Local, state health programs for children scramble with CHIP in limbo

Healthcare enrollment assistant Sharissa Tjok (left) and ICHS employee, and CHIP beneficiary, Qi Qun Ma Wong (right) stand in front of the ICHS Holly Park Clinic in South Seattle. (Photo by Sarah Corn)

The federal Children’s Health Insurance Program (CHIP) is on borrowed time.

If Congress doesn’t reauthorize the program before the end of the year, federal health funding for 58,000 low-income Washington State children and pregnant women will dry up by February 2018.

CHIP funding was designed specifically to help children whose families can’t quite qualify for Medicaid, either because their household income is too high or they immigrated to the United States within the last five years.

For Qi Qun Ma Wong, whose family immigrated from the Dominican Republic in 2007, the program has meant the difference between financial stability and destitution.

The immigrant family’s three children were born in the United States, and the CHIP-funded extension of Washington state’s Medicaid program, also known as Apple Health, covered Wong’s prenatal care, delivery and six weeks of postnatal follow-ups.

Wong’s two daughters were born within five years of her and her husband’s arrival from the Dominican Republic, which allowed Apple Health to cover the pregnancies. Then, about six years ago, a car accident in her youngest son’s first trimester cost Wong just enough hours at work to lose her private insurance. Despite the loss in income, the family still earned too much to qualify for the expanded adult Medicaid coverage.

These days, Wong’s income from her part-time job as a receptionist at the International Community Health Services’ (ICHS) Holly Park Clinic, when combined with her husband’s income, allows her family to live relatively comfortably just under the CHIP eligibility cutoff, which is $7,603 monthly for a family of five.

This means that Wong’s family pays $60 dollars a month all three of her children — now ages nine, seven, and five — to get doctor visits, prescription refills, vision screenings, behavioral therapy and more. Her husband’s full-time job doesn’t provide insurance for the family.

Without CHIP, the cheapest monthly premiums Wong could find through the insurance exchange would raise her payments to over $320 dollars a month per child, and would offer significantly less coverage.

Wong says Apple Health is the only government benefit in which Wong’s family is enrolled.

“The only thing we need is insurance for the kids,” she said. “That’s the only thing my family needs.”

The Apple Health program is also easy for low-income families and immigrant families to understand, in contrast to the complicated plans on the exchange, said Sharissa Tjok, an in-person health exchange assister at ICHS’s International District Clinic.

Wong agreed and said after her children were born they were automatically and immediately enrolled in Apple Health without Wong having to initiate the process. And at every step there were interpreters available to defuse language barriers.

Already gone

Technically, the funding is already gone, said Sarah Kwiatkowski, Senior Public Policy Analyst at the Community Health Network of Washington.

The money ran out on Sept. 30, after congress allowed the previous funding bill to expire without a replacement.

“Congress has already failed to act in time,” Kwiatkowski said. “We are now operating on a wish and a prayer.”

To maintain current coverage levels for as long as possible, Washington has been using money from a pool of unused CHIP dollars leftover from other states’ 2017 allotments. But that funding is expected to run out within a couple of months.

And with only two weeks left until the end of the congressional session, Washington children’s health advocates are calling for the state to come up with its own plans for covering the potential $240 million shortfall.

Filling a hole that big will require a fair amount of budgeting gymnastics, said Jon Gould, deputy director of Children’s Alliance, a Seattle-based kid’s health lobbying firm.

Gould anticipated speaking with Gov. Jay Inslee’s office the day after our interview, regarding a plan his organization has put forward for making up the difference in the governor’s December supplemental budget proposal.

One option would be to submit an amended Medicaid population report, increasing the state’s 2018 allotment. But that would only cover a portion of the funding gap. The state would have make up the difference, and how exactly that would work out remains unclear.

But both Kwiatkowski and Gould seemed hopeful that Inslee and the state legislature would follow precedent and come up with a solution.

“We know, in the state of Washington, [what happens] when we… join forces and try and make sure that whatever is happening at the federal level doesn’t disrupt coverage for our state,” Kwiatkowski said.

When Apple Health’s coverage of undocumented children came under threat during the 2009 recession, two years after the program’s launch, a bipartisan coalition in the state legislature led the fight to keep it in place.

“It was a consensus of Democrats and Republicans not to cut children’s health and not to differentiate between children based on how they came to Washington state,” Gould said.

Regardless of how the funding backfill happens behind the scenes, Kwiatkowski said, the main goal is to minimize the impact on Apple Health patients.

“I think the state advocates are very aligned in making this feel as seamless to families as possible,” Kwiatkowski said.

Sharissa Tjok stands next to the ICHS’s Welcome poster. The message is written in the most common languages in the surrounding neighborhood: Vietnamese, Somali, and Cantonese. (photo by Sarah Corn)