Federal Policy Update
2009 OACCA Advocacy Conference
The Landscape in Washington:
•
A New President
•
New Makeup in Congress:
– SENATE: 56 D; 41 R; 2
Independent; 1 still vacant (MN
election being contested)
– HOUSE: 254 D; 178 R; 3 still vacant
(Solis, Gillibrand, Emanuel)
•
New Congressional Committee Makeup:
– Rep. Henry Waxman now Chairs the
House Energy and Commerce
Committee
– Rep. Danny Davis now on House
Ways and Means Subcommittee on
Income Security and Family Support
•
New HHS Secretary to be Confirmed,
Gov. Kathleen Sebelius
What does this mean for YOU
and the children and families you
serve?....
A lot of work….
but more importantly….
…a
lot of
OPPORTUNITY!
Today, a Brief Overview of:
– Medicaid regulations and the Medicaid Services Restoration Act
– Health provisions of the economic recovery package (now law)
– Other important provisions of the economic recovery package that will
help children and families (now law)
– CHIP reauthorization (now law)
– Mental health and addiction parity (now law)
– Health reform
– Federal Budget
– Fostering Connections Act (now law)
– Prevention initiatives
– Juvenile Justice initiatives
– Child Welfare Workforce initiatives
– Education initiatives
– White House Conference on Children & Youth
Medicaid Regulations
– The Bush Administration issued a series of Medicaid regulations that in the
aggregate, would devastate our nation’s health safety net.
– Two of Major Concern to the Child Welfare and Foster Care Communities:
Rehabilitative Services and Targeted Case Management (TCM)
– The rehab and TCM rules would:
• Take away significant Medicaid funding for these services, shifting the cost to
child welfare and foster care ($2.2 billion/5 yrs from rehab option and $1.28
billion/5 yrs from TCM option);
• Require TCM services to be billed in increments ≤ 15 minutes; and
• Require TCM services to be billed by a single case manager
Status:
– Rehab is delayed until April 1, 2009 (P.L. 110-252, Supplemental
Appropriations Act)
– TCM is delayed until June 30, 2009 (P.L. 111-5, American Recovery and
Reinvestment Act)
– “Sense of the Congress” in recovery package that rehab reg should be
withdrawn
Medicaid Services Restoration Act
– The “Back Up”….and Potentially More
– The Act Would:
• Create a new medical assistance category for therapeutic foster care (TFC)
• Allow states to use bundled rates for rehab or TCM services
• Allow non-medical programs (child welfare, foster care, etc) to continue drawing down
Medicaid funds for rehab and TCM services, as long as they are offered by qualified
providers and the state/local agency is complying with in-place third party liability rules
• Clarify that medical/surgical services for children in 24 hour psychiatric hospitals and
PRTFs are Medicaid-reimbursable (in line with EPSDT)
• Allow states to use multiple case managers when necessary
Status:
– Was introduced by Senator Debbie Stabenow (D-MI) in the 110th Congress
– Will likely be re-introduced by Sen. Stabenow; companion bill in House
Health Provisions of Recovery Package
– Medicaid regs (discussed above)
– 65% subsidy for unemployed workers to continue
purchasing COBRA coverage for up to 9 months
– Extends Transitional Medical Assistance (TMA)
through December 31, 2010
Medicaid FMAP Provision of
Recovery Package
– $87 billion total
– 6.2% increase to all states and territories as long as state
maintains eligibility as it existed on July 1, 2008
– 65% distributed across the board; 35% distributed to
states experiencing particularly high unemployment
– Funding retroactive to October 1, 2008 and through
December 31, 2010
– More info on FMAP Provision:
http://hhs.gov/recovery/statefunds.html and
http://www.cbpp.org/2-13-09sfp.pdf
Other Provisions in the Recovery
Package that Will Benefit Children and
Families
– Title IV-E: 6.2% increase to Title IV-E foster care maintenance
payments and adoption/kinship assistance (not administrative
costs)
– CCDGB: $2 billion for Child Care Development Block Grant
(CCDBG) (funding to subsidize child care for children in lowincome working families and low-income families in which
parents are engaged in education or training)
– TANF: $5 billion for Temporary TANF, to help states with rising
caseloads
– Head Start: $1.1 billion for Early Head Start and $1 billion for
Head Start (comprehensive development services to low-income
infants and preschool children)
Other Provisions in the Recovery
Package that Will Benefit Children
and Families
– Food Stamps: $20 billion for the Food Stamp/Supplemental Nutrition
Assistance Program
– Child Tax Credit (CTC): $14.8 billion for the Child Tax Credit (CTC).
