Casey Amendment Would Protect and Ensure Children’s Health Care

U.S. Senator Bob Casey (D-PA), a member of the Health, Education, Labor and Pensions Committee today introduced an amendment to protect and ensure health care coverage for low-income children.  The amendment would, in part, continue full funding for the Children’s Health Insurance Program (CHIP) through 2019, ensure affordable coverage and high quality benefits for children and make it easier for families to enroll in the program.

“We have had some victories in the effort to prevent the dismantling of CHIP, but there is more work to do in order to preserve and improve health care coverage for children,” said Senator Casey.  “My amendment to the Senate health care reform bill will strengthen coverage for children in CHIP through 2019 to ensure quality care for all vulnerable children. The benefits of health care for children, particularly low-income children and children with special needs, are beyond dispute.  Such care will not only help kids developmentally, do better in school and put them on a healthy path in life; it will also reduce long-term health care costs.”

Specifically, Senator Casey’s amendment would:

•    Continue CHIP funding through 2019;
•    Require a report in 2016 that will compare coverage and benefits for low income children under CHIP to the health care Exchange created in the reform bill;
•    Increase federal matching funding for states that implement best practices for enrolling children;
•    Protect children and families by ensuring, through 2013, that states may not reduce eligibility levels in place on October 1, 2009; will also require, beginning in 2014, that all states must cover children in families up to 250% of poverty;
•    Streamline and simplify the CHIP application process to ensure families know about and can take advantage of coverage;
•    Continue $50 million annual enrollment grants through 2019 to improve outreach to families about CHIP services and enroll children;
•    Prevent eligibility errors by improving the eligibility screening process; and
•    Dedicate any savings to be shared 50/50 between deficit reduction and a new fund for vulnerable children and families.

A detailed summary is included below.

Senator Casey has been a strong advocate for the Children’s Health Insurance Program (CHIP) since his father helped create the Pennsylvania program on which the federal program is based.  He was a leading advocate for the historic expansion of CHIP earlier this year.  And he has been a vocal opponent of the provisions in the original Finance Committee bill that would have dismantled the program.

Senator Casey spearheaded a letter signed by six other senators urging the Finance Committee to support the amendment by Senator Jay Rockefeller (D-WV) that preserved CHIP.  He recently hosted a widely-attended briefing on the importance of children’s health care.  Senator Casey gave numerous floor speeches on the need to do no harm to children in the health care reform debate.  And he actively lobbied his Senate colleagues and the White House on the importance of maintaining CHIP.

Summary of Casey CHIP Amendment

1.    CHIP continues with full funding through FY 2019. After the country accumulates real-world experience with the new coverage system established by reform legislation, Congress can make an informed decision whether to move CHIP children into the Exchange. In the meantime, the popular and successful CHIP program will continue to serve millions of low-income children, without forcing them into a new and untested system of coverage that would dramatically raise their health care costs and reduce covered benefits.

2.    In 2016, HHS reports to Congress about the difference between subsidized coverage in the Exchange and children’s coverage through CHIP. This report will inform Congress’ decisions about what happens to CHIP after 2019. If Congress decides to move CHIP children into the Exchange, this schedule allows time for a well-planned transition.

3.    States can count on federal CHIP dollars through FY 2019. From FY 2013 through FY 2019, states will qualify for federal matching funds whenever eligible children receive covered services. CHIP’s financial structure will thus fit with broader reform, in which Medicaid and Exchange subsidies are guaranteed without any rigid dollar limits in federal law. As a result, federal CHIP financing, like Medicaid and Exchange subsidies, will automatically adjust to changing conditions in each state, without artificial constraints locked into federal statute.

4.    States receive generous federal funding for all CHIP children. Starting in FY 2014, the federal government will pay between 88 and 94 percent of CHIP costs, depending on the state. To qualify for enhanced funding, states must implement recognized best practices for streamlining enrollment of eligible children.
5.    Children can count on CHIP eligibility. Through FY 2013, states may not reduce CHIP eligibility below levels in effect on October 1, 2009. Beginning in FY 2014, all states must cover children up to at least 250 percent of FPL.

6.    Children can count on affordable access to essential health care. States may not increase CHIP costs charged to families, except to reflect increases in median income among low-income families after FY 2013. And if a state would cover a service for poor Medicaid children, it must offer that same service to CHIP children.

7.    Families can conveniently apply for children’s coverage using their federal income tax returns. Beginning in calendar year 2014, parents can ask for their federal income tax returns to be used to establish their children’s eligibility for Medicaid, CHIP, and subsidies in the Exchange. Unless there is reason to believe that the tax return information is inaccurate, it will determine eligibility whenever possible, without requiring families to complete additional, redundant paperwork. However, no tax information can be disclosed to health agencies unless such agencies have contractual or other legal obligations that, in the judgment of the Treasury Department, fully safeguard taxpayer privacy and data security.

8.    Outreach and enrollment grants begun by CHIPRA continue. Grants of $50 million a year will help community-based organizations and states enroll eligible children into coverage.

9.    Health subsidy programs gain access to the National Directory of New Hires (NDNH), which is the nation’s most comprehensive information about quarterly wage earnings and new hires. Programs like Food Stamps, Supplemental Security Income (SSI), and Unemployment Insurance already use NDNH to verify eligibility. By adding Medicaid, CHIP, and Exchange subsidies to the list of programs authorized to access NDNH, the amendment will prevent eligibility errors, safeguard program integrity, and increase the ability of program administrators to establish eligibility based on recent income data.

10.    Any net federal budget savings are shared, 50/50, between deficit reduction and a new Fund for Vulnerable Children and Families. The Secretary of HHS can use this fund to combat infant mortality, help low-income children with autism spectrum disorders and other disabilities, and provide health services (including mental health care) to children who are in foster care or homeless.

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