Transcripts For CSPAN2 Hearing Focuses On Childrens Health I

To order and thank everyone for their forbearance. We have concluded with member Opening Statements. The chair reminds members that all member Opening Statements will be made part of the record. We do want to thank our witnesses for being here today , taking time to testify before the subcommittee on this important issue. Each witness will have the opportunity to give an Opening Statement followed by questions from members. Again, as previously mentioned , we will hear from mr. Michael holmes, jamie schneider, associate commissioner for s Chip Services, health and Human Services from the state of texas and ms. Cindy man. We appreciate you being here today. Mr. Holmes you are recognized for five minutes for an Opening Statement. Thank you chairman. Ranking member greene, members of the subcommittee, my name is mike holmes. I am the ceo of Cook Area Health Services. We provide medical, dental, and Behavioral Healthcare in nine locations more than 12000 patients of rule northern minnesota. On behalf of the more than 1400 Community Health Center Organizations nationwide, i wanted to thank the subcommittee for the longstanding bipartisan support you consistently have shown for Community Health centers. Since 1979, Cook Area Health Services has provided Critical Healthcare access to patients and communities who would otherwise go without. Our service area covers more than 8300 square miles and many of our patients travel 50 miles or more to access care. Each one of our sites is located in the town with a population of fewer than 600 people. As with many rural Community Health centers, we are the only game in town. Its just one part of a much Larger National story. For more than 50 years americas Community Health centers, also known as sq h these have served as the medical home for nations underserved communities and populations. Today Health Centers represent the nations largest primary care network providing highquality care to more than 25 million patients. Our record of success would not be possible without the ongoing support of congress. Im here to urge you to continue support by continuing your investments in the program, specifically the Community Health center fund which provides enormous value to patients, communities, the Health System and the taxpayer. Our success is reflected in the core requirements that every Health Center must meet. They must be open to all. We must serve medically underserved area where. [inaudible] each Health Center is governed by consumer majority board which works closely with Health Center leadership and clinicians to develop innovative responsive to community needs. In 2010, congress created a dedicated source of funding to sustain and grow the natural investment in Health Centers. With an initial fiveyear authorization the fund directed resources to both operational expansion and Capital Investment and Health Centers. As a result, new Health Center sites were added in more than 1100 communities. Health centers are serving approximately 6 million additional people and have expanded Services Like Behavioral Health and dental care. At our Health Center, it allowed us to access add new Access Points and help us expand dental services and three other communities and to significantly expand our care coordination services. In 2015, congress extended the Community Health fund for two additional years and a number of other programs. With that extension nearing its expiration date, we strongly urge you to renew these investments and do so for at least five years so Health Centers like mine can continue to provide liable access to our patients. Without action by the end of the fiscal year, Health Centers in our patients face major disruptions in care. Hhs has estimated that should congress not asked by september 30, it would lead to the closure of 2800 Health Center sites, loss of 50000 jobs, and more importantly, a loss of access to healthcare for some 9 million patients. In conjunction with my testimony today, the minnesota delegation has given me a letter noting their support for Health Centers and the impact on minnesota chcs. In my written testimony i highlighted several of the programs which fall under the subcommittees jurisdiction. Key workforce programs are set to expire on the same timeline is the Health Centers fun. The National Health Service Corps which provides scholarships and loan repayment to clinicians willing to work in underserved areas is a key tool as we recruit and retain clinical staff. 