DES MOINES | Health insurance for roughly 44,000 Iowa children hangs in the balance, waiting for Congress to continue funding the government program for low-income families.

State officials said they are optimistic their federal counterparts will act in time to keep the program funded, but they also are preparing for the worst.

“The state is making contingency plans,” said a spokesman for the state health department. “No decisions have been made at this time, and the department remains optimistic that funding will be reauthorized.”

The Children’s Health Insurance Program, or CHIP, is a federally funded, state-administered program that provides health coverage for children in low-income families. Funding for the program, for the first time in its 20-year history, expired on Sept. 30, the end of the federal budget year, without renewal, leaving states to prop up the program with whatever money they had in their reserves.

Congress on Tuesday included a $2.85 billion infusion for CHIP in a short-term spending plan designed to prevent the federal government from shutting down. The money is designed to help states that are in danger of expiring their reserve accounts.

Iowa officials say they have enough money to run the state program through March, so it is unlikely to need any of the new funding.

But, if Congress fails to fully fund the program next year, difficult decisions will have to be made, state officials said.

“If funding is not reauthorized, the state will need to make decisions about children’s coverage before funding runs out next year. The choices available will vary by program type,” said Matt Highland, the state health department spokesman.

In Iowa, children covered by CHIP are in two categories: 16,000 who qualify for Iowa’s expansion of Medicaid, another low-income health coverage program; and 44,000 whose families make too much income to qualify for Medicaid, but perhaps not enough to afford private health insurance.

The 16,000 children in Medicaid expansion cannot lose coverage because of federal requirements for the program. However, if CHIP is not funded by the federal government, moving those 16,000 children to Medicaid would cost Iowa an additional $10 million to $15 million each year, Highland said.

The other 44,000 children not covered by Medicaid expansion are covered by a state program called Healthy and Well Kids in Iowa, or hawk-i. If Congress does not fully fund CHIP, those 44,000 Iowa children -- who are among 9 million across the country in similar circumstances -- could be left without health insurance.

In case federal lawmakers fail to act and CHIP funding runs out sometime after March, the state is exploring three options for those 44,000 children, Highland said.

* The state could move hawk-i children to Medicaid. That would cost the state an additional $32.8 million each year.

* The state could freeze hawk-i enrollment.

* Or the state could shut down the hawk-i program. If that were to happen, the state would send notice to families and note their option of purchasing health insurance through the federal marketplace established by the Affordable Care Act.

Highland stressed that the state health department has made no decisions and remains optimistic that Congress ultimately will fund the CHIP program.

There is bipartisan support in Congress for CHIP, but disagreements on how it should be funded.

Both of Iowa’s U.S. senators, Chuck Grassley and Joni Ernst, said they support a measure approved by a Senate committee in October that would keep the program funded through Sept. 30, 2022.

“The bipartisan committee vote shows the Senate’s understanding of what this program accomplishes and the need to make sure it continues without interruption,” Grassley said in October after the long-term funding plan was approved by the Senate committee.

Nearly half of U.S. states are in a similar predicament as Iowa, and many are considering options to reduce or limit coverage, according to the Kaiser Family Foundation, a national nonpartisan nonprofit organization that studies and reports on health care issues.

Fourteen of the 24 states with a separate CHIP program, like Iowa’s hawk-i, have said they plan to terminate or phase out CHIP coverage for children; eight have said they will do so by the end of February, according to Kaiser.

Seven states said they plan to freeze CHIP enrollment, and at least three have announced plans to move separate CHIP enrollees into Medicaid, according to Kaiser.

In these states, as in Iowa, state officials find themselves largely at the mercy of the federal government.

One Iowa official is calling for “swift, firm, united action.”

“This crisis affects families in every county of this state. This is an all hands on deck moment for Iowa’s elected leaders,” Nate Boulton, a state senator from Des Moines, hawk-i board member, and Democratic candidate for governor, said after the board’s meeting this past week.

Boulton said the Iowa Legislature should, once it convenes in January, approve a resolution requesting Congress fully fund CHIP, and that Iowa Gov. Kim Reynolds should travel to the nation’s capital to make the case in person to Congress and the president.

“We need swift, firm, united action to prevent a children’s health care crisis in Iowa,” Boulton said.

Reynolds said she is confident Congress will act in time to fully fund CHIP, and that she has been in contact with Sens. Grassley and Ernst to get updates on the process.

“I think, in the end, they’ve always been able to get that done, and I have no reason to believe that they won’t again,” Reynolds said. “I have confidence they’ll get there.”

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