Transcripts For CSPAN3 Hearing Focuses On Childrens Health I

Well call the subcommittee back to order and thank everyone for their forbearance. We have concluded with member Opening Statements. The chair would remind members, pursuant to committee rules, all members Opening Statements will be made part of the record. And 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 then by questions from members. Again, previously mentioned our witnesses, but today we will hear from mr. Michael holmes, ceo cook executive Health Services. Jami snyder, and ms. Cindy mann. We appreciate you being here today. Mr. Holmes, you are recognized for five minutes for an opening statement, please. Thank you, chairman burgess, Ranking Member green, members of the subcommittee. My name is mike holmes. Im the ceo of Cook Area Health Services, providing mental, dental, Behavioral Health care, in nine locations to more than 12,000 patients in rural northeastern minnesota. On behalf of the more than 1,400 Community Health Care Organizations nationwide, i wanted to thank the subcommittee for the longstanding bipartisan support youve consistently shown for Community Health centers. Since 1979, Cook Area Health Services has provided Critical Health care access to patients in communities who would otherwise go without. Our service area covers more than 8,300 square miles. Many of our patients travel 50 miles or more to access care. Each one of our sites is located in a town with a population of fewer than 600 people. As with many rural Community Health centers, were the only game in town. Other Health Center story is just one part of a Larger National story. For more than 50 years, americas Community Health centers also known as fqhcs have served as the medical home for our nations underserved communities and populations. Today, Health Centers represent the nations largest primary care network, providing high quality care to more than 25 million patients. Our record of success would not be possible without the ongoing support of congress. And i am here today to urge you to continue that support by extending your investments in the Health Center program and specifically the Community Health centers fund which provides enormous value to patients, communities, the health system, and the taxpayer. Our success is reflected in the core requirements every Health Center must meet. Each Health Center must be open to all. We must serve a medically underserved area in our population. We must offer comprehensive ranges of primary care services. Each Health Center is governed by a consumer majority board which works closely with Health Center leadership and clinicians to develop innovative responses to community needs. In 2010, congress created a dedicated source of funding to sustain and grow the National Investment in Health Centers with an initial fiveyear authorization. The chc fund directed resources to both operational expansion and Capital Investment and Health Centers. As a result of this development, new Health Center sites were added in more than 1,100 communities. Health centers are serving approximately 6 million additional people and have expanded Services Like Behavioral Health and dental care. At our Health Center, this funding allowed us to add new Access Points in tower, minnesota, and helped us expand dental services in three other communities and to significantly expand our care coordination services. In 2015, congress extended the fund for two additional years alongside c. H. I. P. And a number of other programs. And with that extension nearing its expiration date, we strongly urge you to renew these investments for at least five years so that Health Centers like mine can continue to provide reliable access to our patients. Without action by the end of the fiscal year, Health Centers and our patients face major disruptions in care. Hhs has estimated that should congress not act by september 30th, it would lead to the closure of 2,800 Health Center sites, loss of 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 their support for Health Centers and the impact on minnesotas chcs. In my written testimony, ive highlighted several other programs which fall under the subcommittees jurisdiction. Two key workforce programs are set to expire on the same timeline as the Health Centers fund. The National Health Service Corps which provides scholarships and loan repayment to clinicians willing to work in underserved areas is a key to recruiting clinical staff. 54 of National Clinicians practice in Health Centers today. Additionally, the teaching Health Centers graduate medical Education Program brings physician Residency Training right into Community Based settings like fqhcs where providers are needed the most. Finally, i would like to note that the Medicaid Program is extremely important to Health Centers and those we serve. In every state, the programs work hand in hand to turn 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 high quality care. That purpose is made into reality every day for 25 million patients because of the support of congress. That support begins here in this subcommittee. I urge you to continue that support by extending these Critical Programs on a timely basis and appreciate the opportunity to testify before you today and thank you for making Health Centers an ongoing priority. Thank you, mr. Holmes. The Committee Thanks you for your testimony. Ms. Snyder, youre recognized for five minutes for an opening statement, please. Good morning, chairman burgess, Ranking Member green, and distinguished members of the subcommittee on health. That you for the opportunity to provide testimony on the Childrens Health Insurance Program. My name is jami snyder. I serve as the director of the medicaid and c. H. I. P. Programs for the state of texas. This morning, i would like to provide insight into how c. H. I. P. Has worked for the state of texas in response to the subcommittees inquiries concerning the reauthorization legislation. The texas health and Human Services commission implemented the states c. H. I. P. Program in 1998. The program currently serves approximately 380,000 children. Since implementation, the state has seen a notable reduction in the overall rate of uninsured children below 200 of the federal Poverty Level. From 18 in 1998 to 6 in 2015. C. H. I. P. s statute allows states the flexibility to operate c. H. I. P. As a Medicaid Expansion program, as a separate state program, or as a combination of the two. Texas has historically operated c. H. I. P. As a separate program, which has afford texas the freedom to design a system that alliance 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 an extensive and prescriptive medical benefit for children, c. H. I. P. Regulations offer states flexibility to tailor the benefit package to meet the unique needs of the population served. This allows c. H. I. P. To function as a Nimble Program that is more easily able to respond to changes in the states fiscal outlook, emerging federal legislation, as well as the evolving needs of beneficiaries. Since