Center for American Progress

While Congress Cuts Taxes, Children and Families Are Left Without Health Insurance and Support Services

While Congress Cuts Taxes, Children and Families Are Left Without Health Insurance and Support Services

Congress’ focus on passing tax cuts for the wealthy has left state administrators to explain why families may lose services covered under the Children’s Health Insurance Program and the Maternal, Infant, and Early Childhood Home Visiting program.

A pediatrician does a checkup on a child at a clinic, October 2007, in Florida. (Getty/Joe Raedle)
A pediatrician does a checkup on a child at a clinic, October 2007, in Florida. (Getty/Joe Raedle)

Through most of last December, congressional leadership rode a wave of “manufactured urgency” to pass its tax bill, securing a massive tax cut for big businesses and billionaires—and repealing the Affordable Care Act’s individual mandate—just in time for the holidays. The bill’s passage is just the latest in a series of moves that have upended the financial security of working families. While Congress was focused on the tax bill, it neglected to fund important programs such as the Children’s Health Insurance Program (CHIP) and the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program. Both programs expired on September 30 despite clear evidence and several warnings that if Congress did not take action, children and families would lose access to health coverage and necessary home visiting services.

CHIP, a bipartisan program, provides quality, affordable health coverage to nearly 9 million children and thousands of pregnant women and includes services such as hospital services, well-child check-ups, and immunizations. Along with Medicaid, it is an essential source of health coverage for children of color: Almost 60 percent of the children enrolled in these programs are African American or Hispanic.

MIECHV funds voluntary evidence-based home visiting services for families living in poverty, first-time parents, single mothers, and other families who may benefit from additional support. Many of these families are families of color; nearly one-third of children served are African American, and another one-third are Hispanic or Latino. Programs pair parents with a nurse, a social worker, or an early childhood professional who provides coaching and education throughout pregnancy and a child’s early years. Home visitors empower parents, helping them create a safe and healthy home environment that supports positive maternal and child health outcomes. Home visits can include lessons on positive parenting, proper nutrition, stress management, and child development; breastfeeding assistance; referral to programs that promote family economic security; and much more.

As part of the latest continuing resolution, which funds the government through January 19, Congress included $2.85 billion to the CHIP program and provided no funding for MIECHV. CHIP expenses were meant to be covered through March 31, 2018, with this money, but the Centers for Medicare & Medicaid Services recently announced that funding was only secure in states through January 19.

The future of CHIP

Without CHIP, millions of children and pregnant women are in danger of losing health coverage and services. Even before the end of 2017, many states were fielding calls from parents and families who were extremely worried that their children would lose coverage. As Cathy Caldwell, director of the Alabama Bureau of Children’s Health Insurance, stated, “Our phones are ringing off the walls. We have panicked families wondering what in the world they have as options. It’s very, very stressful here in Alabama.”

Due to a variety of factors, it is incredibly hard to know when a state will use up its CHIP funding. States such as Virginia recently sent notices to families warning that the CHIP program could close. Other states have taken steps to potentially close their programs—such as Louisiana, which submitted a state plan amendment to shut down CHIP. The instability has not only left families across the country wondering how they will ensure their children have affordable health coverage, but it has also left states scrambling to consider options, right when many state legislatures are back in session and planning for budgets and the year ahead.

The future of MIECHV

Prospects for MIECHV services are just as dire. Faced with funding insecurity, as many as 12 states may need to freeze enrollment in MIECHV-funded home visiting programs in early 2018. According to a report in Governing magazine, Iowa plans to stop enrolling new families this month to save remaining funds for families currently receiving services.

MIECHV programs are at risk even in states that have not publicly announced plans to cut services. Oklahoma, for example, used MIECHV funds to expand home visiting to two new counties serving about 3,097 families. Losing MIECHV dollars will hamstring home visiting services in these expansion counties by removing a primary funding stream. And at least one Colorado program has warned that the funding lapse endangers the program’s existence.

Funding uncertainty is also likely to affect staff turnover. As Carol Brady, project director of the Florida MIECHV initiative, explained to the Brookings Institution, “Our greatest fear with the lapse in MIECHV reauthorization is staff attrition … Once staff starts leaving, there will be a ripple effect—participants will drop out and administrators will get nervous about filling positions and enrolling new families.”


CHIP and MIECHV have enjoyed strong bipartisan support over the years, but Congress left them out in the cold in its rush to pass the tax bill, and previous efforts in September to repeal the Affordable Care Act. Neglecting these programs is costly; every day that passes without action introduces more instability to programs, which will affect the availability and quality of vital services for children and families.

These services—including service coordination, parent education, and access to affordable health care—help create positive health outcomes. By the time that Congress finally turns its focus back to CHIP and MIECHV, some of the damage may already be done. The children and families who need these services deserve better from their elected representatives. Congress must reauthorize both programs now.

Cristina Novoa is a policy analyst for Early Childhood Policy at the Center for American Progress. Theresa Chalhoub is a senior policy analyst for the Women’s Health and Rights Program and Health Policy at the Center.

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Cristina Novoa

Senior Policy Analyst

Theresa Chalhoub

Senior Policy Analyst