Children's Monitor Online
A Public Policy Update from the Child Welfare League of America

   
   
Vol. 20, Issue 33: 9/4/2007   
Headlines

Congress Faces Long Agenda for Fall

Appropriations Status

SCHIP Reauthorization Faces Veto Threats, New Restrictions

Loan Forgiveness in House Bill Supports Child Welfare and Child Care

Proposed Medicaid Rehabilitative Services Regulation Awaits Comments

Kinship Bill Picks Up Speed in Senate

CWLA Legislative Alerts Available to Subscribers

Key Upcoming Dates for Congress



Congress Faces Long Agenda for Fall

In addition to the debate over the war, Congress faces a number of critical issues affecting children as members return from the August recess. The most pressing is the reauthorization of the State Children's Health Insurance Program (SCHIP), which is due to expire at the end of September, as well as approval of the appropriations for all children's programs before the start of the federal fiscal year on October 1. In addition, Congress is expected to deal with the Higher Education Act, start debate over the No Child Left Behind education law, reauthorize Head Start, and address the confirmation of the head of the Administration on Children and Families in the Department of Health and Human Services.

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Appropriations Status

When Congress returns in from its August break, it will have to address appropriations before the start of the federal fiscal year, which begins on October 1. Of the 12 appropriations bills, Homeland Security has passed both houses; and Defense has passed the House, but a Senate version has not yet been voted on. All of the remaining 10 have been passed by the full House and by the Senate Appropriations Committee.

The President has said he would veto 9 of the 12 bills: Labor-HHS, Agriculture, Commerce-Justice, Energy-Water, Financial Services, Homeland Security, Interior-Environment, State-Foreign Operations, and Transportation-Housing. It appears likely there will be some form of continuing resolution that would provide continued federal funding for departments awaiting action after October 1, as well as an omnibus appropriations bill that would incorporate several appropriations bills into one piece of legislation.

The House appropriations for the Departments of Labor, Health and Human Services, and Education (Labor-HHS, H.R. 3043) passed July 19 by a vote of 276-140. The bill allocates $151 billion in discretionary spending, an increase of 4.6% from the FY 2007 total of $144 billion. The biggest increases, of more than 7%, were in education funding and some health funding. Both Head Start and child care funding received increases of $75 million. That puts child care at $2.13 billion in discretionary funding, compared with $2.06 billion in 2007, and Head Start at $6.96 billion, compared with $6.88 billion in 2007.

Discretionary funding for Promoting Safe and Stable Families remains at $89 million, the same level as 2007. Funding for CAPTA state grants stayed at $27 million, and funding for the community-based prevention grants remained at $42 million, also the same as 2007. Discretionary grants did increase by $10 million, to $35 million.

The bill remained intact from the version approved by both the House Appropriations Committee. The President has indicated he will veto the bill due to its funding levels. If Congress followed the President's budget request, however, it would result in actual cuts from the 2007 spending levels in addition to any impact inflation would have.

The Senate has not debated its bill (S. 1710), but the committee version provides a 3% increase over current FY 2007, at $149 billion in overall discretionary funding, which also equates to 6% more than the President's budget request. The Senate numbers, however, are slightly lower than the House bill, which spends $1.9 billion more than the Senate version. The Senate bill puts less into some education programs than does the House bill, but it increases funding beyond the President's request.

The Senate bill also does not fund some Administration programs at the same level as the House. The Senate bill provides less for abstinence education and the Compassion Capitol Fund than what the President had asked for or what the House Committee has approved. The Senate bill provides a $200 million increase for Head Start, more than the House version, but provides no increase in child care funding. The Senate also allocates an additional $12 million in discretionary grants under CAPTA, but it more narrowly targets the use of $10 million for Nurse Family Practitioner home visiting programs.

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SCHIP Reauthorization Faces Veto Threats, New Restrictions

Negotiations to reauthorize the State Children's Health Insurance Program (SCHIP) are expected to intensify as Congress returns from recess. Before leaving Washington, both the House and Senate passed legislation that would reauthorize SCHIP, and President Bush vowed to veto either one that reached his desk. SCHIP currently provides much-needed health insurance to more than six million low-income children whose families earn too much to qualify for Medicaid, and those who are either not offered or cannot afford private coverage, as well as some low income adults.

