CWLA 2004 Children's Legislative Agenda
Health Care Services and Teen Pregnancy Prevention
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- Ensure that children in the foster care system receive comprehensive health care, and improve health coverage for children exiting foster care.
- Increase funding for Title V of the Social Security Act, the Maternal and Child Health Services Block Grant, which was created to improve the health of mothers and children through federal-state partnerships.
- Increase funding for the Title X family planning program. Maintain Title X as a categorical federal program that mandates informed patient consent, confidentiality protection for all patients, the type of services offered, and medical standards.
- Increase funding for the Abandoned Infants Assistance program, which provides grants for a range of services for infants and young children, many of whom are HIV-infected or drug-afflicted. These infants are medically cleared for discharge from acute hospital settings but remain hospitalized because of a lack of appropriate out-of-home placement alternatives.
- Support funding for comprehensive health education, including abstinence education, in our communities and schools.
- Support the Family Opportunity Act (S. 622/H.R. 1811), sponsored by Senators Charles Grassley (R-IA) and Edward M. Kennedy (D-MA) and Representatives Henry Waxman (D-CA) and Pete Sessions (R-TX). This bill can make a significant difference in the health and well-being of children with disabilities, including adopted children who are not Title IV-E eligible and children adopted privately or internationally.
- Increase funding for services to children affected by and infected with HIV/AIDS who are now being served by the Ryan White Comprehensive AIDS Resources Emergency (CARE) Act.
- Increase funding for the National Violent Death Reporting System under the Centers for Disease Control and Prevention. This data collection system will provide more information on all violent deaths, especially our understanding of suicides and deaths linked to domestic violence and child abuse.
Health Care for Children in Foster Care
Children in foster care have significant health problems and tend to be extremely vulnerable. Like all children, they need well-child care, immunizations, and treatment for acute illnesses. They also require greater attention due to their high risk for health, mental health, and developmental problems.
Despite their greater needs and the availability of Medicaid for almost all children in foster care, numerous challenges--such as the need for initial screening and comprehensive health assessments, access to health care services and treatment, coordination of care, collaboration among systems, family participation, and attention to cultural issues--prevent many from receiving the care they need.
Many children exiting foster care do not receive needed medical attention due to a lack of health care coverage. Although many children who leave foster care through reunification and adoption are eligible for some type of health insurance, the steps to retain existing coverage or obtain new coverage can be complex. Families sometimes find the process overwhelming and may allow the child's insurance to lapse.
CWLA supports providing 12 months of continuous coverage to all children enrolled in Medicaid and transitioning out of foster care, regardless of changes in family income, assets, or other circumstances; integrating health coverage applications into foster care discharge planning sessions; and expanding Medicaid coverage through age 21 for children who age out of foster care.
Maternal and Child Health Services Block Grant
The Title V block grant helps develop service systems in communities to meet the critical challenges facing maternal and child health, including significantly reducing infant mortality, providing preventive and primary care services for children and adolescents, immunizing all children, reducing adolescent pregnancy, and preventing injury and violence. Funding for Title V is $734 million in FY 2004, an increase of $3.5 million.
Funded under the Maternal and Child Health Services Block Grant, the Community-Based Abstinence Education program is receiving a 24% increase-- $15.8 million-- in FY 2004, for a total of $70 million. CWLA supports abstinence education as part of a comprehensive health education message.
Teen Pregnancy Prevention
CWLA works to ensure a spectrum of programs and services to pregnant and parenting teens to guarantee their well-being and that of their children. To maximize their options in life, these young people, both men and women, must develop the skills necessary to obtain economic independence, self-sufficiency, and long-term family stability. Programs include child care, education, health care, counseling, nutrition, and parenting education. Title X family planning programs received funding of $280 million in FY 2004, an increase of $6.5 million.
Abandoned Infants Assistance Act
Congress will reauthorize the Abandoned Infants Assistance (AIA) Act this year. This program provides grants to public and nonprofit private organizations to develop, implement, and operate programs relating to foster care and residential care for abandoned infants and young children. Projects may include preventing the abandonment of children, identifying and addressing the needs of these children, helping them reside with their birth- or foster families, and recruiting and training foster families. AIA was funded at $12.125 million in FY 2004, a level far below the reauthorization of $45 million.
