Sara Rosenbaum’s Observations on CHIP Funding and Changes to Medicaid 1115 Policy

George Washington University Milken Institute School of Public Health Professor Sara Rosenbaum recently published important commentaries about changes to programs that provide insurance coverage to underserved populations.  Her Medicaid commentary can be found in a recent blog in Health Affairs and an article in The American Prospect.  On the Commonwealth Fund’s To the Point webpage, she comments on the need for continuing funding for the Children’s Health Insurance Program (CHIP)

In the Health Affairs blog, Rosenbaum, who is the school’s Harold and Jane Hirsh Professor of Health Law and Policy, analyzes the basis for and implications of the Trump administration’s initiative to revamp the use of Section 1115 of the Social Security Act to conduct Medicaid demonstrations whose purpose is to eliminate coverage for people who qualify for assistance.  This commentary on the Administration’s new policies builds on Rosenbaum’s previous article in The American Prospect on the misuse of 1115 to carry out demonstrations that damage Medicaid for the people it serves, rather than improve it.  In her article, she explains why even without any congressional action, the administration has considerable power under existing law to modify Medicaid but argues that to be legal, modifications must promote Medicaid’s core objective, which is to provide eligible people with access to health care, not remove it.  The article and blog both raise questions about whether the Administration’s latest actions are indeed, authorized under 1115. 

CHIP has not been funded since September 30.  States are beginning to run out of money and soon will need to take the first steps to notify millions of families that their children’s insurance coverage will end.  The House of Representatives has passed legislation to continue CHIP funding, and similar legislation has been approved by the Senate Finance Committee, which oversees CHIP.  However, there is much uncertainty as to when the legislation to extend funding, which has bipartisan support, will reach the Senate floor or become law. Furthermore, in order to come up with the money needed to extend CHIP funding, the House bill makes cuts in other important health care programs – cuts that are considered non-starters in the Senate.  How these issues will be resolved remains unclear.  Rosenbaum’s blog on the Commonwealth Fund’s To the Point webpage explains why the program offers a critical health insurance pathway for children living in families with modest means.