Transcripts For CSPAN2 Hearing Focuses On Childrens Health I

[inaudible conversations] would call the subcommitteeee back toward her and thank everyone for their forbearance. Weve concluded with number Opening Statements. It sure would remind members pursuant to committee was on the 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 witnessss will have the opportunity to give an Opening Statement followed by questions from members. Again, previously mentioned today well hear from mr. Michael holmes, chief by qu executive officer precarious Health Services, the associate commissioner for Medicaid Services from health and Human Services commission in the partner in the hill. And ppreciate you being here today. Mr. Holmes come you are not recognized for five minutes for an Opening Statement, please. Thank you, chairman burgers, Ranking Member green, members om the subcommittee. Rankin the federally qualified Community Health centerof the s providing medical and Behavioral Health care in nine locations to more than 12,000 patients in rural minnesota. On behalf of more than 1400 Community Health Center Organization nationwide. The longstanding bipartisan support you are consistently showing for Community Health centers. Since 1979, they provided Health Care Access to patients and communities who would otherwise go without. The service area covers more than 8300 square miles in many of our patients travel 50 miles or more to access care. In fewer than 600 people. We are the only game in town. Much Larger National story. Americas Community Health centers also known as fdic and the underserved communities and populations. Health centers represent the nations largest primary care network providing highquality care to more than 25 million patients. Rsse a record of success would not be possible without the ongoing support of congress to name here today to urge you to continue to support extending investments in the Health Center program and specifically the communitybl Health Centers fund which provides enormous value to patients, communities, the Health System and the taxpayer. Success is reflected in the core requirements every Health Center must meet. Each Health Center must be open to all. Must serve our population and they must offer comprehensive ranges of primary Care Services and governed by a consumer majority board which worksrve ma closely to develop responses to community needs. In 2010 congress created a dedicated the investment Health Centers. The fund directed resources and operational expansions in Capital Investment in Health Centers. D as a result of this investment, sites are added in more than 1100 communities. 1100 communities. Health centers are serving approximately 6 million additional people and expanded services by the dental care. Health center allowed us to add new access in minnesota and helped us expand dental services from three other communities and to significantly expand our coordination services. In 2015, congress extended the Community Health funds for two additional years alongside chip and a number of other programs. D without extension nearing its Expiration Date or strongly urge you to renew these investmentsal and to do so for at least five years so customers like mine can continue to provide reliable access to our patients. Without action by the end of the fiscal year, they face major disruption than care. Hhs is estimated that shouldld congress not act by september 30th would be to the closure of 2000 Health Center sites, over 50,000 jobs and more importantly a loss of access to care for some 9 million patients. In conjunction with my testimony today, the minnesota delegation has given me a letter noting support for Health Centers and the impact on minnesotas chcs. 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 the Medicaid Program is extremely important to Health Centers and those we serve inch every state the programs work hand in hand to rush the promise of coverage into health care. E half of patients are covered by medicaid. A tomb of a time of rapid change in our Health System. Health centers help in that change, ensuring every american in need has place to go for hign quality care. That purpose is made into reality every day for 25 million patients because of the support of congress and that supportit begins here in this subcommittee immigrant urge you to continue that support by continuing these program and appreciate the opportunity to testify and thank you for making healther ins an ongoing priority. Thank you. The Committee Thanks you fore your touch. Miss snyder. Good morning, chairman burgess, Ranking Member green and distinguished members of the subcommittee on health. Thank you for for opportunity to provide time on the Childrens Health Insurance Program. Im jamie midder. I serve as the director of the mid okayed and chip programs for the state of texas. This morning id like to provide insight into how chip has worked for the state of texas in response to the subcommittees injuries concerning the reauthorization legislation. The texas health and Human Services commission implemented the states chip program in 1998. The program serves approximately 380,000 children. Since implementation the state has seen a notable reduction in the overall rate of up insured children below 200 of the0 federal Poverty Level from 18 in 1998 to 6 in 2015 chip statute allows state thursday operate chips as a Medicaid Expansion program as a separate state program or the combination of the two. Texas has historically operated chip as a separate program, which has afforded texas the freedom to design a system at lines with the philosophy in whsuring accountability in management of public funds and like the Medicaid Program, which offers an extensive monday program for children, chipg regulations offer the states to tailor the package to meet thehe unique needs. This aloud chip to fungs as a Nimble Program able to respond to exchanges the fiscalout and the evolving needs of beneficiaries. Since the onset of the program, texas has delivered Chip Services through a managementro care model. The state currently contracts with 17 managed Care Organizations delivering services to chip members statewide. The managed care Delivery System offers additional advantages as ncis or innocent viees through a risk based medicaid regulations make it difficult for states to implement costil effective effective cost sharing mechanisms for the full range of medicate bush rid. In con tsa chip offers states greater flexibility to design programs in which families retain a measure of responsibility for the cost or their childs care. Most families in chip pay an annual enrollment fee and all families in chip make copayments for office visits, prescription medications, inpatient hospital care, and nonemergent care provedded in an emergency room setting. Chips is a critical part of thex Health Care Safety net . Texas. Offering a Healthcare Benefit to children who do not qualify for the Medicaid Program. S texas overall experience is that chips simply works. It provides reliable medical and dental benefits to the covered population at a rate of 156 per member per month, and is 67 less on a per member basis than the cost of coverage for the states medicaid population. The state requests quality data offer evidence of the efficacy of the program, and 90 increase in children receiving recommended vaccines in the first two years of life for measurement years 2011 through 2015. A decision to not reauthorize the chip program would result in a loss of over 1 billion in funding annually to the state of texas, and a corresponding loss of healthcare coverage for more than 380,000 children. If funding for the program is not