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Home > Advocacy > CWLA 2009 Children's Legislative Agenda/2009 Hot Topics > 2009 Legislative Hot Topics


2009 Legislative Hot Topics

Protecting Human Services in a Recession

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As a result of the current economic downturn, at least 39 states have proposed cutting or have already cut vital services, many of which serve our neediest populations. These include reductions to child welfare and foster care services, Medicaid, Children's Health Insurance Program (CHIP), education, housing assistance, and Temporary Assistance for Needy Families (TANF) cash assistance. These cuts hurt families and children. Unemployment, lack of resources and needed services, losing homes, and poverty are known risk factors for child abuse and/or neglect. Many economists have recently advised that providing direct help to families experiencing such stress jumpstarts the economy, because they spend the money quickly, and that state aid which maintains vital services prevents more harm to the economy and the people.

Children and families need protections against hunger, sickness, and unemployment. Government investments in human services protect people from hardship and invest in shared prosperity. These investments avert severe hardship among low-income populations and preserve needed state and local services.

Protecting the Medicaid Safety Net


  • The Administration should withdraw a series of Medicaid regulations that in the aggregate, would devastate our nation's health care safety net. Two rules that must be withdrawn because they would particularly harm vulnerable children and youth in our nation's child welfare and foster care systems are the Targeted Case Management and Rehabilitative Services rules.

  • In the interim, Congress should if necessary extend the current moratorium on the Medicaid regulations so that the new administration has adequate time to act.


Two optional services that have proven to be extremely beneficial to children in care are Rehabilitative Services and Targeted Case Management (TCM). Medicaid Rehabilitative Services help reduce physical and mental disabilities that many children in care experience as a result of abuse, neglect, or similar trauma. Rehab services provide strong support for therapeutic foster care (TFC) programs. Maintaining a full continuum of care is important so that each child can receive the most appropriate intervention. TFC is an integral part of that continuum, as it provides clinicallyand cost-effective individualized treatment within a family setting for children and adolescents experiencing serious mental illness, emotional or behavioral disorders, or other disabilities.Taking into account the vulnerability of children in foster care, at least 38 states employ the Medicaid TCM option to ensure children in foster care receive a comprehensive approach and greater coordination of care.

In 2007, the Bush Administration issued a proposed regulation dealing with Rehabilitative Services and an interim final regulation dealing with TCM Services. These regulations were issued alongside other similarly restrictive Medicaid regulations that together would devastate our nation's health care safety net.

The rehab and TCM rules established ambiguous "intrinsic to" or "integral to" tests that appear to wholly shift costs to state child welfare and foster care systems that are struggling tremendously, particularly during the current recession. The 110th Congress included a moratorium on six Medicaid regulations, including rehab and TCM, in the Supplemental Appropriations Act of 2008, which was signed into law on June 30, 2008 (P.L. 110-252). The rehab rule is delayed until April 1, 2009. Congress very recently extended the moratorium on the TCM rule until June 30, 2009 (HR 1). These moratoria grant the new Administration time to properly consider the regulations' harmful impact and take appropriate action.

Home Visiting Programs


  • Urge members of Congress to cosponsor and pass the Education Begins at Home Act (S. 244).


Home visitation programs refer to different models that provide in-home visits to vulnerable or new families. Stand-alone and center-based programs annually serve at least 400,000 children between the ages of 0 and 5. Because a child's early years are the most critical for optimal development and provide the foundation necessary for success in school and life, home visiting can make a lifetime of difference. Program goals include an increase in positive parenting practices, an improvement in the health of the entire family, an increase in the family's ability to be self-sufficient, and enhanced school readiness for the children. Home visitation services stabilize at-risk families by significantly affecting factors directly linked to future abuse and neglect. Research shows that families who receive at least 15 home visits have less perceived stress and maternal depression, while also expressing higher levels of paternal competence.

Senator Christopher Bond (R-MO) first began promoting home visiting when, as governor of Missouri, he signed the Early Childhood Education Act of 1984. This legislation helped expand the Parents as Teachers (PAT) programs in all state school districts. PAT joins several other model programs used by states across the country. States follow these different models depending on local needs and preferences. Other home visitation programs include Nurse-Family Partnership (NFP), Healthy Families America, Early Head Start, Home Instruction for Parents of Preschool Youngsters (HIPPY), and the Parent-Child Home Program.

The Education Begins at Home Act (EBAH), recently reintroduced for the 111th Congress, would establish the first dedicated federal funding stream solely for quality, voluntary home visiting programs for parents with young children. Under the legislation, each governor would designate a lead state agency to oversee and implement the state program. The states can use their grants to supplement-but not replace-current state funding. If a state currently lacks a home visitation program, the funds can be used to develop a program. A state's grant funding award would be based on the number of children 5 and younger living in the state.

CWLA Advocacy Team

Linda Spears
Vice President, Policy & Public Affairs

Tim Briceland-Betts
Co-Director Of Government Affairs

John Sciamanna
Co-Director of Government Affairs

Cristina Fahrenthold
Government Affairs Associate, Outreach

YaMinco Varner
Government Affairs Associate, Child Welfare

Laura Weidner
Government Affairs Associate, Health

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