1. National: CMS Medicaid and CHIP Directives/Rules Changes House Energy & Commerce Committee: Members of the House Energy and Commerce Committee agreed to place a moratorium on seven HHS Medicaid regulations until April 1, 2009. The bill could be passed as a stand-alone measure, or could be attached to an emergency Iraq spending bill to expedite its enactment. More information is available at http://energycommerce.house.gov/. Senate Subcommittee on Health: Senate Democrats April 9 lambasted federal guidance limiting enrollment in the State Children's Health Insurance Program (CHIP), saying the directive is illegal and will result in denial of health care coverage to millions of children. Democrats on the Senate Finance Health Subcommittee said the directive from the Centers for Medicare & Medicaid Services placed an unattainable mandate on states and was an attempt by the Bush administration to limit CHIP coverage when faced with certain passage of legislation in 2007 expanding the program. "With the stroke of a pen, and for less than $100 in postage the [Bush] administration has unleashed a tidal wave of financial uncertainty that will be measured in the loss of billions of dollars in state aid, and hundreds of thousands of children being denied access to health insurance," said subcommittee Chairman John D. Rockfeller IV (D-W.Va.). Rockefeller said he believed CMS did not have the legal authority to issue the directive. More information is available at http://finance.senate.gov/sitepages/hearing040908.htm/. 2. Wyoming: Manager Expects Kid Care to Continue Parents in Wyoming shouldn't be worried about their children losing health care benefits from the State Children's Health Insurance Program (CHIP) any time soon, said Patti Guzman, manager of Wyoming's program. As of early February, 5,883 Wyoming children were enrolled in Kid Care, Wyoming's version of CHIP. The children's health insurance program, funded partially by the federal government and administered by individual states, was debated in Congress last year. Federal funding for state programs was set to expire September 30, 2007. Democrats and others presented bills that would have expanded coverage to more than 4 million children. President George W. Bush vetoed two CHIP bills that would expand the program. In December, Bush signed a resolution that extended the existing program through March 2009. Guzman said she foresees the government re-authorizing--or at least extending--the program in 2009. "Everything I have heard from our counterparts in other states, (is) there is still a lot of interest in CHIP," Guzman said. Until March 2009, Guzman said they plan to run the program as is. If things do go awry, Guzman said they have the ability to freeze enrollment in the program. But she doesn't see this occurring. Even though they are constantly finding new kids to enroll in the program, numbers haven't increased significantly. Anywhere from 25 to 100 Wyoming kids join the program every month, but almost as many lose coverage at the same time. Either kids turn 19, income levels change or a parent simply doesn't fill out the annual renewal form, she said. [Allison Rupp, Jackson Hole Star-Tribune, 03/01/08] 3. Nevada: Cap to Impact Families and Rural Health Centers In another potential blow to healthcare, as well as to rural health centers, the statewide program Nevada Checkup is set to place a cap on the number of children, which may be enrolled. The 30,000 cap is slated to go into effect in April and State enrollment is currently more than 29,000. An article published in the Las Vegas Review Journal notes the cap, which would quell a projected statewide enrollment of 32,000 by the end of 2008, is part of a plan by Nevada Governor Jim Gibbons to cut spending. The cap will help save the state approximately $700,000 according to information received via South Lyon Medical Center. Nevada Check Up is the state's children's health insurance program. It provides low-cost, comprehensive health care coverage to low income, uninsured children up to 18 years of age who are not covered by private insurance or Medicaid. Those eligible are those whose family income falls between 100 and 200 percent of the federal poverty level guidelines. Other requirements include being a legal citizen or "qualified alien" in the U.S., having not had insurance in the past six months or having lost insurance due to reasons beyond the parents' control and the child must not meet qualification for Medicaid. Also, according to the State website, the Nevada Checkup Plus program (Employer Sponsored Health Care Insurance Program) will be discontinued effective April 1 due to State budget shortfalls. South Lyon Medical Center Administrative Assistant Jane Belez said the cap would mean, once reached, it would preclude new children from enrolling in the program until another child discontinues enrollment. Aside from impacts to children and their families, she indicated financial impacts to the hospital could come from the fact the facility cannot refuse treatment regardless of lack of coverage. As to an average of Nevada Checkup patients visiting South Lyon each month, exact figures were not available at press time; however, according to the State site, as of January 2008, 705 children living in Lyon County are enrolled with the highest numbers between ages 7 and 13 with second highest between ages one and six. This number is down from last January's Lyon County enrollment of just more than 761 and December's enrollment of nearly 740. Overall, of the nearly 1,400 dropping from enrollment effective January 2008, the top reason is lack of response at redetermination time, the State site says. Other top responses include lack of information, income became too high, Medicaid eligibility is found and/or dual enrollment in Medicaid and Nevada Checkup is discovered. [Patrick Abanathy, Reno Gazette Journal, 02/01/08]