the onset of the program, texas has delivered c. H. I. P. Services through a managed care model. The state currently contracts with 17 managed Care Organizations, delivering services to c. H. I. P. Members statewide. The managed care Delivery System offers additional advantageous, as mcos are incentivized through a riskbased, capitated Payment System to contain costs while implementing Innovative Service delivery and provider payment mechanisms to improve Health Care Outcomes for their members. Medicaid regulations make it difficult for states to implement effective cost sharing mechanisms for the full range of medicaid beneficiaries. In contrast, c. H. I. P. Offers states greater flexibility to design programs in which families retain a measure of responsibility for the cost of their childs care. Most families in c. H. I. P. Pay an annual enrollment fee. And all families in c. H. I. P. Make copayments for office visits, prescription medications, inpatient hospital care, and nonemergent care provided in an emergency room setting. C. H. I. P. Is a critical part of the Health Care Safety net in texas, offering a Health Care Benefit to children who do not qualify for the Medicaid Program. Texas overall experience is that c. H. I. P. Simply works. It provides reliable medical and dental benefits to the covered at 156 a month, population at 67 less on a per 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 to 6 accessing well child visits and a 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 c. H. I. P. Program would result in a loss of over 1 billion in funding annually to the state of texas and a corresponding loss to the children. If funding is not extended beyond september 2017, it is estimated the state will exhaust remaining resources by february 2018. As such, texas would be faced with a prospect of dismantling the c. H. I. P. Program. As mandated by the aca, under continue adherence to Maintenance Requirements at a lower medicare matching rate. Through its routine budgetary planning process, texas has assumed continued funding for the c. H. I. P. Program for fiscal years 2018 and 2019 at the enhanced federal matching rate. Should congress elect not to move forward in reauthorizing c. H. I. P. , the state of texas will no longer be able to administer this Critical Program which has a proven track record of success stemming from its adherence to the fundamental principles of state administrative flexibility, personal responsibility, and innovation aimed as enhancing the outcomes for beneficiaries. Thank you for your testimony. Ms. Mann, youre recognized for five minutes for an opening statement. Microphone on . Its on . Is it on . Yes. Thank you. Good morning, chairman burgess and Ranking Member green and distinguished members of the subcommittee. Im pleased to be here this morning. Im a partner at minette health and i work on matters relating to the medicaid and Childrens Health Insurance Program. Prior to that i served as the director for the center for medicaid and c. H. I. P. Services at cms, responsible for federal policy, federal oversight of medicaid and c. H. I. P. , and supporting state implementation of these programs. Im going to focus today on my testimony on the role of c. H. I. P. In providing affordable coverage to children, the issues facing congress on the expiration of the funding. I also do 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 Health Centers. With 20 years of experience with the c. H. I. P. Program, its hard to believe its 20 years behind us, we know what has made this program successful. And we know whats put it in jeopardy. C. H. I. P. Works when it has robust and Stable Funding, when and and when it has a strong history of partnership with medicaid. When the Program First started, the funding was ample for states that were just ramping up their program. But very quickly, by 2002, some states began to see shortfalls in their funding. We saw a mismatch between the allotments and states needs in terms of their coverage of children. And that was not unexpected in some respects. Congress didnt know how many states would pick up the c. H. I. P. Program, what the participation rates would be. But it gives us an example of what happens when you have a mismatch in funding. Georgia, for example, reluctantly froze enrollment from march to july of 2007 and only lifted the freeze after Congress Passed a supplemental budget. Florida froze enrollment. It froze it for just five months. And during those five months, 44,000 children, c. H. I. P. Children, were placed on a waiting list. When c. H. I. P. Was reauthorized in 2009, there was strong support from the congress to avoid those kinds of shortfalls and enrollment freezes. C. H. I. P. Provided ample funding and revamped the system for distributing dollars. It built in new adjusters and contingency funding and a new system for redistributing funding across states. That funding formula has been maintained through the subsequent extensions. Going forward, adequate financing for c. H. I. P. Must be assured. Beyond extending the basic program funding, Congress Also needs to consider the issues raised so far. 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 program is very much integrated into states budgets and helping a number of states to adopt or plan for program improvements. We must also recognize that that enhanced funding goes hand in hand with the maintenance provision. Without that, millions of children will be at risk of losing coverage or paying much higher cost for that coverage. C. H. I. P. Made affordable coverage available to millions of children. But given the marketplace changes, the uncertainties over the future of subsidies and cost sharing reductions, indeed uncertainties over the Medicaid Program, it is essential to protect not just the funding for the program but childrens eligibility for coverage. I would suggest its unlikely we would continue the m. O. E. Requirement without also supporting states ability to fund that requirement and that need for stable coverage for children. Next, let me circle back to my point about c. H. I. P. Working in large part because of the foundation of medicaid. Medicaid of course is the much Larger Program, covering about 37 million children. The two programs depend on each other. Kids go back and forth between the two programs all the time as families circumstances change. Even more fundamental is that medicaid supports c. H. I. P. By coverage so many of the children with the greatest Health Care Needs. Lowest income children, children in poor health, kids in foster care, kids with disabilities. C. H. I. P. Wasnt designed to do that heavy lifting. It doesnt have the financing structure or the benefit structure to do that. C. H. I. P. Is an incredibly critical part of that coverage continuum for children. But it cant do the job alone. Finally, i would say that congress has much to be proud of, given its longstanding support of childrens coverage. Together, medicaid and c. H. I. P. Have brought the uninsurance rate for children below 5 . It was over 15 in