Congress had until the end of September to extend the Children's Health Insurance Program (CHIP), which provides basic coverage for low-income children and pregnant mothers in Minnesota. Lawmakers in Washington failed, fixating on throwing other people off their insurance by repealing the Affordable Care Act.
That leaves Minnesota, which has already exhausted its $115 million CHIP dollars for the year, in dire straits.
Unlike many other states, Minnesota uses CHIP money to supplement its federal, dollar-for-dollar Medicaid match, instead of operating a separate CHIP program. Using CHIP money this way allows Minnesota to insure low-income children and pregnant women with 88 percent federal funds, and just 12 percent state funds.
It also means that if Congress allows CHIP to lapse, Minnesota has to dig deep in its own pockets to continue services for 125,000 children and 200 infants. About 1,700 pregnant Minnesotan women who are ineligible for Medicaid due to their immigration status (undocumented or temporary visitors to the U.S.) and rely exclusively on CHIP risk losing their prenatal and postpartum care, as well as any other medical service short of actually going into labor.
"What is particularly ridiculous and galling is that CHIP reauthorization has been on folks' radar for a long time now, it has bipartisan support, and it just doesn't get done," says Bharti Wahi, executive director of the Children's Defense Fund. "In lieu of taking care of these children, [Congress] decided to spend a significant amount of energy around ACA repeal, a bill that doesn't have bipartisan support, that doesn't require action in this moment."
Should Congress fail to pass CHIP reauthorization soon, and Minnesota is forced to start gouging its general fund, state childhood programs and services would see a significant squeeze, Wahi warns.
More children in the state are eligible for early care and learning than currently receive it due to limited resources, she says. And the Minnesota Family Investment Program, which requires low-income parents to work in return for cash and food assistance, hasn't seen a cap increase since 1986.
"[Not reauthorizing CHIP] can set us back in the state not only in healthcare, but in many other areas," Wahi says.
Minnesota Department of Human Services Commissioner Emily Piper has long warned Congress about the consequences of letting CHIP lapse. Last week, she learned that the Centers for Medicare and Medicaid Services (CMS) could offer Minnesota some stop-over funding from its pool of unspent CHIP funding nationwide, but it wasn't until late Monday evening that Minnesota was cleared to receive $3.6 million in one-time funding for October.
After that, it's Piper's hope Congress will set its priorities straight.
"I got the sense that they're very heavily invested in reauthorizing CHIP in a bipartisan way, but that being said, there's a lot happenning in Washington that's not necessarily good for states or good for government, particularly in public healthcare programs like Medicaid and CHIP," she says.
As of Monday evening, there were CHIP bills in both the U.S. House and Senate. However, neither extends the 23 percent increase in federal match for CHIP that the Affordable Care Act initiated in 2015. DHS's conservative estimate is that Minnesota would lose $60 million a year without it.
If or when Congress finally reauthorizes CHIP, Piper says she needs the feds to make Minnesota whole.
"This is another symptom of the broader problem, that things aren't working in Washington, D.C.," she says. "All of this uncertainty and instability and inaction creates problems for us when we are the ones who are ultimately responsible to the people of Minnesota to deliver the services the government has said it would provide."