UPDATED

By Christina A. Samuels

On Dec. 21, Congress passed a short-term government spending bill designed to keep the Children’s Health Insurance Program operating through March, but it’s far from the five-year funding package that advocates for the program were hoping for.

So where would does the lack of a long-term deal leave the 9 million children and 370,000 pregnant women served by CHIP, which is aimed at families who earn too much to qualify for Medicaid but who can’t afford insurance for their children or themselves on the open market?

Advocates offer some worrisome scenarios.

Families would have to scramble to find other insurance programs that they can afford. Many of them would go without insurance, and start to ration health care for their children based on what they can afford. Emergency rooms could feel the strain. And even if the program is funded sometime early in the new year, a lack of faith in CHIP’s stability may be hard to overcome—studies have found that once families drop off the CHIP rolls, it can take years to bring them back.

Those were the takeaways that came from a press call Wednesday organized by the Georgetown University Center on Children and Families that included two state CHIP administrators.

The press call took place before participants knew about the government funding bill. But they made it clear that the program needs more than a series of temporary fixes.

“Even what’s happened so far, I believe, will cause irreparable damage to the CHIP program. It will take us years and years to overcome it,” said Cathy Caldwell, who oversees CHIP for the Alabama Department of Public Health. About 84,000 Alabama children are served by CHIP.

Earlier in December, Congress reallocated CHIP reserve funds to states facing immediate shortfalls. But that ended up causing other states to lose money that they had been counting on. As a result, 25 states and the District of Columbia are now projected to run out of CHIP funds by the end of January.

Shifting around more money to patch the system will just leave states with more uncertainty, said Linda Nablo, the chief deputy director at Virginia’s Department of Medical Assistance Services

“A short-term fix without adequate funding is not just useless, its dangerous,” Nablo said. Virginia has about 68,000 children and 1,100 pregnant women on its CHIP rolls.

Congress is acting as if “the only real issue is when states run out of their last dollar. They totally ignore the fact that these are large health-care systems, and they must be managed,” Nablo said.

There’s no disagreement among lawmakers about whether to continue CHIP. A path to reauthorize the program for five years is already on the table. But lawmakers have been relying on reports that indicate that states can keep the program running on reserve funds, said Joan Alker, executive director of the Georgetown University center. That, and Congress’s focus on passing tax reform legislation, has reduced the urgency to act on CHIP.

“State administrators are walking a tightrope, and they have no good choices until Congress acts decisively with funding,” Alker said.

Caldwell, in Alabama, said her state just started notifiying families earlier this month that CHIP funding may not be there in the new year. “Our phones are ringing off the wall. We have panicked families wondering just what in the world they have as options,” Caldwell said.

There’s evidence that it’s hard to regain families who have dropped of the CHIP rolls. The news site Vox reported that in 2003 and 2004, Florida enacted restrictions on CHIP enrollment. Enrollment dropped from 337,000 to less than 200,000. Those restrictions were lifted in 2005, but enrollment in the program was just around 250,000 in 2010, years after the restrictions were lifted.

A similar story took place in Alabama, Caldwell said. The state froze enrollment for several months in fiscal 2004 because of a funding shortfall. That freeze and waiting list were only in place for seven months, she said, “but we had people continuing to think we had a funding shortfall and a freeze out there for 10 years. Some of them think the program went away and that they have no options. We joke that that was the most successful message we every put out there.”

Home Visiting Also Caught in Funding Limbo

The Maternal, Infant, and Early Childhood Home Visiting Program, known as MIECHV, is caught in a similar funding limbo. Republicans and Democrats say they both agree on the value of the program, but it also lapsed at the end of September.

In this situation, however, there is disagreement on how the program should be funded. The House wants state and local entities to match every federal dollar they receive. Though states do contribute funds for home visiting, a one-to-one match has not been required before. The Senate wants to maintain the current funding scheme.

The program served about 160,000 families in fiscal 2016. Iowa has already announced it won’t enroll any new families.

Karen Howard, the vice president of early-childhood policy at the advocacy organization First Focus, said that funding for home visiting and for children’s health insurance could be rolled into a bill meant to keep the government operating until a larger budget is passed.

“Put them on for their full term renewal and do not let us hang out there in the wind through January,” Howard said. “That’s what we’re hoping and urging them to do, and we see no reason they can’t do it.”