The House bill, the Children's Health and Medicare Protection Act (CHAMP, H.R. 3162), which passed by 225-204, would provide $47 billion in additional funding for SCHIP over five years, permitting nearly 5 million children who otherwise would go uninsured to receive coverage. The House bill would also guarantee dental care and slightly improve access to mental health care services, erase a ban and grant states the option to cover legal immigrant children and pregnant women who have been in the United States for less than five years, provide performance bonuses to states that have adopted a certain number of enumerated best enrollment practices, and grant states the option to implement express lane eligibility.

Of particular note for the child welfare community is Section 814 of the CHAMP Act, which would place a one-year moratorium on any regulation, regulatory guidance, use of federal payment audit procedures, or other administrative action that would restrict coverage or payment of Medicaid rehabilitative services in any way. The Centers for Medicare and Medicaid Services (CMS) recently proposed such a regulation.

The Senate also passed its SCHIP reauthorization legislation (S. 1893) by 68-31, a vote large enough--if held--to override a presidential veto. It would offer less additional funding for SCHIP than would the House bill, but it would still move the program in the right direction by encompassing 4 million children who otherwise would go without coverage. The Senate bill would require mental health parity for SCHIP programs, but is weaker than the House bill on dental benefits.

The Senate did not include a state option to cover legal immigrant children and pregnant women who have been in the country for less than five years, and it would give only up to 10 states the ability to implement express-lane eligibility, in the form of demonstration programs. The Senate bill was ushered through in an extremely bipartisan fashion and continues to carry widespread support.

President Bush has said he will veto either the Senate or House versions of SCHIP reauthorization if they reach his desk, insisting Congress is wrongly moving toward "federalizing health care." The Administration's opposition to SCHIP's forward movement to enroll more eligible children reached new heights when, late a Friday evening in the middle of the August recess, CMS issued policies that would make it next to impossible for states to cover children in families who earn over 250% of the federal poverty level ($51,625 for a family of four), even if they are currently doing so.

When SCHIP was originally enacted in 1997, it was understood states were very differently situated--in terms of cost of living, for example--and the law therefore gave them the flexibility to uniquely tailor their SCHIP programs, including the ability to set eligibility levels. Under the new policies, however, such state efforts to cover more low-income children would be significantly curtailed. To cover children in families above 250% FPL through SCHIP, states would have to prove the individuals--in this case, children--have been uninsured for at least an entire year, that the states have enrolled at least 95% of their children below 200% FPL who are eligible for either SCHIP or Medicaid, and that the number of children in the target population insured through private coverage has not decreased by more than 2% in the past five years.

Senators Robert Menendez (D-NJ) and Gordon H. Smith (R-OR) are leading a bipartisan effort in Congress to block these policies. New York Governor Eliot Spitzer (D) has threatened legal action on the grounds the policies contradict current SCHIP federal law and were imposed without notice or the required comment period. New York State is especially vulnerable because it has filed a State Plan Amendment and is awaiting approval to increase eligibility for its Child Health Plus program to 400% FPL.

The next few weeks are critical SCHIP's future. A thoughtful, yet timely reauthorization is especially necessary considering the U.S. Census Bureau in its recent annual report on Income, Poverty, and Health Insurance Coverage found a rise in the number of children under 18 who are uninsured--from 8.05 million in 2005 to 8.66 million in 2006.

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Loan Forgiveness in House Bill Supports Child Welfare and Child Care

Congress will have to resolve differences over a higher education student loan bill, which includes language on loan forgiveness for child welfare workers. Both the House version (College Cost Reduction Act of 2007, H.R. 2669) and the Senate version (Higher Education Access Act of 2007, Senate substitute for H.R. 2669) passed in July. A final bill will be considered under reconciliation rules that limit debate prohibit filibuster.

One area of difference is loan forgiveness. Both bills provide long-term loan forgiveness for public services employees, including child welfare workers. The definitions between the bills for public service vary but generally include public education, public health, law enforcement, legal services and "public child and family service agencies." The House language provides loan forgiveness of $1,000 a year, up to $5,000 (five years), if a person works in one of eight areas of national need as well as the current national service program. The Senate provision provides loan forgiveness after an individual has been employed in child welfare for 10 years.

One area defined as public need is child welfare workers who receive a degree in social work or a related field and who are employed in either public or private child welfare services. Other areas of national need include child care and Head Start teachers, nurses, foreign language specialists, librarians within certain fields, bilingual teachers in certain areas of the country, speech pathologists in preschools or kindergarten through 12th grade, and certain public-sector employees.

