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New people signing up for CHIP are not doing it, however, through referrals from the state itself. Texas also has stopped spending money to promote CHIP at clinics and other care and community venues to the families who might benefit.

The CHIP program also has been under fire after a state auditor reported in July that poor oversight at the Health and Human Services Commission allowed a $20 million overpayment to a third-party insurance provider, a move that forced the removal of 17,000 children from the CHIP rolls, according to Texas Comptroller Carole Keeton Strayhorn.

Future on the line

The state’s insistence that it balances its budget without raising taxes is deceptive, Dorman-O’Donnell said. “We are going to be paying more in the long run in insurance or through the communities in [property] taxes,” she said.

Bryant, of Texas Children’s in Houston, said increases in copays (an extra $2 or $3 a visit) “may seem small, but for families on strict budgets with multiple kids suffering from chronic illness, that’s a big burden.” She said one nurse devised a plan to defray expenses for CHIP families by soliciting contributions to help patients pay for hospital-area parking.

Cuts in mental health treatment also are taking their toll, Bryant said. Those who have had cancer and lost their hair or lost a limb and who suffer from mental health comorbidity problems as a result, “need to be helped with their ability to cope,” she said. “I have kids right now who can’t get those services because of CHIP cuts.”

Bryant said she encourages nurses and other caregivers to write to their congressional representatives to restore CHIP funds. “Nurses and the whole interdisciplinary team are saddened by these cuts and what they are doing to sick children,” she said. “Even though these are chronically ill children, these are our children and our future.”