Temporarily expands the Child Tax Credit by lowering the eligibility level
to tax filers with at least $3,000 of earnings (prior law, credit was only
available to those with earnings of $8,500 or more in tax year 2008 and
$12,550 in tax year 2009)
Status:
– Signed into law February 17, 2009 (P.L. 111-5)
– At least $15 billion of the Medicaid FMAP funds released starting February 25.
State breakdown can be viewed: http://hhs.gov/recovery/statefunds.html.
– Other provisions’ funding such as child care is pending; will be spread out over
two years.
More Info on Recovery Package:
– Center on Budget and Policy Priorities Paper with
State-by-State Estimates of Provisions Impacting
Low-Income Americans: http://www.cbpp.org/1-2209bud.pdf
– Coalition on Human Needs Chart:
http://chn.org/pdf/2009/ConfEconRecoveryChart2170
9.pdf
– http://www.recovery.gov/
CHIP Reauthorization
•
•
•
$32.8 billion additional
In human terms, this maintains enrollment for 7 million and provides
coverage for 4.1 million more children
Important New Provisions:
– State option to lift 5 year waiting period that legal immigrant children and
pregnant women currently face to enroll in Medicaid or CHIP
– Mental health parity
– Dental. Children in private coverage w/out dental can get wraparound
through CHIP.
– State option to implement express lane eligibility.
– Performance bonuses to states that exceed enrollment baselines for
children in Medicaid and implement certain enrollment practices
– $100 million in grants available for outreach and enrollment
CHIP Reauthorization (cont.)
• Citizenship Documentation: State option to use SSN to verify
citizenship prior to enrolling in Medicaid or CHIP.
• Quality: Creates a Medicaid Payment Advisory Commission to
examine access and provider payment issues in Medicaid.
• Eligibility for Children:
– States already above or with approval to go above 300% FPL
will still receive enhanced federal match for these children
– New states going above 300% will receive regular Medicaid
match
Status:
– Signed into law February 4, 2009 (P.L. 111-3)
– Next day, rescinded the August 17, 2007 policy directive
restricting states’ ability to cover children over 250% FPL
Mental Health & Addiction
Parity
• Requires group health plans with 50 or more enrollees
who choose to offer mental health and addiction benefits
to provide them on the same terms as other medical
conditions.
• Prohibits such insurers from setting higher financial
limitations (deductibles, copayments, coinsurance, and
out-of-pocket expenses) or lower limits on treatment for
mental and addiction illnesses.
• Requires equal out-of-network benefits.
• Does NOT preempt stronger state parity laws.
Parity (cont.)
Parity Law is Significant Because:
 Estimated that it will help at least 113 million Americans receive
easier access to treatment. These may be families on the verge,
who with proper treatment, can safely remain together and out of
the system.
 Over 10 years in the making…
 Hopefully shows that the stigma associated with mental illness is
decreasing and people understand that quality treatment works.
 Applies to Medicaid managed care plans; new CHIP law requires
parity in CHIP.
Status:
 Signed into law on October 3, 2008 as part of economic “bailout”
 Guidance will follow
Health Reform
• Even with recession, many are saying we cannot wait. Must reign in
ineffective spending and make significant progress towards covering
more of the nearly 46 million uninsured Americans.
• Obama would like to cover all children. CHIP was a “down
payment.”
• Contours are still TBD, but will likely build on existing programs and
coverage options.
Status:
• Discussions happening now. Key players include Sens. Kennedy,
Baucus, Grassley, Enzi and Reps. Dingell, Waxman, Barton,
Pallone, Deal, Rangel and Stark.
• Baucus would like a bill on the Senate floor by the Summer; others
skeptical.
• $630 billion/10 years reserve fund in FY 2010 budget for health
reform.
