POINT OF ORDER
A Capitolwire Column
By Chris Comisac
Deputy Bureau Chief
Capitolwire
HARRISBURG (June 4) – Remember when then-U.S. House Speaker Nancy Pelosi, D-California, uttered the immortal words, “we have to pass the bill so that you can find out what is in it, away from the fog of controversy,” regarding the federal Affordable Care Act (ACA), also known as Obamacare?
Well here’s a relatively new item I – and I think plenty of other people – didn’t know until recently: a decent portion of the kids in Pennsylvania’s Children’s Health Insurance Program (CHIP) are going to be forced into the Medicaid program, regardless of what Gov. Tom Corbett decides about expanding the state’s Medicaid program.
Yep, you read that correctly.
For a while now, most of us thought this would happen only if the state went along with Medicaid expansion. We thought it was optional – contingent on expansion – but it’s not.
Nope, it seems, tucked away within the nearly 1,000 pages of the ACA, and in the thousands of pages of regulations issued by the federal government pursuant to the law since then, is a provision that all kids with family incomes up to and including 138 percent of the federal poverty level – including kids who already have perfectly good privately-provided health insurance – are to be placed in the Medicaid program. No expansion necessary.
They can no longer be in CHIP, according to federal officials. And it doesn’t sound like the feds are budging on the matter.
“Friday afternoon, we had a lengthy conversation with Cindy Mann, Director of CMS,” the Center for Medicaid Services, the federal agency which is negotiating with states seeking to enter the Medicaid expansion, Senate Minority Leader Jay Costa, D-Allegheny, told Capitolwire’s Peter L. DeCoursey last week, when asked about issues that could impact Medicaid expansion.
“She reiterated that they will not likely deviate from the national guidelines published in April of this year,” ruling out the state’s staying in CHIP and getting Medicaid-level reimbursements, Costa said.
Republican and Democratic leaders from Pennsylvania have taken swings at the issue, and for most of that time, most of us have been under the impression that we only needed to worry about it if we expanded our Medicaid program. Gov. Corbett has cited the CHIP situation as one of the reasons for his hesitancy to expand.
But, it turns out, Corbett and his administration were only recently informed that his decision is immaterial for at least 70,000 children out of the more than 187,000 currently enrolled in CHIP.
“These are the pieces of the puzzle that we continue to put together,” wrote Department of Public Welfare spokesperson Carey Miller in an email late last week. “We finally received clarification on the CHIP kids and learned that children up to 138 percent of federal poverty level would be shifted to Medicaid – regardless of expansion in Pennsylvania.”
“We just recently received the calculations from CMS regarding the number of children who would be involuntarily moved,” said Miller.
She added: “Our main concern is the switch could result in a disruption of care for these families currently enrolled in CHIP if they are forced to move to Medicaid, as not many health care providers participate in the Medicaid program.”
Making matters even worse is the possibility that most of CHIP will be gutted, at least from the perspective of its enrolled population.
Roseanne Placey, spokesperson for the state Insurance Department – which oversees CHIP – said of the recent development: “It really has to do with the way the ACA is written regarding federal poverty income guidelines at the 100 to 138 percent levels. So we believe at least 70,000 CHIP enrollees within the free CHIP program would be involuntarily transferred to Medicaid.
“If that were to occur, that would effectively decimate the PA CHIP program. It would take our enrollment down to the levels of about 15 years ago.
“The CHIP program has evolved and matured over its 2 decades of existence –now with comprehensive benefits, robust provider networks and numerous choices in insurance company contractors. These are things our CHIP families have come to rely upon. So we are asking for flexibility for our program.”
And according to the Corbett administration, 70,000 is the floor for how many kids could be moved.
In a letter to federal officials sent at the end of last week, Corbett said his administration worries that as many as 144,000 of the kids will be pushed into Medicaid.
“I don’t think we can confirm the higher end of those numbers – we are saying at least 70,000 kids,” said Miller, noting, however, that they are still working through the details, with federal officials, about how the ACA’s new federal poverty income guideline will impact Pennsylvania.
Even the more vocal Medicaid expansion proponents weren’t aware of this.
While noting the Senate Democrats were aware that children above the age of 6 to age 19 and foster care children to age 26 up to 138 percent of poverty were, regardless of expansion, mandated by the ACA to be covered by Medicaid, Senate Minority Appropriations Committee executive director Randy Albright wrote in an email: “We didn’t know if it [mandated insurance coverage] would be provided through existing CHIP or Medicaid at CHIP reimbursement rates.”
Corbett spokesperson Christine Cronkright wrote in an email that “it’s unfortunate” there are people “willing to dismantle a nationally-recognized program in [a] rush to blindly expand an entitlement program without all of the facts and the true impact of an expansion on Pennsylvania.”
With regard to the impact of expansion, Miller explained, “Adding the CHIP kids to Medicaid does impact our analysis for Medicaid expansion, as it will increase the number of individuals on the Medicaid program.”
But the costs take a back seat to the issue of “decimating a highly successful, robust program,” said Miller.
For me, though, what’s very concerning is that it appears the feds intended this. And state officials on both sides of the aisle didn’t understand kids would lose their current insurance and its benefits, and have it switched to Medicaid.
CHIP participants also potentially could lose their doctor if the physician isn’t both a CHIP and Medicaid provider. How does that square with President Barack Obama’s promise that no one will lose their current health insurance if they want to keep it?
Is it any wonder that no state has yet signed an agreement with the federal government to implement Medicaid expansion? Sure plenty have said they want to expand, but none have signed on the dotted line to implement expansion.
Given the pace so far, it might take a lot longer than Jan. 1, 2014 before many, if any, states are up and implementing all the aspects of the ACA, including expansion.
Simply saying you want to expand Medicaid is one thing; working out the details is another.
The other states – even with billions of federal dollars being dangled in front of them – are, just like Corbett, still trying to understand how their states will be impacted and then getting the best deal they can get.
Regardless of what you believe the governor really thinks about expansion, Corbett sticking to his guns about getting questions answered before making a decision about expansion appears to be a prudent move, given this new development about CHIP.
