pay claims if no payment is made under the parent's health insurance within 30 days. These special rules help ensure that children and pregnant women receive care without delay and that sufficient pediatric and obstetric providers participate in Medicaid.
Budget legislation enacted in 2013 modified the special rules for pediatric and prenatal care and child support orders, but those changes were delayed until October 2017.[12] In the case of prenatal and pediatric care, the changes allow states to withhold payment for up to 90 days if doing so is cost-effective and wouldn't "adversely affect access to care." For child support situations, states can wait 90 days to pay claims except when necessary to ensure access to care.
The HEALTHY KIDS Act would go further than the 2013 changes and fully repeal the special treatment for prenatal and pediatric care and child support orders. This could make it harder for children and pregnant women to get care. If pediatric and obstetric providers must wait for payment and bill other insurers -- particularly insurers in other states, which is often the case in child support situations -- some providers would likely be less willing to participate in the program. Moreover, in some situations, needed care could be delayed while providers sort out the responsibility of the different insurers.
Treatment of Lump-Sum Income Under Medicaid
The bill would have a significant impact on the streamlined enrollment process designed to simplify the process of determining Medicaid eligibility and coordinating eligibility for Medicaid with eligibility for marketplace subsidies. States would have to add new questions to the Medicaid application and track lottery winnings and other lump sums for what would likely be a limited return. For example,
Finally, the House bill would further increase Medicare premiums on very high-income beneficiaries, potentially undermining the program's universal nature. Most beneficiaries' monthly premiums cover 25 percent of the cost of coverage for Medicare Parts B and D. Higher-income beneficiaries pay more. In 2018, single beneficiaries with incomes over
[1]
[2]
[3]
[4] "Recommendations for the Future of CHIP and Children's Coverage," Medicaid and
[5]
[6] During the
[7]
[8] Medicaid and
[9] A separate provision in the HEALTHY KIDS Act would also modestly increase
[10] See also
[11] These rules are in section 1902(a)(25) of the Social Security Act.
[12] Section 202 of the Bipartisan Budget Act of 2013 (Public Law 113-67).
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