Health care programs lapse, risking thousands' care but leaving time to renew

Two federal programs that support the health care of thousands of low-income Northwest Arkansans expired this weekend, though Arkansas likely has a few months before it'll feel the full effects.

Congress hasn't renewed the budgets for the Children's Health Insurance Program or for much of the government's support for hundreds of community health centers around the country. The programs didn't end, but the directives setting aside money for them expired Saturday at the end of the federal fiscal year.

The health insurance program in Arkansas pays for ARKids First B, which pays for medical, dental and mental care for uninsured children in low-income families while their parents kick in a small amount, such as $10 per doctor's visit. Approximately 10,000 kids in Benton and Washington counties and several times more statewide were enrolled for at least part of fiscal 2016, according to the state Department of Human Services.

The expiration of community health center support risks curtailing the care for more than 36,000 patients who go to the Community Clinic in Springdale and several surrounding cities each year, Executive Director Kathy Grisham said. She said federal money covered about one-sixth of the clinic's annual budget, or about $1 million in 2015, the latest year Grisham provided.

The ARKids money won't vanish overnight thanks to quirks in federal budgeting that should allow money from the old budget to keep arriving into next year, said Brandi Hinkle, human services spokeswoman.

"We don't want parents to be fearful that their kids are going to lose their coverage," Hinkle said, adding this kind of thing has happened before with programs such as Supplemental Nutrition Assistance, commonly called food stamps. "It's very typical for the federal government for things to go past their renewal and then be reauthorized without any break in their service."

The federal government provides around $200 million toward the insurance program, according to Arkansas Advocates for Children and Families.

The lapses have sparked some anxiety, however, given a year in Congress dominated by repeated, unsuccessful Republican attempts to limit Medicaid spending for people with low incomes or disabilities and to soften several health insurance regulations. Work on the overall federal budget and a new Republican proposal to cut some income taxes are also crowding the field. Then there's the aftermath of three major hurricanes.

Grisham said the federal money going to Community Clinic could drop immediately, which would leave it to rely on its reserve to make up the difference for now. The clinic has enough in reserve to cover about five months' worth of its overall expenses.

"It's a perfect storm year," Grisham said, adding she's spoken with the state's congressmen about the problem. "We're making phone calls all today, like we've been doing all month."

J.R. Davis, spokesman for Gov. Asa Hutchinson, said the children's insurance program had a 20-year record of success.

"We urge timely action by Congress to ensure continuity of the program," he wrote in an email.

The insurance program money could last in Arkansas until at least April, but dozens of other states could run out before then, according to a survey from the nonpartisan Kaiser Family Foundation, which analyzes health policy. Hinkle couldn't provide a specific length of time for the wiggle room but said it's months long.

If the money for ARKids B isn't renewed in time, Hinkle said the department would spread the word and advise families to move to the insurance exchange set up under the Patient Protection and Affordable Care Act, often dubbed Obamacare. The exchange offers a variety of health plans to compare and subsidies for low-income families.

"We do not expect that in this case whatsoever," Hinkle added.

Grisham said a total lapse of the federal support could lead to a loss of staff members, though she also doubted that would happen.

The two programs provide vital help in paying for routine visits, for immunizations, and more complex care, Hinkle and others said. ARKids B is open to families who make up to about twice the federal poverty line, a limit that comes to about $43,000 for a family of three.

Community Clinic provides care on a sliding scale based on patients' income and accepts anyone who walks in the door. It runs more than a dozen offices in six Northwest Arkansas cities, including several school-based health centers.

Joy Shirley, director for student services at Fayetteville Public Schools, said care from ARKids B or A, a related program that is essentially Medicaid for impoverished children, can help children stay focused in school or stay in school, period. The district's social workers will often help families apply for coverage if they wind up needing it for a variety of reasons.

"It occurs to families who are working; it occurs to families who don't have that extra income coming in due to their own medical needs," she said.

Both programs enjoy bipartisan support, including from Arkansas' Republican members of Congress. Sen. Orrin Hatch, R-Utah and chairman of the Senate Finance Committee, endorsed a five-year extension for the health insurance program, for example.

Caroline Rabbitt, a spokeswoman for Arkansas Sen. Tom Cotton, R-Dardenelle, wrote in an email, "CHIP is critical to improving coverage and access to care for Arkansas children and Senator Cotton fully supports its reauthorization. He's hopeful the Senate will soon take action to ensure this important program continues."

Sen. John Boozman's spokeswoman, Sara Lasure, said Boozman, R-Rogers, is confident the people covered by both programs won't have their coverage interrupted.

"Senator Boozman has been a longtime advocate for community health centers," Lasure wrote. "He understands the critical role they play in delivering quality health care to Arkansans and providing services on a daily basis to many people who would not otherwise be able to afford care."

NW News on 10/01/2017