Without action by Congress, this health program for kids and pregnant women is at risk

Tens of thousands of low-income children and pregnant women in the central San Joaquin Valley rely on a health insurance program that could lose its federal funding by the end of the year.

Statewide, about 2 million children and pregnant women depend on the Children’s Healthcare Insurance Program that Congress has yet to renew for this fiscal year, which began Oct. 1.

In Fresno County, 53 percent of children are on Medi-Cal, which includes those on the Children’s Healthcare Insurance Program.

Advocates said the future of the program is in jeopardy unless federal funding is restored.

The Children’s Healthcare Insurance Program, which started in 1997, has allowed California children to lead healthy lives, said Sandra Celedon, executive director for Fresno Building Healthy Communities, a local coalition for improving access to health care for Fresnans. “If programs like these are reduced or dramatically cut, this would prevent our most vulnerable Central Valley residents from obtaining life-saving care such as preventative immunizations, dental care, and pregnancy-related care,” she said.

Nearly 1 million people in the Valley rely on Medicare and on Medi-Cal, Celedon said. People would suffer if those programs are altered or reduced, she said. And the economy would suffer, she said. “In Fresno County alone, our economy would lose more than $430 million.”

California gets about $2.7 billion a year in federal money for the Children’s Healthcare Insurance Program.

Gov. Jerry Brown and state lawmakers put aside nearly $400 million in extra funding for the program in the current state budget as a backstop for potential federal cuts. But if the program isn’t renewed, there could still be an estimated $280 million hole to fill in the budget, and state lawmakers say they don’t know where they’ll get it.

“Ultimately we would have to go back and take a look at a budget and see if there’s a way that we can backfill that,” said state Assembly Health Committee Chairman Jim Wood, D-Healdsburg. “We’re very concerned.”

Letting the program expire has put the children and women who use it in a tenuous position, said California Budget and Policy Center fellow Esi Hutchful. The nonprofit advocates for programs that help low-income Californians.

The House voted largely along party lines this month to authorize five more years of funding for the insurance program. The Republican bill included higher premiums for some Medicare users and other cuts to social programs to offset the program’s costs, provisions the GOP hasn’t previously insisted on including. Republicans said the provisions would weed out people who take advantage of loopholes in the Affordable Care Act or use Medicare even when they can afford other insurance. Democrats objected to the bill because they said it would take away health care from some people to pay for other people’s health care.

The House bill is unlikely to get a vote on the Senate floor because of the potentially unpopular cuts to social programs. Nor have Senate leaders scheduled a vote on their version of the measure, which does not include cuts to offset the insurance program’s costs.

Congress is scheduled to work fewer than a dozen more days before the end of the year, and it has a crowded to-do list that includes tax reform, funding disaster relief and keeping the government open. But the authorization for the insurance program funding could be inserted into one of those bills.

California Sens. Dianne Feinstein and Kamala Harris have urged Senate leaders to hurry.

“As days go on without the program reauthorized, more and more states will be faced with difficult budget decisions and vulnerable children and pregnant women could lose their coverage,” they wrote in a letter to Senate leaders last month.

Though the federal government and states both fund the insurance program, each state can tailor how the program works. Colorado and Virginia, for example, can end the program when federal funding runs out.

But a few years ago, California rolled its children’s insurance program into Medi-Cal – the state’s version of Medicaid – through the Affordable Care Act. That meant the federal government would cover 88 percent of the cost, but it came with a caveat: California cannot freeze enrollment or end the program for most families until October 2019, even if federal funding ends.

If the program’s money runs out, nearly all of the recipients would continue to get insurance through Medi-Cal, said California Department of Health Care Services spokesman Anthony Cava. But the federal government would pay only 50 percent of the cost, as it does for adult Medicaid recipients. California would have to make up the difference, which the independent California Legislative Analyst’s Office estimates would be $280 million this fiscal year and up to $600 million next fiscal year.

When it set aside the nearly $400 million in backstop funds, the Legislature assumed Congress might lower the percentage it pays this year, not fail to fund the insurance program entirely, said Hutchful, the California Budget and Policy Center fellow.

If Congress doesn’t act, the governor is considering adding funding for this year’s program in next year’s budget, according to the California Department of Finance.

But Assemblyman Wood said there’s not “pots of money just sitting around,” and when the Legislature returns in January, it’ll have to work on figuring out where to find the money in the budget.

State Senate Health Committee Chairman Ed Hernandez, D-Azusa, said Congress declining to fund the insurance program is the “worst-case scenario.”

“Covering these children is probably the most important thing that we have to do … It’s a shame,” he said. “I hope that they reconsider. I hope they do renew it and that they fund it at the current level.”

This story was originally published November 30, 2017 at 6:47 PM with the headline "Without action by Congress, this health program for kids and pregnant women is at risk."