Hold the Celebration: Thousands of Colorado CHP+ Kids Still Face Uncertainty
Update 2/9: The Senate passed a two-year spending bill that includes funding for community health centers and CHP+ before 2 a.m. Friday in a 71 to 28 vote. The House followed suit around 5:30 a.m., voting 240 to 186 in favor, and President Donald Trump signed the bill around 8:40 a.m.
Those were huge sighs of relief you heard across Colorado a couple weeks ago when Congress finally extended Child Health Plan Plus (CHP+) funding for six years.
But Coloradans concerned about the state’s low-income and vulnerable children are worried about another important safety-net program that’s still awaiting Congressional funding approval: The Community Health Center (CHC) Fund, which expired in September.
In Colorado, there’s a crucial connection between CHP+ and community health centers.
At any point, about 75,000 Colorado children are enrolled in CHP+. And, according to the 2017 Colorado Health Access Survey, about one-third of those children rely on community health centers for care. These centers — also known as federally qualified health centers, or FQHCs — serve those who are uninsured, underinsured or covered by public insurance programs such as Medicaid and CHP+.
This means that an estimated 24,000 Coloradan kids and their families, who lived through months of uncertainty about their CHP+ coverage, now face continued uncertainty about the places they rely on for care, community health centers.
CHP+ kids may have to find a new source of care if Congress doesn’t reauthorize the community health center funding. Many of the centers are already considering potential responses, including cutting back services, laying off staff and even closing clinics, according to a George Washington University survey.
The impact, though, isn’t limited to children. The fund provided $80.1 million to 20 clinics in Colorado in 2016. Those health centers served about 550,000 Coloradans at more than 200 sites from the Western Slope to the Eastern Plains, according to the Health Resources and Services Administration.
But there may be action soon. The community health center funding debate is part of the bigger government spending discussion underway in Washington. Lawmakers are working to meet a deadline today (February 8) in order to avoid the second government shutdown of the year. Both the House and Senate are expected to vote on a two-year budget deal, which includes a two-year reauthorization for community health centers with increased funding. Other health care investments in the deal include:
- Ten years of funding for the Children’s Health Insurance Plan (CHIP), increased from six years. (CHIP is the federal equivalent of Colorado’s CHP+ program.)
- $495 million over two years for the National Health Service Corps.
- $363 million over two years for Teaching Health Centers.
Congress will be burning the midnight oil in Washington to finalize these details, but that’s where they stand now.
Both CHP+ and the health centers help to expand access to health care for vulnerable Colorado children. This table offers a comparison of the two programs.
Comparing CHP+ and Community Health Centers in Colorado
| Federal Funding Source | Child Health Plan Plus (CHP+) | Community Health Centers |
|---|---|---|
| Purpose | Insurance for children and pregnant women in low-income families with incomes higher than Medicaid eligibility. | Community health clinics that reduce barriers such as inability to pay. |
| Colorado Children Served | 75,333 | 203,947 |
| Year Created | 1997 | 2010 |
| Funding Source Prior to September 30, 2017 | Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) | Affordable Care Act’s Community Health Center Fund |
| Political Support | Bipartisan | Bipartisan |
| CHI Funding Analysis | CHP+ Blog | Community Health Center Blog |
While about 33 percent of the children covered by CHP+ rely on community health centers for their care, just 14 percent of children covered by Medicaid do the same. Colorado kids and pregnant women eligible for CHP+ have incomes that are a bit higher than those eligible for Medicaid.
Which leads to another question: Why do CHP+ enrollees rely more heavily on community health centers for care?
CHI analysts posed three hypotheses to answer this question. We first considered the possibility that families with at least one child enrolled in CHP+ would be more likely to spend more of their income on medical costs than other families. However, the data don’t support this hypothesis. The CHAS shows that 11.8 percent of families with a child enrolled in CHP+ report spending a significant portion of their income on medical expenses compared with 13.8 percent of families that do not have a child enrolled in CHP+. (A significant portion is defined as five percent of income for families whose income is below 200 percent of the poverty level and 10 percent of income for families whose income is greater than 200 percent of the poverty level.)
Our two other hypotheses:
- It is harder for children enrolled in CHP+ to find a primary care doctor accepting new patients, particularly in rural areas.
- We hypothesize that CHP+ parents may be getting their health care at community health centers, so it makes sense for the entire family to get care in one place. These parents may be uninsured because it’s a stretch to afford private insurance, due to the fact that their family income is only slightly above Medicaid eligibility levels. Community health centers accept uninsured patients as well as patients with public insurance, making it easier for families with both insured and uninsured members. Parents of Medicaid children will usually qualify for Medicaid themselves and the whole family may use private providers for care.
Do you have an idea about the answer to this question? CHI would love to hear your thoughts about community health center use in Colorado. Tweet @CHI_JIngalls or email me at IngallsJ@ColoradoHealthInstitute.org with any ideas you have that might answer this question.
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