54 practice and Health Centers today. Additionally, the teaching Health Centers and medical Education Programs bring Residency Program where providers are needed the most. Finally, id like to note that the Medicaid Program is extremely in important to Health Centers and those we serve. They work handinhand to return the promise of coverage into the reality of care. Nearly half of all Health Center patients are covered by medicaid. This is a time of rapid change in our Health System. Health centers probably help with that change, even though as we remain committed to our basic founding principle, ensuring that every american in need has a place to go for highquality care. That purpose is made into reality everyday for 25 million patients because of the support of congress and that sport begins here in the subcommittee. I urge you to continue that sport by extending these Critical Programs on a timely basis and appreciate the opportunity to testify before you today and thank you for making this an ongoing priority. Thank you for your testimony. Mrs. Snyder you are recognized for five minutes for an Opening Statement. The morning distinguished members of the subcommittee. Thank you for the opportunity to provide testimony on the Childrens Health Insurance Program. My name is jamie snyder. I serve as the director of the medicaid and chip program for the state of texas. I would like to provide insight into how chip has worked for the state of texas in response to the reauthorization legislation. The texas health and Human Services commission implemented the state chip program in 1998. The program currently serves approximately 380,000 children. Somesince implementation theyve seen a notable reduction in the overall rate of uninsured children before below two 100 of the federal Poverty Level, from 18 in 199826 in 2015. It allows states the flexibility to operate chip as a Medicaid Expansion program, a separate state program or as a combination of the two. Texas has historically operated chip as a separate program which has afforded texas the freedom to design a system that aligns with the states philosophy of ensuring accountability in the management of public funds and increasing personal responsibility for program participants. Unlike the Medicaid Program which offers a medical benefit for children, chip regulations offer states flexibility. This allows them to respond to changes in the evolving needs of beneficiary. Since the onset of the program, texas has delivered Chip Services through managed care model. They currently contract with 17 managedcare organizations delivering services to chip members statewide. The managed care Delivery System offers additional advantages as ncos are incentivized through a riskbased Payment System to contain costs while implementing innovative delivery and provider payment mechanisms to improve Health Outcomes for their members. Medicaid regulations make it difficult for states to implement costeffective mechanisms for the full range of medicaid beneficiaries. In contrast, they offer greater flexibility to design programs in which families retain a measure of responsibility for the cost of the childs care. Most families pay an annual enrollment fee, and all families make copayments for office visits, prescription medication, inpatient hospital care, and nonemergent care provided in an emergency room setting. Its a critical part of the healthcare safety net in texas offering a Healthcare Benefit to children who do not qualify for the Medicaid Program. Texas overall experience is that ship chip simply works. It provides reliable and medical benefits to the population at a rate of 156. Member. Month which is 67 less on a. Member basis than the cost of coverage for the states medicaid population. The states quality data also offers evidence of the efficacy of the program, indicating a 21 increase in children age 3 6 accessing wellchild visits and a 90 increase in children receiving recommended vaccines in the first two years of life from measurement years 2011 2011 2015. The decision to not really fund the program would result in a corresponding loss of healthcare coverage for more than 380,000 children. If funding for the program is not extended beyond September September 2017, its estimated the state will exhaust remaining resources by february 2018. As such, texas would be faced with the prospect of dismantling the chip program and as mandated by the aca, the state would also be expected to continue adherence to effort requirements at a lower medicaid matching rate for over 250,000 children now served under the states Medicaid Program. Through its routine budgetary planning process, texas has assumed continued funding for the chip program for fiscal years 2018 and 2019 at the enhanced federal matching rate. Should congress elect to not move forward, the state of texas will no longer be able to administer this Critical Program which has a proven track record of success stemming from the fundamental principles of state administrative flexibility, personal responsibility, and innovation aimed at enhancing outcomes for beneficiaries. Thank you for your testimony. You are recognized for five minutes. Good morning. I am pleased to be here this morning. I am cindy man and i work on matters primarily focused on public coverage specifically the medicaid and Childrens Health insurance. Ive also served as the chairperson responsible for federal policy, federal oversight of medicaid and chip and sporting state and meditation of these programs. Going to focus today my testimony on the role of chip in providing affordable coverage to children and the issues facing the funding. I also want to note the strong support of the comments by mr. Holmes in terms of the incredibly important value and critical function of federally qualified. With 20 years of experience, its hard to believe its 20 years, we know what has made this Program Successful and we know whats put in jeopardy. It works when it has robust and Stable