With CHIP funding slated to expire in September (at the same time as the Primary Care Cliff), advocates are gearing up on Capitol Hill to pass a funding extension ASAP. Given that a number of state legislatures will have finished their legislative sessions for the year well before September rolls in—including 9 that will be complete by the end of March—there is increasing pressure that Capitol Hill act sometime this month to extend the program. Accordingly, three sets of legislators have proposed legislation to extend the program’s funding. Each bill is different and neither advocacy groups nor legislators have coalesced around any one particular option.
NACHC staff are working closely with legislators and other advocacy groups in DC to ensure that whatever CHIP bill ultimately passes on dovetails with health center priorities. House and Senate Republicans (Chairmen Orin Hatch, Fred Upton, and Joe Pitts, in particular) introduced bicameral joint draft legislation (as of yet unnamed), which can be viewed here, and are soliciting feedback from stakeholders. House Energy and Commerce Democratic Ranking Members Frank Pallone and Gene Green have introduced H.R. 919, the CHIP Extension and Improvement Act of 2015, whereas Senate Finance Committee Democrats Sherrod Brown, Robert Casey, Debbie Stabenow, Ranking Member Ron Wyden, and Minority Leader Harry Reid have introduced S. 522, the Protecting and Retaining Our Children’s Health Insurance Act of 2015 (or the PRO-CHIP Act). The key differences between the bills are as follows:
- Both Democratic bills extend funding for CHIP for an additional 4 years, whereas the Republican discussion draft does not specify a timeframe; instead they are seeking feedback as to how long funding should be extended for.
- Both Democratic bills would continue the current funding allotments to states, including a provision from the ACA that would increase the federal matching rate by 23 percentage points starting in 2016; the Republican draft legislation would eliminate the 23 percent increase.
- Both Democratic bills would extend the current performance incentive program that provides states additional funding if they meet a minimum number of requirements that streamline eligibility and enrollment.
- Both Democratic bills would make “Express Lane Eligibility” a permanent option for states, whereas the Republican draft bill would not. Express Lane Eligibility permits states to use eligibility information they have already received and verified for eligibility in other programs, such as SNAP, to streamline enrollment of eligible children into Medicaid and CHIP.
- The Democratic House bill would provide 12 month continuous eligibility for adults and children, ensuring uninterrupted coverage and reducing churn between public and private programs within the course of a single year.
- The Democratic House bill would extend the Medicaid primary care payment “bump” from the ACA and extend it to apply to additional providers. Health centers, however, are still ineligible due to health centers’ unique payment methodology.
- The Democratic House bill would also mandate reporting requirements of pediatric quality measures and increase the match rate for pediatric quality reporting.
- The Republican draft bill would end current “maintenance of effort” provision from the ACA that would require states to maintain their current eligibility levels for children enrolled in the program, thus allowing states to reduce eligibility levels or eliminate streamlined enrollment procedures.
- The Republican draft bill would allow states to impose waiting periods of up to one year, eliminating the current limit of 90 days, and thus requiring that the child enroll in marketplace coverage during that year.
- The Republican draft bill would eliminate the enhanced funding for translation and interpretation services for enrollment and retention of populations for whom English is a second language.
- Lastly, the Republican draft bill would rename the program, returning it to its original name of SCHIP (the State Children’s Health Insurance Program) rather than CHIP.
Given the timing overlap with the Primary Care Cliff, we are paying close attention to whether there might be options to include funding for both CHIP and the Cliff in any upcoming legislative package on Capitol Hill. Please feel free to contact Heather Foster at email@example.com with any questions about the various legislative proposals.