H.R. 3922 extends funding for the Children’s Health Insurance Program (CHIP) through Fiscal Year (FY) 2022, Federally Qualified Health Centers (FQHCs) through FY2019, and revises CHIP and Medicaid.
Specifically the bill:
- Extends funding through FY2022 for CHIP allotments, as well as the Child Enrollment Contingency Fund, the Childhood Obesity Demonstration Project, and Pediatric Quality Measures Program, and specified outreach and enrollment grants;
- Reauthorizes through FY2022 the qualifying-states option and the express-land eligibility option;
- Extends funding through FY2019 for FQHCs through the Community Health Center Fund;
- Extends funding through FY2019 for the National Health Service Corps, Teaching Health Center Graduate Medical Education, Family-to-Family Health Information Centers, the Youth Empowerment Program, and the Personal Responsibility Education Program;
- Allows state CHIP programs to adopt more restrictive eligibility standards with respect to children in families whose income exceeds 300% of the poverty line who have an offer of employer-sponsored insurance;
- Ensures the unwinding of the enhanced Federal Matching Assistance Percentage (E-FMAP) for child-health assistance by not extending the E-FMAP beyond FY2019, providing a 11.5 percent E-FMAP in FY2020, and returning to the traditional pre-ACA CHIP matching rate in FY2021 and FY2022;
- Eliminates Medicaid payment reductions for disproportionate-share hospitals (DSH allotments) in FY2018 and FY2019, and offsets the cost of this policy with new additional reductions in FY2021 through FY2023;
- Increases Medicaid funding for Puerto Rico and the Virgin Islands through FY2019 and allows funding be further increased through 2019 if the oversight board certifies Puerto Rico takes specific actions to improve its Medicaid program’s quality, integrity, and accountability;
- Allows states to define their grace period requirements for patients receiving advance premium tax credits (APTCs) and cost sharing reductions (CSRs) or move to a default of one month;
- Redirects Prevention and Public Health Fund dollars to support critical prevention and public health programs in this bill;
- Improves current law related to third-party liability under Medicaid and CHIP to save Medicaid and CHIP programs by ensuring other liable third parties pay to the extent of their liability;
- Specifies how a state must treat qualified lottery winnings and lump-sum income for purposes of determining Medicaid eligibility.
Children’s Health Insurance Program (CHIP) – CHIP is a means-tested program that provides health coverage to targeted low-income children and some pregnant women in families that have annual income above Medicaid eligibility levels but have no health insurance. CHIP is financed by the federal government and the states. The states are responsible for administering CHIP. Federal CHIP funding expired on September 30, 2017.
After the expiration of FY2017 funds, and until the provision of FY2018 funds, states may use redistributed funds and unspent allotments to continue to provide healthcare coverage, however at least one state is projected to exhaust all federal CHIP funding as early as November, and all states are expected to exhaust federal funding unless FY2018h funding is provided.
**Federal Qualified Health Centers (FQHCs) **– FQHCs, specifically, community health centers, are community-based, patient-centered organizations that provide comprehensive health services to medically-underserved populations, regardless of ability to pay. Funding for community health centers expired at the end of FY2017. This bill would extend funding for an additional two years.
**APTCs and CSRs Grace Period **– Under current law, subsidized patients with exchange plans have a three-month grace period if they do not pay their insurance premiums, meaning their plan cannot discontinue coverage for nonpayment of premiums. H.R. 3922 allows states to define their own grace periods, or move to a default of one month.
**Prevention and Public Health Fund (PPHF) **– PPHF was created under the Affordable Care Act to fund “programs authorized for prevention, wellness, and public health activities”. H.R. 3922 allocates more than $6 billion from this fund to support public health programs under the bill.
Federal Matching Assistance Percentage – CHIP spending is by the federal government at a matching rate higher than that of the Medicaid program. This is known as the enhanced federal medical assistance percentage (E-FMAP). Under current law, a 23 percentage point increase in the CHIP federal matching rate that went into effect in FY2016 will expire at the end of FY2019. H.R. 3922 sets this E-FMAP at 11.5 in FY2020 and returns to CHIP’s historic matching rates beginning in FY2021.
**DSH Allotments **– Under current law, allotments are made to states for payments to hospitals that treat a disproportionate share of uninsured and Medicaid patients. DSH allotments are increased each year by the percent change in the consumer price index and then will be adjusted by scheduled cuts between 2018 and 2025. H.R. 3921 eliminates the scheduled cuts for in FY2018 and FY2019, and offsets the cost of this policy with new additional reductions in FY2021 through FY2023.
The summary below was written by the Congressional Research Service, which is a nonpartisan division of the Library of Congress, and was published on Nov 3, 2017.
