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Charlie Dent, Pennsylvania lawmaker

Bipartisan bill would strike down ACA provision requiring states to move children to Medicaid from CHIP

By Virgil Dickson
Posted: January 30, 2014 - 3:00 pm ET

A proposal to strike down a Patient Protection and Affordable Care Act provision that forces states to move children from the Children's Health Insurance Program to Medicaid could become the rarest of healthcare legislation in Washington these days—a bill with bipartisan support that sails through Congress and gets the president's signature.

U.S. Rep. Charlie Dent (R-Pa.) said he's optimistic he will get bipartisan support for the measure, which could affect about 30,000 children in his state, and could affect up to a half-million depending on how far along states are in the implementation process.

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The ACA provision in question mandates that states move children whose families make less than 133% of the federal poverty level from CHIP to Medicaid. Once fully implemented, about 28% of CHIP enrollees, or around 562,103 children nationwide, would need to make the transition according to research from the Georgetown Center for Children and Families. Thirty-thousand children would be affected in Pennsylvania, Dent's home state.

The bill's introduction follows months of back and forth between HHS and Pennsylvania Gov. Tom Corbett, who wants his state exempted from that ACA provision. As a compromise, the federal agency late last year gave the state a one-year extension to comply. The ACA had mandated all states be in compliance by Jan. 1, 2014. The hope is Dent's bill will become law by the time the clock runs out.

Dent's measure, the Children's Health Insurance Protection Act, would give a state the option of covering eligible children in either Medicaid as a “Medicaid child funded with CHIP dollars” or just keep them in its current CHIP program. Child insurance programs tend to reimburse at higher rates than Medicaid.

Despite the partisan animosity over the ACA, Dent told Modern Healthcare he is optimistic his bill will be enacted because “it does not undermine the law, it simply protects a vulnerable population.” He also notes that Rep. Allyson Schwartz (D-Pa.) is a co-sponsor.

For Dent, this legislation has personal meaning. He was one of the state legislators who helped pass Pennsylvania's CHIP law in 1992; that law was the basis of the national program, which launched in 1997.

The Obama administration has noted that the Medicaid program is better for children because a wider array of services are covered. However, Dent counters that coverage does not equal being able to find a doctor, something that's been difficult for some Medicaid beneficiaries.

At this point, no other state appears to be contesting the ACA provision. The CMS released a guidance late last year that gave states the flexibility to take up to a year to transition children from CHIP to Medicaid if they submitted a written request by Nov. 1, 2013. Pennsylvania appears to be the only one that requested an extension, according to sources on the Hill and Wesley Prater, a senior health policy analyst at Georgetown's Center for Children and Families.

Dent added that his bill would have no effect on states that have already moved children off CHIP in compliance with the ACA.

Follow Virgil Dickson on Twitter: @MHvdickson

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