AUSTIN — Three-year-old Zachary Ogletree doesn’t speak. But after two years of therapy, he’s learned other ways to communicate with his family.

“You know how babies learn how to talk by watching the parent? With Zachary, it takes a lot more than that because his brain is unable to do that,” said his mother, Tommie Ogletree of Lewisville. “We use a lot of sign language with him. We have these pictures with words on them as well as the picture. If he wants a snack, he’ll give me the snack card.”

Zachary, who was diagnosed with severe autism as a baby, is one of 8,000 Denton County kids enrolled in the Children’s Health Insurance Program. It covers 9 million children, including over 400,000 in Texas, whose parents make less than 200 percent of the federal poverty level but too much to qualify for Medicaid.

Zachary’s mother depends on CHIP to pay for the 20 hours a week he spends in therapy. He’s learning to communicate beyond sign language and picture cards and to master basic life skills such as holding a fork and spoon. Without CHIP, each session would cost $410. Ogletree said regular therapy is crucial for his development.

“If he doesn’t have that schedule, it really messes him up,” she said. “It throws everything off and makes him misbehave. He doesn’t want to eat or do anything.”

Parents like the Ogletrees have been on edge about their children's health care since Congress allowed CHIP funding to expire Sept. 30. The House passed a bill in early November that funds the program for five years, but the Senate has yet to act.

From left: Tommie Ogletree holding Zachary Ogletree, 3; Sydney Ogletree, 12; Bradley Ogletree, 10; and Kelley Ogletree in their home this month in Lewisville. Zachary, who was diagnosed with severe autism as a baby, is one of 8,000 Denton County kids enrolled in the Children's Health Insurance Program. (Vernon Bryant / Staff Photographer)

Congress has two more weeks to fund CHIP after the House and Senate approved a spending bill Thursday that keeps the government open until Dec. 22. The stopgap legislation also gives money to several states that are running out of funds to keep CHIP going.

On Friday, El Paso Rep. Beto O’Rourke and 98 other Democratic representatives sent a letter to Congressional leaders urging them to approve CHIP funding quickly.

“No one in Texas or across the country should have to lose their health coverage for others to maintain it,” O’Rourke said in a prepared statement. “Families throughout the country are depending on us to ensure their children have healthcare coverage going into the new year.”

Texas has enough funds to keep CHIP running until Jan. 31 and requested an additional $90 million to go through the end of February. Without the money, the Texas Health and Human Services Commission will have to send families cancellation notices three days before Christmas.

Spokeswoman Carrie Williams said commission officials hope the federal Centers for Medicare and Medicaid Services will confirm sometime this month that Texas will receive the money to fund CHIP through February, regardless of what Congress does.

Texas officials have explored other options. Legislative Budget Board staffers figured out an accounting trick to stretch remaining federal funds for a few weeks by not claiming a higher federally funded match on kids who formerly were in CHIP but are now covered by Medicaid. But it wouldn't last long.

CHIP's history and future

CHIP has had strong support from both parties since its creation in 1997, so children’s health advocates are confused about this unprecedented delay.

Matt Moore, vice president of government relations at Children’s Health in Dallas, said Congress needs to pass a reauthorization bill quickly or millions of children will be in a tough spot.

“We’ve been disappointed they haven’t taken care of it in a timely manner yet,” Moore said. “There are a lot of members of Congress who thought it would be taken care of earlier in the year. As time went by, CHIP kept getting pushed back to the back burner. Here we are in overtime, and we really are wringing our hands and getting truly concerned about it.”

Mimi Garcia, director of policy at Texas Association of Community Health Centers, said she has no idea why Congress has not yet passed a CHIP funding bill.

“I’m a little bit baffled by it, personally,” she said. “There has been ample opportunity, and it’s clear they’re prioritizing other things over health care in our communities and insurance for children.”

But some people don't want to see CHIP continue in its current form. Drew White, senior federal policy analyst at conservative group Texas Public Policy Foundation, said he wants Congress to give control of the program to the states.

But he said CHIP has enough bipartisan support that Congress will fund it as is.

"What's likely to occur is a straight extension rolled in the fiscal package at the end of December," White said. "Considering it has pretty strong bipartisan backing behind it, we'll probably see it reauthorized."

'Living paycheck to paycheck'

Beyond emergency room scares and sick visits to the doctor, there’s also the cost of raising a healthy child. Lizbeth Cervantes works as a clerk for Women, Infants and Children’s Services at Los Barrios Unidos Community Clinic in Dallas. She has two sons — 1-year-old Adrian and 3-year-old Thiago — who are covered by CHIP.

When Thiago dislocated his shoulder, Cervantes paid $120 for his hospital visit and treatment. Without CHIP, she said, the bill would have set her back more than $1,800.

Her sons are up to date on their vaccines, but if CHIP funding runs out, she doesn’t know how she’ll pay for the several shots they still need.

“We’re already really tight on budget,” Cervantes said. “We are living paycheck to paycheck. Every now and then we get a little extra, and it goes to clothes and shoes for the kids.”

She’s considered adding them onto her work insurance, but it would cost an extra $500 a month that she said she doesn’t have.

Ogletree also isn’t sure how they would pay for her children’s health care without CHIP. She left her job as a surgery technician to take care of Zachary, leaving her husband as the sole source of income for the family of five.

“We’re looking at $800 to $900 a month for private insurance, and that’s not realistic for us,” Ogletree said. “That’s not even Zachary’s therapies. That’s just for well checks or if they get sick, and that’s with a high deductible. You might as well throw in $800 a month into your fireplace.”

Even now, saving thousands of dollars with CHIP, this holiday season will be lacking, she said.

“Right now, we’re not even able to give our kids a Christmas because money is so tight.”

CORRECTION, 2:38 p.m., Dec. 11, 2017: An earlier version of this story incorrectly said the federal Centers for Medicare and Medicaid Services was expected to issue a written commitment Dec. 9 that Texas would receive the money to fund CHIP through February. State health commission officials hope to receive confirmation later this month.