Continuing Community Health And Medical Professional Programs to Improve Our Nation, Increase National Gains, and Help Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act of 2017 or the CHAMPIONING HEALTHY KIDS Act
DIVISION A--CHAMPION ACT
Community Health And Medical Professionals Improve Our Nation Act of 2017 or the Champion Act
TITLE I--EXTENSION OF PUBLIC HEALTH PROGRAMS
(Sec. 101) This bill amends the Patient Protection and Affordable Care Act to extend funding through FY2019 for community health centers and the National Health Service Corps. Health centers that serve medically underserved populations may receive supplemental grant funds to increase access to primary care services. In awarding health center operating grants, special consideration may be given to a new center that is located in a sparely populated area or in an area that has a higher level of unmet need. Loan guarantees are no longer made to assist health centers to plan and develop a managed care network or to plan and develop practice management networks. The bill provides funds for FY2018 to support the participation of health centers in the All of Us Research Program in the National Institutes of Health's Precision Medicine Initiative.
The bill increases and extends funding through FY2019 for teaching health centers that sponsor graduate medical residency training programs. Priority is given to teaching health centers that serve health professional shortage areas, serve medically underserved communities, or are in rural areas.The Department of Health and Human Services must report on expenses associated with graduate medical residency training programs.
(Sec. 102) The bill amends the Public Health Service Act to extend funding through FY2019 for type I diabetes research and the prevention and treatment of diabetes in Native Americans.
(Sec. 103) The bill amends the Social Security Act to increase and extend funding through FY2019 for family-to-family health information centers, which assist families of children with disabilities or special health needs.
(Sec. 104) The bill creates, and makes appropriations in FY2018 and FY2019 for, the Youth Empowerment Program. The program shall fund allotments to states or other entities to implement education exclusively about sexual risk avoidance (voluntarily refraining from sexual activity). Up to 20% of an allotment may be used to build evidence for sexual risk avoidance education.
The bill extends funding for the grant program for personal responsibility education through FY2019.
(Sec. 201) The bill revises the grace period that health insurers must provide to recipients of premium subsidies before discontinuing health coverage for nonpayment of premiums. The grace period is shortened from three months to one month unless state law includes an applicable grace period.
The Government Accountability Office must report about the effects on consumers of aligning grace periods for Medicaid, Medicare, and plans offered on health insurance exchanges, including whether such an alignment may reduce fraud, waste, and abuse under Medicaid.
(Sec. 202) The bill reduces appropriations for the Prevention and Public Health Fund through FY2025 and continues funding through FY2027.
DIVISION B--HEALTHY KIDS ACT
Helping Ensure Access for Little Ones, Toddlers, and Hopeful Youth by Keeping Insurance Delivery Stable Act of 2017 or the HEALTHY KIDS Act
TITLE I--CHIP EXTENSION AND OTHER MEDICAID AND CHIP PROVISIONS
(Sec. 301) The bill extends funding through FY2022 for the Children's Health Insurance Program (CHIP).
In addition, the bill reauthorizes through FY2022:
the qualifying-states option (which allows states that provided coverage to now CHIP-eligible children prior to CHIP's enactment to continue to provide such coverage), and the express-lane eligibility option (which allows states to use eligibility findings from other public benefit programs to determine children's eligibility for Medicaid and CHIP). Beginning in FY2020, the bill allows state child-health plans to adopt more restrictive eligibility standards with respect to children in families whose income exceeds 300% of the poverty line.
(Sec. 302) The bill extends funding through FY2022 for the Childhood Obesity Demonstration Project and the Pediatric Quality Measures Program.
(Sec. 303) The bill: (1) extends funding through FY2022 for specified outreach and enrollment grants, and (2) makes eligible for such grants "parent-mentors" who are trained to assist families with children who have no health-insurance coverage.
(Sec. 304) Current law provides states with an enhanced Federal Matching Assistance Percentage (FMAP) for child-health assistance through FY2019. The bill maintains the enhanced FMAP in FY2020, but halves the percentage-point increase.
(Sec. 305) The bill eliminates Medicaid payment reductions for disproportionate-share hospitals (which receive additional payment under Medicaid for treating a large share of low-income patients) in FY2018 and FY2019, but increases such reductions from FY2021-FY2025.
(Sec. 306) The bill also increases Medicaid funding for Puerto Rico and the U.S. Virgin Islands through FY2019. Such funding shall be further increased through 2019 for both territories if Puerto Rico takes specified actions to improve its Medicaid program.
(Sec. 401) The bill alters provisions related to third-party liability under Medicaid and CHIP.
(Sec. 402) The bill specifies how a state must treat qualified lottery winnings and lump-sum income for purposes of determining Medicaid eligibility.
(Sec. 403) The bill eliminates Medicare premium subsidies for beneficiaries with annual incomes exceeding $500,000.