Family Opportunity Act
The Family Opportunity Act (S. 622/H.R. 1811) would permit families to purchase Medicaid on a sliding-scale basis and allow states to extend Medicaid coverage to children with potentially severe disabilities. Families of children with severe disabilities often struggle to provide their children with appropriate medical services. The Senate Finance Committee approved this legislation on September 30, 2003. The full Senate and the House have yet to act on this bill.
Ryan White CARE Act
First enacted in 1990, the Ryan White CARE Act is the largest federal investment in the care and treatment
of people living with HIV/AIDS. The CARE Act supports a range of community-based services to children, youth, and families, including primary and home health care, case management, substance abuse treatment and mental health services, and nutritional services. Recognizing the need for increased services, Congress funded the Ryan White CARE program at $2.03 billion in FY 2004, an increase of $12 million.
National Violent Death Reporting System
Today in the United States, children from birth to age 4 are more likely to be murdered in their homes than in the streets, usually at the hands of a family member. We know too little about the circumstances leading to these deaths. Child abuse cases require cross-reporting among many agencies, from police departments to child protective services.
For the first time, this information is being assembled nationwide. By linking regional data about the circumstances surrounding child abuse and neglect, the National Violent Death Reporting System (NVDRS) will give us the information we need to successfully tackle a public health concern that kills more than 1,000 children a year. Currently, NVDRS is up and running in 12 states. Funding for NVDRS in FY 2004 was $3.75 million.
- Children in foster care demonstrate significantly higher rates of acute and chronic medical problems, developmental delays, educational disorders, and behavioral health problems than do other children of similar backgrounds. 1
- Eighty percent of children in foster care have at least one chronic medical condition, 25% have three or more chronic problems, and an estimated 30% - 70% have severe emotional problems. 2
- The U.S. teen pregnancy rate declined 26.8% between 1990 and 1999--from a peak in 1990 of 116.9 pregnancies per 1,000 young women ages 15 - 19 to 85.6 pregnancies per 1,000 in 1999. 3
- Every tax dollar spent for contraceptive services saves an average of $4 that would otherwise be spent to provide medical care, welfare benefits, and other social services. 4 For every dollar spent to provide publicly funded contraceptive services, the government saves an average of $3 in Medicaid costs for pregnancy-related health care and medical care for newborns. 5
- In 2002, approximately 2,000 children younger than 15, and 6,000 young people ages 15 - 24, became infected with HIV worldwide every day. 6 In the United States, the estimated number of new pediatric AIDS cases each year (those among children younger than 13) plummeted to 92 in 2002, from a high of 952 in 1992. 7
- Simms, M.D., & Halfon, N. (1998). The health care needs of children in foster care: A research agenda. Child Welfare, 73, 505 - 524.
- Silver, J.; DiLorenzo, P.; Zukoski, M.; Ross, P.E.; Amster, B.J.; & Schlegel, D. (1999). Starting young: Improving the health and developmental outcomes of infants and toddlers in the child welfare system. Child Welfare, 78, 148 - 165; Halfon, N.; Mendonca, A.; & Berkowitz, G. (1995). Health status of children in foster care. Archives of Pediatric and Adolescent Medicine, 149, 386 - 392.
- Henshaw, S.K. (2003). U.S. teenage pregnancy statistics with comparative statistics for women aged 20 - 24. Retrieved online, December 29, 2003, from www.agi-usa.org/pubs/teen_stats.html. New York: Alan Guttmacher Institute.
- Alan Guttmacher Institute. (1998). Teenage pregnancy and the welfare reform debate. Retrieved online, December 29, 2003, www.guttmacher.org/pubs/ib5.html. New York: Author.
- Forrest, J.D., & Samara, R. (1996). Impact of publicly funded contraceptive services on unintended pregnancies and implications for Medicaid expenditures. Family Planning Perspectives, 28, 188 - 195.
- Joint United Nations Programme on HIV/AIDS and World Health Organization. (2003). AIDS epidemic update 2003. Retrieved online, December 29, 2003, from www.unaids.org/unaids/en/resources/ publications/corporate publications. Geneva, Switzerland: UNAIDS.
- Centers for Disease Control and Prevention. (2003). Cases of HIV infection and AIDS in the United States, 2002. HIV/AIDS Surveillance Report, 14. Retrieved online, December 29, 2003, from www.cdc.gov/ hiv/stats/hasr1402.htm.
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