The politics of the year-end spending deal could push critical funding for low-income children’s health insurance into next year, leaving thousands of pregnant women vulnerable to loss of prenatal coverage.
While the majority of the population covered by the Children’s Health Insurance Program are kids, pregnant women also rely on the program as a source of coverage. CHIP covers roughly 9 million low-income kids and approximately 370,000 pregnant women, some of whom may not have another option for health insurance should a state have to close its program.
“The one thing about the pregnant-women coverage is it, in many cases, can be provided through CHIP without regard to immigration status,” said Edwin Park, vice president for health policy at the Center on Budget and Policy Priorities. “For someone who is receiving these services, they may not be eligible for other forms of coverage like the [Obamacare] marketplace.”
Funding for the program expired in September and states have had to prepare to shut down or scale back their programs in some way. Colorado, for example, has begun sending out letters to members and families saying the program will end on Jan. 31.
Receiving notices that the program may shut down could cause confusion among users of the program. “If the word starts getting around that Congress may not fund it, they may think it’s not there already,” said Joan Alker, executive director of the Center for Children and Families at Georgetown University. “I worry that we’ll start losing kids and pregnant women.”
Experts and advocates note that some pregnant women could face a disruption in coverage during an important time of their pregnancy.
“A gap in coverage could fall during a critical window of prenatal care, making it difficult or impossible for expectant mothers to see a doctor or get treatment for conditions like high blood pressure or gestational diabetes,” said the March of Dimes in a statement. The group adds that a pregnant woman could be left with high costs if coverage lapses when she gives birth or if the child is born with health issues.
As of January, five states extended coverage for pregnant women through CHIP and 16 states use the program funding to provide coverage through the unborn-child option, where pregnant women can be covered regardless of immigration status, according to the Kaiser Family Foundation.
The March of Dimes says seven states that cover pregnant women are expected to exhaust CHIP funds by the end of January: Colorado, Massachusetts, Minnesota, Oregon, Texas, Virginia, and Washington.
But it looks like the path to getting funding renewed by the end of the year could be a heavy lift for Congress.
House Republicans this week released a year-end continuing resolution that would extend CHIP for five years and community health centers for two years, but uses controversial offsets not supported by Democrats. This includes reducing the Affordable Care Act’s Prevention and Public Health Fund and making wealthier beneficiaries pay higher Medicare premiums.
“I don’t think the House CHIP bill moves the agenda forward at all,” said Senate Finance Committee ranking member Ron Wyden. “It is yet another partisan approach; looks like it’s trying to score partisan points rather than dealing with the serious problem.”
But Senate lawmakers have not released an alternative set of offsets. “We are continuing to work closely together,” said Wyden.
If lawmakers fail to get to an agreement, they could fall back on a similar short-term patch that they used in the two-week continuing resolution to keep states afloat through the end of the year. But this did not include new funds, and advocacy groups, including the American Academy of Pediatrics, said the stopgap measure did not address issues facing the program.
“States will use their limited staff time and resources developing contingency plans and notices to families,” the groups said in a statement this month. “As more states send out notices, more families will become confused and it becomes increasingly likely that some children will miss doctor appointments or go without medication, or that some pregnant women will go without prenatal care.”
The Centers for Medicare and Medicaid Services is doling out redistribution funds—unused CHIP allotment money—to shortfall states, but that funding source will not last forever.
“I would be very surprised if CHIP could get through January without new money … at some point, the redistribution pot is going to run out,” said Alker.