If Congress doesn’t save kids’ health insurance, it will cost Idaho millions

Dec. 18--She loves to dance, but 8-year-old Mia Centeno was born with an extra bone in one of her feet. It's painful enough that she couldn't walk until she was 3 years old, much less dance. So her mother, Nayeli Macias, takes her to a specialist twice a year who keeps Mia on her feet.

"Eventually, she'll have to have surgery for that," Macias said. "It will probably be between 10 and 12 years old."

Macias has relied on CHIP -- the Children's Health Insurance Program -- to help pay for Mia's medical care. But the program is at risk of losing all its federal funding, which could shake up Idaho's CHIP coverage and put new costs on this state.

Congress failed to reauthorize the program in the fall. That halted new funding. Now, Idaho and all other states are burning through the last of their money for CHIP while lawmakers in D.C. debate how to pay for the program's renewal.

The 22,117 Idaho children who were on CHIP as of October could fare better than in some other states if the CHIP well runs dry. That's because Idaho law requires the state to provide health insurance for kids who are just above the poverty line.

"Absent a change in that law, these kids are still going to be covered," said Chris Smith, a spokesman for the Idaho Department of Health and Welfare.

So, the department is working on a possible contingency plan if Congress fails to act. It will put CHIP kids on Medicaid -- which would keep them covered and allow them to keep seeing the same health care providers.

That solution will cost Idaho millions of dollars. Idaho's CHIP program is 100 percent federally funded. But Idaho Medicaid is only about 71.5 percent federally funded. So for each child moved off of CHIP, Idaho would have to pay 28.5 percent of the cost of their health insurance instead of zero percent.

The estimated cost, just to finish out this fiscal year? About $9 million.

The Centers for Medicare and Medicaid Services would need to approve the switch, and the Idaho Legislature would have to approve the new spending.

Gov. Butch Otter is "aware of the possibility" that Idaho would lose CHIP support, according to spokesman Jon Hanian, "which is why we have been encouraging adoption of continued funding for CHIP and working closely with our congressional delegation."

"It is on my radar screen and the co-chair's radar screen," said Sen. Shawn Keough, R-Sandpoint, who co-chairs the Idaho Legislature's Joint Finance-Appropriations Committee. "I'm hopeful that Congress will step up and take care of it. If it doesn't, for me personally, I think the state should try to do so. We're talking about children, and needy children. ... And a lot of the care, as I understand it, is preventative in nature."

'It's expensive'

Many of the children on CHIP are from working families who earn too little to afford health insurance but too much to qualify for Medicaid. Macias works as an immigration legal assistant for a nonprofit in Canyon County.

Mia goes to her primary doctor for annual checkups, to the eye doctor every three to six months and to a specialist twice a year. During a recent week, Mia was sick and had a total of three health care visits. Each one would have required a minimum $100 deposit if not for CHIP, Macias said. Idaho CHIP does require some families to pay for care, but the monthly premiums and copays are very low.

"A lot of people sometimes think ... 'anybody can pay for doctor visits,' but once you look at it and see it, it's expensive," Macias said.

Most members of Congress seem to agree CHIP must be be renewed. But they haven't been able to find common ground on how to pay for it. Democrats objected to a bill that passed the House in November for tweaks it would make to Medicare and Affordable Care Act funding. And a Senate version that passed that chamber's Finance Committee (which includes Idaho Sen. Mike Crapo) has apparently stalled. The House bill was again tucked into a short-term spending measure meant to keep the federal government open past this week, but on Friday the Associated Press reported senators had yanked the measure from that package.

The New York Times and Axios have reported Congress is most likely to pass temporary extensions of CHIP, and perhaps a longer-term solution in January. But Friday, Texas Republican Sen. John Cornyn tweeted, "Congress will pass a long term CHIP bill next week."

"I can't tell you exactly when, but we'll get it done," Sen. Orrin Hatch, R-Utah, told Politico.

Congress will pass a long term CHIP bill next week https://t.co/ZkZOMS7Eaj

-- Senator JohnCornyn (@JohnCornyn) December 15, 2017

Health and Welfare expects federal funds to fuel its CHIP program at least through January. But medical care is expensive, and the funds aren't endless.

This year, the department for the first time asked the Centers for Medicare and Medicaid Services for money from what is essentially a CHIP reserve pool. It received $5.1 million in redistributed CHIP funds in December and has requested another $7 million for January.

"This is not 'stopgap' funding or anything special," said Smith, the department's spokesman. "It is previously appropriated but unspent money that, under a provision in existing law, CMS can redistribute to states to keep their CHIP coverage funded because of the delay by Congress in reauthorizing the program. ... [While] redistributed CHIP funds have been available before from CMS, this is the first time Idaho has ever had to request them to keep CHIP coverage funded."

For now, the department is working with CMS on its contingency plan. But it hopes Congress will figure something out in the nick of time, and Idaho won't have to scramble to keep children insured.

Audrey Dutton: 208-377-6448, @audreydutton

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