Federal Budget
FY 2009 Omnibus (H.R. 1105):
• Nine appropriations bills unfinished from last year (all except
DOD, Homeland Security, and Veterans Affairs)
• $410 billion, $19 billion more than Bush proposed
• Small boosts to: Child care, Head Start
• Status: Passed the House Feb. 25; in the Senate
FY 2010:
• February 26, President Obama released his FY 2010 budget
outline
• Key Portions:
•
•
•
•
Over $630 billion/10 years for health reform
$1.1 billion for Early Head Start; $1 billion for Head Start
Over $80 million in 2010 for nurse home visitation
Makes permanent the expansion of the Child Tax Credit
Fostering Connections Act
Kinship Care
• State option to use federal Title IV-E
funds for kinship guardianship
payments for children raised by
relative caregivers
• To qualify, children must:
be eligible for federal foster care
maintenance payments
reside with the relative for at
least six consecutive months in
foster care
• Be likely to otherwise remain in
foster care until they aged out of
the system
Fostering Connections Act
Kinship Care (cont.)
• State agencies must identify and provide notice to all adult
relatives of a child within 30 days after the child is removed
from the custody of the parent(s).
• Kinship payment rate may equal but cannot exceed what
would have been the foster care payment
• States may waive non-safety licensing standards (as
determined by the state) on a case-by-case basis in order to
eliminate barriers to placing children with relatives. HHS must
submit a report on states’ use of waivers within 2 years.
Fostering Connections Act
Transition Age Youth
• State option to extend care to youth age 19,
20, or 21 as long as youth are involved with
education, employment, or unable to do either
due to a medical condition. Option can begin
on October 1, 2010 (FY 2011).
• Child welfare agencies must help youth
develop a transition plan during the 90-day
period immediately before a youth exits from
care at 18, 19, 20, or 21
Tribal
– Option for tribes or tribal consortia to directly access and administer IVE by submitting a plan to HHS
– Takes effect on October 1, 2009 (FY 2010).
Fostering Connections Act
Adoption
– De-links federal adoption assistance from the now non-existent AFDC
program. Gradually phased in. Some populations covered right away:
• Special needs adoptions over age 16; all special needs covered by year 10.
• Siblings of eligible children also eligible right away.
• Children in foster care for 5+ consecutive years also eligible right away.
– Adoption Incentives Program reauthorized for 5 years:
• States get additional $1000/adoption if rate exceeds highest foster child
adoption rate since 2002.
• $8000 additional per older child adoption (9 years +)
• $4000 additional per special needs adoption
Fostering Connections Act
Health
– State child welfare agency must work with the state Medicaid
agency (and other healthcare experts) to create a plan for the
ongoing oversight and coordination of health care services for
children in foster care.
– Medicaid agency is NOT relieved of its duty to provide care.
– Plan must include:
•
•
•
•
health screening and follow up screenings;
how needs will be identified and addressed;
how medical information will be updated and shared;
steps taken to ensure continuity of care including the possible use
of medical homes for each child;
• oversight of prescription medication; and
• how the state consults with medical and nonmedical professions on
the appropriate treatment of children.
Fostering Connections Act
Status:
– Signed into law on October 7, 2008
– Still a lack of clarity in regard to guidance and
likely to be that way until more HHS positions
are filled.
– Congressional staff indicated at our
conference that some Children’s Bureau
guidance was too narrow.
More Info:
– http://www.cwla.org/advocacy/adoptionhr6893.htm
Prevention Initiatives
– Education Begins at Home Act (EBAH):
–
–
• Would establish the first dedicated federal
funding stream solely for evidence-based,
quality, voluntary home visiting programs
for parents with young children
• Governor would designate a lead state agency to oversee and implement the state
program
• States can use their grants to supplement—but not replace—current state funding
• State's grant funding award would be based on the number of children 5 and younger
living in the state
Fully fund programs such as PSSF, CAPTA, Title V Maternal and Child Health Block
Grant, SSBG
Use Fostering Connections to expand family group decision making; use IV-E training
funds for training court personnel in prevention and intervention programs
Status:
– EBAH:
• Senate bill introduced by Sen. Bond (R-MO) and Sen. Murray (D-WA), S. 244
• House bill likely to be re-introduced shortly
– Others have been recommended to the new Administration and Congress
Juvenile Justice and
Delinquency Prevention Act
– Federal initiative designed to assist state and local governments
and private nonprofit agencies in supporting and initiating
programs that prevent and treat juvenile delinquency.