Funding and when it has a strong Medicaid Program with which to partner in covering children. When the program was first started, the funding was ample for states that were just ramping up the program but very quickly, by 2002, some states began to see shortfalls in the funding. We saw mismatch between the allotments and state needs in terms of their coverage. That was not unexpected in some respects, congress didnt know how many states would pick up the chip program, with participation rates would be but it gives us an example of what happens when you have a mismatch in funding. Georgia reluctantly frozen moment from march until july 2007 on only lifted the freeze after they pass the supplemental budget. Florida frozen roman for just five months. During those five months, 44000 children, chip children, were placed on a waiting list. When it was reauthorized in 2009, there was strong support from the congress to avoid those kinds of shortfalls and enrollment freezes. They provide an ample funding and revamp the system for distributing dollars. Builtin new adjusters. It built in contingency funding and a new system for redistributing funds across the state. That funding formula has been maintained to the subsequent extensions. Going forward, adequate financing must be assured. Beyond extending the basic program funding, Congress Also needs to consider the issues that have been raised so far for the 23 percentage point increase in the match rate and the maintenance of effort provision, both of which were in the Affordable Care act. As my colleague from texas noted, the enhanced funding for the chip program is very much integrated into state budgets and helping a number of states to adopt program improvements. We must also recognize that the enhanced funding goes handinhand with the maintenance of provision. Without that millions of people will be at risk of losing coverage are paying much higher cost for that coverage. They made affordable coverage available to millions of children and given the market marketplace changes and costsharing reductions, it is essential to predict not just the funding but childrens program. Next, let me circle back to my point about chip working in large part because of foundational medicaid. The two programs depend on each other. Kids go back and forth between the two programs as family circumstances change. Even more fundamentally is that medicaid supports chip by covering so many of the children. Kids in foster care, kids with disability, chip wasnt designed to do the heavy lifting. They dont have the finance structure or the benefit structure to do that. Its an incredibly critical part of that coverage continuum but he cant do the job alone. Finally, congress has much to be proud of given its longstanding support of childrens coverage. Together medicaid and chip have brought the uninsurance rate for children below 5 . It was over 15 in 1997 when it was first enacted. It is a historic low and a great achievement, but with sweeping changes to medicaid and chip reauthorization outstanding, much is at stake for our children. Thank you for your time and support. Thank you to all of our witnesses for your testimony. We appreciate you being here and being flexible with us as the hearing has been rescheduled a couple times. I would like to go to mr. Guthrie, five minutes for his questions. Thank you very much. Before i get into my question, i know weve had some comments from my colleagues and others in medicaid and the way the a hca dealt with medicaid, we know its a program thats going rapidly and could implode. We very carefully sat down and walked through to see how we could move forward in the principal way of moving forward, i know theres a block grant option in the bill, but the principle way to move forward was on an approach to medicaid that was bipartisan. Every sitting member of the senate who was in the senate of the 1990s on the democrat side signed a letter to go too. Capita allotments. Medicaid, over the next ten years will grow by 20 . I just want to make sure the record reflects that. First, in addition to basic medical benefits, the chip Program Includes Behavioral Health services, vision exams and corrective lenses. There is also a limited dental benefit. In your testimony you seem to contrast this with medicaids extensive yet prescriptive medicaid benefit for children. I believe every member this committee wants to ensure low income children have adequate access to healthcare whether medicator chip. It sounded like you might have some ideas on the way medicaid to better serve children. Do you have any ideas you would like to share with us . Thank you vice chairman. Absolutely, we are of fundamental believer in the medicaid and chip program. I think as evidenced by my testimony, we enjoy the flexibility that the chip Program Offers two states in designing a benefit that is responsive to the population that serves under the chip program which is a population of children that dont qualify for medicaid. Certainly, we always, in texas and many other states we are looking at opportunities of personal responsibility into programs such as medicaid, and clearly weve already done so with chip. We do realize the populations that are served under those programs are distinctly diff