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Watch CWLA's Member Testimony on YouTube!

CWLA Member Testifies on the Hill

Twila Costigan, the program manager for the Adoption and Family Support Program, Intermountain - a CWLA member agency in Helena, Montana - testified in a hearing held by the U.S. House of Representatives Committee on Oversight and Government Reform.

The hearing, entitled, “The Administration’s Regulatory Actions on Medicaid: The Effects on Patients, Doctors, Hospitals, and States” examined a range of regulatory changes that have recently been proposed or implemented by the Department of Health and Human Services (HHS). After providing a thorough and effective overview of the importance of Medicaid rehabilitative services to children involved with the child welfare and foster care systems at an October 3rd briefing on Capitol Hill, Twila Costigan was invited back to testify at this important hearing.


Click here to watch the hearing on YouTube! Web link.



Ms. Costigan specifically responded to a proposed regulation (CMS 2261-P/72 Fed. Reg. 45201) that would significantly change the contours of Medicaid rehabilitative services—vital services that offer a realistic opportunity to, in the least restrictive setting possible, reduce physical and/or mental disabilities of children in care and restore them to optimal functioning level. Ms. Costigan testified that for Intermountain and the seriously emotionally disturbed children that it currently successfully treats, if the regulation went into effect as proposed, their program would simply be "gone". It would severely disrupt the continuum of care, program staff would no longer be able to teach effective interventions to parents and children, and the children themselves would no longer receive necessary personal and social skills training.

Ms. Costigan has served as the Program Manager for the Adoption and Family Support Program, Intermountain - a CWLA member agency in Helena, Montana - since 1997. In total, she has 27 years experience in child welfare as a group home parent, milieu counselor in residential treatment, Child Protective Services social worker, and licensing and adoption worker.

Click here to watch the hearing on YouTube!

More Details about the Hearing

In addition to Ms. Costigan, seven other knowledgeable individuals sat on the first panel, including David Parrella, Director of Medical Care Administration for CT DSS and Chair of the Executive Committee for the National Association of State Medicaid Directors. Mr. Parrella testified that while integrity is a legitimate concern, this is not a “runaway train” situation and that it is “simply wrong” for the Centers for Medicare and Medicaid Services (CMS) to allege that certain rehabilitative services are not Medicaid’s responsibility, despite decades of providing the services. Congressman Christopher Murphy (D-CT) similarly said that such separation of responsibility for payment may hold in a philosophical world, but does not make sense in the real world. Congressman Murphy highlighted the difficulty of unbundling therapeutic foster care services and a broader level, argued that stripping federal funding in a blanket manner is not a properly tailored response to any abuses that may or may not be occurring.

Director of the Center on Medicaid and State Operations at CMS, Dennis Smith, sat on the hearing’s second panel. Smith testified that Medicaid is there to pay for services that are medically necessary, for Medicaid beneficiaries, and when the match rate is accurate. Medicaid runs into a problem, however, when state and local programs “push the edges of the envelope even further.” When Chairman Waxman asked Smith to point to specific language in the Medicaid statute that permits CMS to act in such a forward fashion, Smith cited various provisions, only to have Waxman respond that he believes CMS is “taking matters into its own hands” and acting beyond Congress’s intentions. Waxman concluded the hearing by reassuring those in attendance that the Committee will continue to monitor these issues—both CMS’s proposals and their impact on vulnerable populations.

To watch CWLA's member testify on YouTube, visit
Web link.

To read about CWLA's concerns with the proposed rehabilitative services regulation, see
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