extended beyond september 2017, it is estimatede that the state will exhaust remaining resources bybywith t february 2018. As such, texas would be faced with a prospect of dismantling the chip program and as mandated by the aca the state would be expected to continue adherence to maintenance of effort requirements at a lower medicate federal matching rate for over 250,000 children now served under the state residents Medicaid Program. States Medicaid Program. Through the budget area planning process texas as humid funding for fiscal years 2018 and 2019 at the enhanced federal matching rate should congress elect not to move forward in reauthorizing chips the state of texas will bo longer be able to administer the program which has a proven record of success stemming from adherence to the principle of permanent responsibility, flexibility, and innovation aimedded a enhancing outcomes for beneficiaries. Chair thanks you for your tim. Miss mann youre recognized for five minutes for an openingmorn statement. Good morning, chairman burgess and Ranking Member green. And distinguished members of the subcommittee. Im pleased to be here this morning. Cindy man n and i work of matters of public coverage the medicaid and Childrens Health Insurance Program and as floated prior to joining them i served as a director of the center for medicaid and Chip Services at sms, responsible for federal policy, federal oversight of medicaid and chip, and supporting state implement take of programs. And a focus today on the testimony of roll on chip the providing affordable coverage for children, the issues facing congress on the expiration of the funding and want to note strong support of the comments by mr. Holmes in terms of the incredibly important value and critical function of federally quality Health Centers. With 20 years of experience with the chip program hard to believe its 20 years ben know what has made the program success. And what has put it in jeopardy. Chip works when it has robusthe and Stable Funding, and when ito has a strong Medicaid Program with which to partner and covering children. Lets took for the chips history on financing. When the program was first started, it was at the funding was apple for states just ramping up their program but very quickly by 2002 some states ban to she shortfalls in funding and we say a mismatch between allotment and state needs in terms of coverage of children. That was not unexpected in some respectes. Congress didnt know how many state wood pick thin chip program. But it gives us an example of what happens when you have misinch in fund. Georgia frozen rowlingment from march of july to 2002 and only lift the freeze after Congress Passed a supplemental budget. Florida frozen enrollment and for five month and 44,000 chip children were placed on a waiting list. When it was reauthorized in 2009 there was strong support from the congress to avoid those kind of shortfallsfalls and enrollme. Chip provided amp funding and revamped the estimator distributele dollar, built in adjustors and build in con con contingency funding. That formula has been handy maintained. Beyond extending the basic program funding, Congress Also needs to consider the issues that have been raised so far, the 23 porch 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 fund are for the chip program is integrated into state budgets and helping a number of states to adopt or machine for program improvement. We must recognize the enhanced funding goes hand in hand with the maintenance of effort provision. Without that provision millions of children will be at risk of losing coverage or paying much higher costs for that coverage. Chip made affordable coverage available to million oses children but given the market place changes, uncertainties of the future of subsidies and cost sharing reductions and the uncertainty in the Medicaid Program. Its essential to protect not just the funding but childrens eligible for coverage and i suggest its unlikely we would continue the moe requirement without the stable coverage for children. Let me circle back to my point about chip working because of the foundation of medicaid. Medicaid is the much Larger Program covering 37 millionds gk children. The two programs depend on each other. Kids go back and forth between the two programs all the time as family circumstances change, but even more fundamentally is medicaid supports chip by covering so many children with the greatest healthcare needs. Lowest income children, children in poor health, kids in foster care, kid width disables. Chip was not designed to do that heavy lifting. Doesnt they the finance or benefit structure to do that. Tit chip is a critical part of the care but cant do the job alone. Congress has much to be proud of. Medicaid and chip have brought in the uncovered rate down. Its a historic low and a great achievement but with sweepingip changes to medicaid and now area in during and chip reauthorization outstanding much is at stake nor nations children. Thank you for your time and support. Chair thanks all of our witnessed for their testimony today and appreciates your being here. And your being flexible with us as this hearing was rescheduled a couple of times. I now want to go to vicechairman of the committee, mr. Guthrie, five minutes for his questions. Thank you very much. With get into my questions we have had some comments from colleagues and others on medicaid and the way the ahca death with medicaid. Medicaid is a program that is growing rapidly and could implode in so what we decided to do when we very carefully sat down and walked through the ahca is how to move forward. N this principle way of moving fur theres a block grant option the bill but the principal way was on a approach to medicaid that in the 1990s was bipartisan. Matter of fact every sitting member of the senate who was in the senate in the 1990s on the dem crack site, signed a letter to president clinton supporting an option of going to per capita allotment, some being key Ranking Members and leadership on the other side. Medicaid over the next ten years under the proposal will grow, not cut, will grow by 20 . So i want to make sure the record reflects more than some of the rhetoric we have heard. First, miss snyder in addition to basic medical benefits texas Chain Program includes Behavioral Health services,wi vision examples and corrective lensing, hearing examples and hearing aids, physical occupational and Speech Therapy and durable medical equipment. Theres also a limited dentallo benefit, and your testimony youu seem to contrast this with medicaids extensive let prescriptive medical benefit for children ill believe every member of thisee wants to ensure low income children have adequate access to health care but sounded like you might have some ideas on the way medicaid could better serve children. Any ideas you would like to share with us . Thank you, vicechairman. Absolutely we are a fundamental believer in texas in both the medicaid and chip program. Think as as is evidenced by my testimony we enjoy the flexibility that the chipp Program Offers to states in designing a benefit that actually is responsive to the population that serves under the chip program, which is a population of children that dont qualify for medicaid. Certainly in texas were looking at opportunities to infuse elements of personal responsibility into programs such as medicaid, which clearly we have done so with chip but we do realize the populations served are different and want to be cog cognizant of those determine u differences in terms of at the population when we consider cost sharing opportunity, benefit limitations and so forth. Thank you. And mr. Holmes, also, the reliance