Loan forgiveness for child welfare and child care workers has been a long priority for CWLA. CWLA's legislative agenda chapter on child welfare workforce outlines the need for loan forgiveness as one of the tools that could help address the current workforce shortage. CWLA has sent a letter to conferees from both houses asking that they keep the House language in any final agreement.

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Proposed Medicaid Rehabilitative Services Regulation Awaits Comments

CWLA is collecting comments and concerns surrounding the proposed rule recently published by CMS that would impact Medicaid rehabilitative services. These services are defined as "any medical or remedial services (provided in a facility, a home, or other setting) recommended by a physician or other licensed practitioner of the healing arts, within the scope of their practice under State law, for maximum reduction of physical or mental disability and restoration of an individual to the best possible functional level." Many states implement rehabilitative services for various populations, including children in foster care. The services are critical to improving the well-bring of children in foster care, as they offer a realistic opportunity to--in the least restrictive setting possible--reduce or restore the physical or mental disabilities that many children in foster care have, in both a person-centered and evidence-based manner.

The proposed rule (CMS 2261-P/72 FR 45201), may be viewed in its entirety online. Perhaps most alarming, the proposed regulation implements an "intrinsic elements" test, specifically excluding from federal Medicaid financial participation those services "furnished through a nonmedical program as either a benefit or administrative activity, including services that are intrinsic to elements of programs other than Medicaid, such as foster care, child welfare, education, child care...juvenile justice."

The "intrinsic to" test appears to want to ensure that Medicaid does not pay for services that CMS deems are the responsibility of other programs, such as foster care, child welfare, or juvenile justice, but no specific guidance is provided on what intrinsic to really means. Therapeutic foster care services would surely be affected, with the proposed rule excluding from the definition of rehabilitative services therapeutic foster care services, except for medically necessary rehabilitation services that are clearly distinct from packaged therapeutic foster care services. By denying federal financial participation, this appears to effectively revoke the option to bundle rates for therapeutic foster care.

To assist CWLA in thoroughly evaluating the potential impact of the proposed regulation on children and families, as well as on the agencies and providers who serve them, please send feedback on the proposed regulation to Laura Weidner, CWLA Government Affairs Associate for Health, at lweidner@cwla.org. CWLA will submit its own comments for review by CMS and urges other individuals and groups to do the same by the stated deadline of October 12, 2007 at 5:00 p.m.

Efforts are under way to stall or stop any such regulation. Section 814 of the CHAMP Act (H.R. 3162), which would reauthorize SCHIP and passed the House before August recess, contains a one-year moratorium on official promulgation of rules or other administrative action that would restrict coverage or payment for services covered under the Medicaid rehabilitative services option. CWLA is working with other concerned mental health and disability groups to garner support in Congress for this provision, with the hope it will be maintained in the SCHIP reauthorization conference report.

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Kinship Bill Picks Up Speed in Senate

The Kinship Caregiver Support Act (S. 661) picked up several key sponsors just before Congress left for the August recess. The bipartisan bill introduced by Senators Hillary Clinton (D-NY), Olympia Snowe (R-ME), and Thad Cochran (R-MS) now has a total of 17 cosponsors. The most recent additions are Senators Debbie Stabenow (D-MI), Maria Cantwell (D-WA), and Patrick Leahy (D-VT), who all became cosponsors on July 24.

Six of the cosponsors are on the critical Senate Finance Committee, including Senators John Kerry (D-MA), Blanche Lincoln (D-AR), and Charles Schumer (D-NY), in addition to Snowe, Stabenow, and Cantwell. The House bill, H.R. 2188, now has 17 cosponsors as well, including the lead bipartisan cosponsors, Representatives Danny Davis (D-IL) and Tim Johnson (R-IL). Representative Todd Platts (R-PA) who cosponsored the Education Begins at Home Act (H.R. 2343) with Davis, has also agreed to cosponsor the kinship bill.

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CWLA Legislative Alerts Available to Subscribers

CWLA's Legislative Alerts provide breaking news, advocacy information, and critically important timely details of legislative battles. In an effort to broaden CWLA's advocacy network on behalf of children, anyone can now subscribe and receive the same information. This effort compliments CWLA's weekly electronic legislative newsletter, the Children's Monitor, which is also available free to any subscriber. We encourage you to register to receive these items directly and to pass on the information to other colleagues, family, and friends.

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Key Upcoming Dates for Congress

  • September 4: End of Congressional August Break
  • September 24-26: CWLA Mid-Atlantic Region Conference
  • September 30: SCHIP Reauthorization expires
  • October 1: 2008 federal fiscal year begins



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