New federal spending plan has mixed news for Colorado kids
This morning after an only hours-long government shut-down, Congress passed a long-term budget package that was signed into law by President Trump. The package keeps the government running for six weeks to allow lawmakers time to write a final federal budget for this year and provides longer term fiscal certainty through September 2019. The law includes funding for a number of programs that are critical for kids and families, including CHIP, home visiting, and child care. It also includes some concerning provisions, such as cuts to the Prevention and Public Health Fund and changes to third-party liability policy in Medicaid that could reduce access to care for pregnant women. And it is silent on a solution for the future of young people living, working, and parenting in our communities through the Deferred Action for Childhood Arrivals program.
Here are a few positive highlights for kids and families:
- An additional four years of funding for the Children’s Health Insurance Program (CHIP) for a total of 10 years of CHIP funding. This is the longest extension of funding for the program in history, and will provide a level of certainty for Colorado families who use CHIP for their health coverage. It will also provide more state budget stability as states plan for their CHIP programs. The Congressional Budget Office (CBO) projected that extending CHIP funding for ten years would save $6 billion.
- An additional $5.8 billion in funding over two years for the Child Care and Development Block Grant (CCDGB), doubling current discretionary funding levels. CCDBG provides federal funding for the Colorado Child Care Assistance Program (or CCCAP). Estimates suggest that Colorado would see an increase of more than $35 million in federal funding for CCCAP in fiscal year 2018 as a result. This additional funding provides Colorado with opportunities to further expand access to high quality child care. Currently, only 13 percent of eligible children receive assistance through CCCAP. This additional funding also provides an opportunity to continue to ensure that child care provider reimbursement rates are adequate to ensure providers accept CCCAP and can deliver quality care.
- Five years of funding for the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, which expired in October 2017 and provides federal funding for evidence-based, voluntary home visiting programs in Colorado that serve pregnant women and families with young children. These services include Nurse-Family Partnership (NFP), Parents as Teachers (PAT), and Home Instruction for Parents of Preschool Youngsters (HIPPY). These programs promote the health, safety and development of young children, provide parenting support, and make connections to resources for families.
- Two years of funding for Community Health Centers (CHCs), after funding expired in September 2017. CHCs are a critical source of health care, including preventive and primary care, for kids and families enrolled in Medicaid and CHIP, or who are uninsured or underinsured. According to a new blog from the Colorado Health Institute, CHCs in Colorado serve over 200,000 children.
On the other hand, the budget package makes significant cuts to the Prevention and Public Health Fund created by the Affordable Care Act. In Colorado, federal funds from the Prevention and Public Health Fund are used for chronic disease prevention and health promotion efforts like lead poisoning prevention, smoking cessation programs and reducing racial health disparities as well as for monitoring infectious diseases like Zika.
The package also includes a change to Medicaid third-party liability policy that could reduce access to care for pregnant women. Medicaid is always the payer of last resort and state Medicaid agencies hold Medicaid payments to providers when they believe that an individual has another source of coverage to require that other source of coverage to pay first. Currently, there are exceptions to this rule for prenatal care and Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services for kids. Claims for these services must be paid in a timely way by state Medicaid agencies, though the agencies can then try to recuperate payments from third-party payers. The budget package removes this exception in the case of prenatal care, delaying payments to prenatal care providers in Medicaid. This policy change may reduce the places where pregnant women enrolled in Medicaid can access prenatal care, which ensures that babies get off to a healthy start and helps avoid serious and costly health issues down the road.
Finally, the budget package does not include a solution for the Deferred Action for Childhood Arrivals (DACA) program. A total of 800,000 young people, including 17,300 Coloradans, are recipients of DACA and have lived in the United States since childhood. One out of every four DACA recipients nationwide is also a parent. These parents of American citizens are relying on the protections of DACA to work, support their families, and contribute to their communities. A study found that after DACA was introduced in 2012, the mothers eligible for the program saw an immediate improvement in their children’s mental health—diagnoses of adjustment and anxiety disorders fell by more than 50 percent among these children.
We will continue to analyze the impact of this law. We are excited about the positive movement on several long-standing, and overdue, priorities for children, but are troubled by efforts to undermine quality health coverage included in the proposal. In addition, we continue to call on Congress to pass a permanent solution for Dreamers and, if they fail to address the issue in this budget compromise, move quickly to address this issue creating turmoil and anxiety throughout Colorado communities.