A water fountain with a "Do Not Drink Until Further Notice" sign posted above it
A sign next to a water dispenser at North Western high school in Flint in May 2016. Carlos Barria/Reuters

Placing funding for the Children’s Health Insurance Program (CHIP) in jeopardy has an unexpected consequence in Flint.

Political gridlock has created a lapse in funding for a program that provides health insurance to poor children. It may also end up being culpable for preserving lead service lines that still run under the city of Flint, Michigan.

Since its creation in 1997, the Children’s Health Insurance Program (CHIP) has provided healthcare for children and pregnant women from low-income families who don’t qualify for Medicaid. But this year, Congress failed to meet the September 30 deadline for the program’s renewal. Although committees in both the House and Senate have passed bills to reauthorize CHIP, no one is sure when a final measure will appear. The state of CHIP’s funding is up in the air, and those who rely on it are left in limbo.

CHIP doesn’t just provide money for straightforward medical needs like immunizations and doctor’s visits. Under a special contract with Michigan approved by the federal government last year, families in Flint can apply for funding to assess their pipes and sample their water quality, in the wake of a water crisis that contaminated water throughout the Rust Belt city and elevated the blood lead levels of thousands of children. Under the five-year agreement, CHIP has also provided aid for pipe replacement; contractors get paid using CHIP funds for those homes with children who qualify for the program. That money has been a boon for the underfunded city. And the longer the federal government takes to fund CHIP, the more administrators worry about how they can pay to keep Flint’s residents safe.

“The loss is going to be a huge issue,” said Retired Brigadier General Michael McDaniel, the head of the Flint Action and Sustainability Team (FAST Start). FAST Start was tasked in February 2016 with finding and replacing the service lines in Flint that were made of potentially toxic materials like lead and galvanized steel. Under McDaniel’s guidance, the city has replaced the tainted service lines in over 6,000 out of an estimated 29,100 homes. But, he said, “I know state funds aren’t enough to do all that we need to do next year.”

In Flint, Michigan, the toxic mix of corrosive water and hazardous water service line material put some of the city’s youngest residents at risk of a host of cognitive and behavioral problems for which there is no known cure. As a result, the government raised the age limit of children in Flint who could qualify for CHIP and Medicaid to 21.

McDaniel says Michigan’s Department of Health and Human Services (MDHHS) told him CHIP funds for Flint are still available through April 2018.

"MDHHS is closely watching the federal activity regarding CHIP funding,” Angela Minicuci, the MDHHS spokesperson, said in an email to CityLab. “Should the funding not be reauthorized prior to when the state exhausts our remaining allotment, we’ll need to either secure additional funding from the state Legislature or amend/cease the contract accordingly."

Essentially, if the program is not reauthorized before that, the city and MDHHS will have to fund the program through other means—and may need to cease CHIP use entirely should they come up short. Though McDaniel is relinquishing his position in Flint come January, the incoming FAST Start had planned to use CHIP funding in 2018. Now, McDaniel can’t sure what’s going to happen.

The costs in 2017 for excavation and line replacement came to just under $20 million—16% of which came from CHIP funding—and the allotted state funding for 2018 is less than that. McDaniel has been open about the fact that he does not think Flint has enough money to get rid of the lead service lines in the three-year window the city had hoped for.

Carin Speidel, coordinator of the state’s DHHS Lead Safe Home Program, told Bridge Magazine that CHIP funding has “really multiplied the services we’re able to provide for families.” She went on to say that, should the funding disappear, the consequences, “will be devastating.”

Roughly 9 million children across the U.S., including those in Michigan, rely on CHIP’s core function—providing health insurance to kids whose parents don’t qualify for Medicaid. And already, many states have explored shutting down their programs, warning parents to look for private insurers, or preparing to funnel money from elsewhere to temporarily cover the program.

There are also an estimated 7.3 million homes across America that connect to their local water systems using lead service lines. According to the Lead Service Line Replacement Collaborative, the price tag of that nationwide replacement is more than $30 billion. Yet, over the next decade, America could fall $1.44 trillion short of what it needs to spend on infrastructure, according to the American Society of Civil Engineers.

Flint has had targeted congressional funding to tackle its own pipe problems, but McDaniel sees CHIP as a useful tool for other cities dealing with the same issue, who might also seek similar contracts to Michigan’s for replacing hazardous pipes at qualifying homes. According to a report by the Robert Wood Johnson Foundation and Princeton University’s Woodrow Wilson School of Public & International Affairs, other states could enter into similar agreements for testing, preventing, and abating lead through a CHIP provision that allows “health service initiatives” (HSIs).

While Congress agrees that it should provide money for CHIP, neither the House and the Senate nor the Democrats and the Republicans can agree on how to fund it. When the House passed a bill to extend the program in November, Democrats voted against it because they did not like the cuts to public health programs and insurance coverage that were also included in the legislation. Meanwhile, Senate has thus far put off finalizing a bipartisan deal in order to focus on the tax bill.

Republican Senator Orrin Hatch, chair of the Senate Finance Committee, and Michigan Governor Rick Snyder did not respond to requests for comment.

“You just look at this and shake your head,” said the former Brigadier General who has worked in infrastructure assurance for the Pentagon. “When what you’ve done for a living is planning, and you see something like [the holdup in CHIP funding], you say ‘Oh God.’ No matter what your political ideology is, it’s just stupid. We’re being so shortsighted.”

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