How the SGR repeal law ensures access to care for kids

AMA Wire
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The law that repealed the sustainable growth rate (SGR) formula also included important provisions to help maintain the health and well-being of American children.

The Medicare Access and CHIP Reauthorization Act (MACRA) addresses a variety of issues, including extending funding to the Children’s Health Insurance Program (CHIP), which provides low-cost health care coverage to children in low-income families who don’t qualify for Medicaid. This post, the third in a series examining what physicians need to know about the MACRA, looks at the CHIP provisions, which include increased funding provided to states for the program.

As of last year, 8.1 million children were enrolled in the program, which is implemented in all 50 states. CHIP was authorized through 2019, but no new funding was available after 2015, until passage of the MACRA.

The law extends funds for CHIP for two additional years (through 2017) with no major structural program changes. It maintains the general financing structure and the provisions to the program put forth by its last reauthorization in 2009. That includes extending coverage to pregnant women and coverage protections included in the Affordable Care Act, such as streamlined enrollment processes and increased outreach.

The law also extends for two years “express lane eligibility” for certain enrollment programs. This provision allows states to use data from other agencies to facilitate enrollment in CHIP coverage, such as information from the Supplemental Nutrition Assistance Program or the Special Supplemental Nutrition Program for Women, Infants and Children. Finally, the MACRA extends funding for the CHIP outreach and enrollment program for two years, which helps states find uninsured children who are eligible for CHIP.

“Physicians see the benefits of CHIP on a daily basis: Parents who work hard but are unable to afford health insurance are able to obtain the care their children need to stay healthy and strong,” the AMA said about the program in a 2009 letter to a U.S. Senate committee. “CHIP provides a critical health insurance safety net for children from low-income families and has been successful in significantly reducing the number of children without coverage.”

Learn more about the MACRA, access FAQs (log in) about the new legislation and read other posts in this MACRA series at AMA Wire. Watch for future posts on the many facets of the MACRA and how they’ll affect how physicians practice in years to come.

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Patrice Harris, MD
Dec 01, 2016
Donald Trump’s cabinet secretary pick would bring the insight of a longtime physician and a willingness to listen to organized medicine’s concerns.