Budget Tangles Ensnare Key Early-Childhood Programs

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Congress is late in turning in two important assignments that affect young children: Both the Children's Health Insurance Program and a federally funded program that provides counseling to vulnerable families expired Sept. 30, the end of the fiscal year.

Neither program will run out of money immediately, and both programs have support from Republicans and Democrats. But the expiration, even if it proves temporary, illustrates how difficult it has been for Congress to address other legislation as it has wrestled, unsuccessfully, with repealing the Affordable Care Act.

The highest-profile of the two programs to expire is the Children's Health Insurance Program, which Congress failed to extend by the end of September, could put a financial strain on states—and eventually jeopardize coverage for the roughly 9 million children covered by the program.

Financial Hit

And it's not good news for district leaders and the children they serve, said Sasha Pudelski, the co-chairwoman of the Save Medicaid in Schools Coalition.

"We desperately want to make sure that kids are coming with health care, ready to learn," said Pudelski, who is also the assistant director of policy and advocacy for AASA, the School Superintendents Association.

What's more, some schools could take a financial hit if the program isn't renewed soon.CHIP, which was created in 1997 with bipartisan support, is aimed at children whose families make too much money to qualify for Medicaid—the state and federal health-care program for the poor—and who aren't afforded health care through their employers or can't cover the cost of insurance on the individual market.

Fourteen states and the District of Columbia treat their CHIP dollars the same way they treat their money from Medicaid. Schools in those states—which include some big population centers like California and Michigan—are reimbursed by both Medicaid and CHIP for such services as speech therapy, mental health, and hearing and vision screenings, Pudelski said.

Schools receive about $4 billion a year from Medicaid, but it's tough to say just how much they get from CHIP on top of that, Pudelski said. She expects that schools could miss out on funding, or be delayed in receiving it, if the program isn't renewed soon.

And if children show up to school in need of health services to enable them to learn—like hearing aids or glasses—districts might decide to use their own resources to help.

"If a kid comes in and can't see and can't hear and we have someone in-house who can help them, we have to divert resources to take care of their health needs," Pudelski said.

And she's warning school superintendents to be prepared to deal with parents' questions about how they can fill in gaps in their child's coverage if states aren't able to step in.CHIP was last renewed in 2015 with no significant changes. Lawmakers typically renew it far ahead of the deadline, said Elisabeth Burak, the senior program director of the Center for Children and Families at Georgetown University.

Stress on Families, States

The delay means a lot of unnecessary stress on families and state leaders alike, Burak said. Renewing the program quickly "should be a no brainer."

It's not clear, though, when Congress will act. To keep the program up and running, Sens. Orrin Hatch, R-Utah, and Ron Wyden, D-Oregon, have introduced a bill in the Senate that was considered in committee last week. Over in the House, lawmakers have attached an extension of CHIP to a broader package that includes some controversial changes to other health programs, including Medicare, which offers insurance to the elderly. Rep. Pete Sessions, R-Texas, said last month that the need to extend isn't "dire or urgent." He argued that states have enough money left in their coffers to keep them going until the end of the year.But Burak pointed out that Minnesota has already sent a letter to its congressional delegation saying that the state would have to take "extraordinary measures" and may have to spend $10 million of its own money to make sure health services are extended. The National Governors Association has also asked Congress to extend CHIP.

Plus, the uncertainty itself is a problem. States need to plan their CHIP expenditures, which is tough to do if they're not sure the program is sticking around, Burak said. What's more, if states need to tap some of their own money to make up for a loss in CHIP funding—even a temporary one—K-12 spending could be squeezed.

Home Visiting

The home-visiting program—its formal name is the Maternal, Infant, and Early Childhood Home Visiting Program—served about 160,000 families in fiscal 2016. It provides home-based services to families of young children who are facing a variety of stresses.

"It's kind of shocking that they weren't able to come together andreauthorize it," said Holly Whitworth, the program manager for the Parents as Teachers home-visiting program that is overseen by Eastern Idaho Public Health in Idaho Falls. That program serves 50 families with a range of needs, Whitworth said: Sometimes the parents have mental-health problems or developmental delays; some are teenagers, and many struggle with housing or food insecurity.

There's deep disagreement in Congress on how to pay for the program. In the House, a bill to reauthorize home visiting at $400 million a year for five years narrowly passed, but that measure would require states to match every federal dollar they receive. Advocates have said that state budgets can't handle the outlay.

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The Senate introduced a bill that would fund home visiting for the same amount, without the state match requirement. The full body did not have a chance to vote on the bill before the fiscal year ended.

In Idaho, Whitworth said there will be some funding left to continue working with the families who are currently enrolled, but the program can't recruit additional families without knowing that money will be available in the future. And there's the counselors, who don't know if they will still have jobs once the money runs out, she said.

"We're hopeful that ... they'll get back to work and they'll reauthorize it immediately, understanding how vital it is for families to have that continuity," Whitworth said of Congress.

Vol. 37, Issue 08, Page 12

Published in Print: October 11, 2017, as Budget Tangles Ensnare Key Early-Childhood Programs
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