– Encourages states to coordinate and integrate the juvenile justice
and child welfare systems to improve outcomes for children and
reduce delinquency.
– Established in 1974 and most recently authorized in 2002.
Status:
– Senate bill in the last Congress (S. 3155) passed Senate Judiciary
Committee. It is expected this Committee will do so again soon.
– This bill builds on the coordination between the child welfare and
juvenile justice systems, and is more specific in improving
protocols and procedures between these systems.
– The House has not yet acted on this reauthorization.
Youth PROMISE Act
• Provides federal resources for local, communitybased strategies to reduce gang violence and
crime.
• Local councils will develop a comprehensive plan
for implementing evidence-based prevention and
intervention strategies. These strategies will be
targeted at young people who are at-risk of
becoming involved, or involved in, gangs or the
criminal justice system to redirect them toward
productive and law-abiding alternatives.
• Funding will be made available to implement
these strategies.
Status:
– Legislation has been introduced with bi-partisan support in both
the House and Senate: H.R. 1064, S. 435.
– Hearings are expected to begin soon.
Workforce Initiatives
– Keeping qualified workers on the job and reducing turnover
– Loan Forgiveness
• In 2008 as part of the Higher Ed Act, up to $2,000/year for child welfare workers at
public or private agencies for each of the first 5 years the worker remains at the agency.
• Status: Law, Congress must appropriate the funding. Department of Ed must issue
regs.
– Training Funds:
• In 2008 as part of the Fostering Connections Act, training funds opened to private
agencies and court- and child welfare-related employees including CASAs and GALs
• Status: Law, regulations to be issued. Hopeful that these will broadly interpret and allow
states to leverage funds and strengthen the workforce.
– Other Funding:
• Should increase the $7 million in Title IV-B, part 1 training funds to strengthen the child
welfare workforce
• Should increase the $20 million in PSSF (Title IV-B, part 2) for workforce improvement
Education & Children in Care
– Belief that a child
placed in foster care
should be permitted
to attend the school
at which s/he is
most comfortable
– Fostering Connections Act:
• Case plan must take into account the stability of the current educational
setting
• Child welfare agency must coordinate with local education agency so that
child remains in the school where s/he is enrolled at the time of foster
placement. If not in the best interest of the child to remain at the same
school, child must be enrolled immediately at an appropriate new school
• Status: Guidance will be issued. Foster care maintenance payments can be
used for transportation.
White House Conference
on Children & Youth
• CWLA is leading the call to re-establish a White
House Conference on Children & Youth in 2010,
focused on child welfare.
• President Theodore Roosevelt called the 1st
conference in 1909 and one was held every 10
years, until 1970
• There is an actual conference attended by
delegates, governors, and the policy committee,
but the truly important part is the time leading up to
the conference. State and local meetings that
bring together state agencies, advocates, experts,
policymakers, and children youth and families
•
Issues to be addressed include: permanency, health and mental health
care, education, substance abuse, housing, juvenile justice, workforce
issues, tribal access and services, strategies to help families, and strategies
to prevent abuse
White House Conference
on Children & Youth
Status:
• House bill introduced, H.R. 618,
by Rep. Chaka Fattah (D-PA) and
Rep. Todd Platts (R-PA). 43
sponsors thus far, including 7
added after CWLA’s Advocacy
Day.
• Senate bill will likely be reintroduced shortly
More Info and to Sign Up in Support:
http://www.cwla.org/advocacy/whitehouseconf10.htm
Questions??
Health: Laura Weidner, lweidner@cwla.org
Fostering Connections, Economic Recovery:
John Sciamanna, jsciamanna@cwla.org
Prevention: YaMinco Varner, yvarner@cwla.org
Juvenile Justice: Tim Briceland-Betts, bricebet@cwla.org
White House Conference:
Cristina Fahrenthold, cfahrenthold@cwla.org