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

   
   
Vol. 20, Issue 34: 9/10/2007   
Headlines

Loan Forgiveness Dropped From College Loan Bill

Movement on SCHIP Blocked in Senate; Opposition Mounts Against New Eligibility Policies

Senator Dodd Introduces Disaster Needs of Children Bill

Proposed Regulation for Medicaid Rehabilitative Services Still Open for Comment

Appropriations Status

CWLA Legislative Alerts Available to Subscribers

Key Upcoming Dates for Congress



Loan Forgiveness Dropped From College Loan Bill

Due to opposition from Senate conferees, a provision to create a new loan forgiveness benefit for child welfare workers was dropped from H.R. 2669, the College Cost Reduction Act. Two versions of the legislation, which deals with federally backed college loans, had been approved last July, one by each house. One area of difference was a provision that would have provided loan forgiveness of $1,000 a year, up to $5,000 (five years), if a person worked in one of eight areas of national need. One category included child welfare workers. Also included were Head Start and child care teachers. This language was dropped in the final agreement.

Both bills included a loan forgiveness section for public services workers, but only after an individual works for 10 years. This is not as generous as proposed in the House bill, which included child welfare workers who receive a degree in social work or a related field as an area of public need. This would have covered workers employed in either a public or private child welfare services. The other areas of national need were 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 and through grade 12, and certain public sector employees. The provision in the original House bill was strengthened during House committee deliberation by an amendment offered by Representatives John Yarmuth (D-KY) and John Tierney (D-MA).

There is some discussion around the possibility of including a provision similar to the House language in the upcoming debate over the reauthorization of the Higher Education Act. The college loan reforms were split off from that Higher Education legislation, and the House leadership has indicated it will take up that discussion later this year. At press time, Congress was planning on voting on the final conference agreement.

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Movement on SCHIP Blocked in Senate; Opposition Mounts Against New Eligibility Policies

Senate Majority Leader Harry Reid's (D-NV) effort to move reauthorization of the State Children's Health Insurance Program (SCHIP) by appointing conferees by unanimous consent was blocked on September 4 by Senate Minority Leader Mitch McConnell (R-KY). Before the August recess, the House and Senate each passed versions of legislation that would reauthorize SCHIP, a successful program that 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 lower income adults.

Many members were hoping to begin formal deliberations in light of the program's September 30 expiration date, but McConnell objected, citing procedural issues and the fact the House had not yet formally requested a conference on the bills or appointed conferees. Senate Republicans seem to want a commitment up front that the SCHIP package will not exceed the Senate's version, and some members have specifically stated they will withdraw their support if reauthorization crosses a certain line in the sand. Votes in support are especially vital, considering President Bush's threat to veto either the House or Senate SCHIP reauthorization bills as they currently stand.

The House bill, the Children's Health and Medicare Protection Act (CHAMP Act, H.R. 3162) is a larger package, providing $47 billion in additional funding over five years for SCHIP, whereas the Senate's bill (S. 1893) would offer approximately $35 billion in additional funding over five years. Other fundamental differences exist, such as how the bills are paid for and the House's changes to Medicare, that are not dealt with in the Senate measure.

There is growing speculation about what will happen to SCHIP if a deal is not agreed to and signed by the President by September 30. Without a conference report, the next best scenario is for Congress to pass an extension of SCHIP at current levels. As an August 28 Congressional Research Service (CRS) report explains, legal authority for SCHIP programs would continue even in the absence of funds being appropriated for FY 2008, and the programs could be terminated only via an approved state plan amendment to do so. If there is no FY 2008 allotment, however, many states would obviously run into severe financial hardship. CRS believes 35 states would exhaust their federal SCHIP funds in FY 2008—12 of them facing an immediate shortfall—requiring that they either draw down Medicaid dollars instead or wait for the U.S. Department of Health and Human Services to redistribute FY 2005 allotments.

On the same day the conference committee appointments were delayed, the American Public Human Services Association and the National Association of State Medicaid Directors sent a letter to HHS Secretary Michael O. Leavitt expressing their concern with policies the Centers for Medicare and Medicaid Services (CMS) announced on August 17 that would make it next to impossible for states to continue or plan to use SCHIP to cover children in families who earn over 250% of the federal poverty level (250% of FPL is $51,625 for a family of four).

Among the preconditions CMS enumerated to cover children in families above 250% FPL through SCHIP, states would have to prove the beneficiaries--in this case, children--have been uninsured for at least an entire year. Such states would also have to show they have enrolled at least 95% of their children below 200% FPL who are eligible for either SCHIP or Medicaid. APHSA and NASMD called this "reversal of a decade-long policy of state flexibility to expand coverage...inexplicable and deeply troubling."

In response to CMS's stated purpose of protecting against crowd-out, APHSA and NASMD pressed there is "limited evidence to suggest that there is [such] a problem for this population." Governors Arnold Schwarzenegger (R-CA) and Elliott Spitzer (D-NY) have sent a similar letter to President Bush requesting the proposed policies be withdrawn; Senators Gordon Smith (R-OR) and Robert Menendez (D-NJ) are leading a bipartisan effort in Congress to block the proposal.

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Senator Dodd Introduces Disaster Needs of Children Bill

Senator Christopher Dodd (D-CT) has introduced the Addressing Disaster Needs of Children Act of 2007 (S. 1970), which would work to better the situation for children struggling in the aftermath of a disaster. The legislation would establish a 10-member National Commission on Children and Disasters that would investigate facts and causes relating to children during disasters and emergencies , and provide recommendation to the President and Congress based on its findings.

Members of the Commission would have demonstrated expertise in a variety of issue areas, including child welfare, child physical and mental health, housing services relevant to children and families, and juvenile justice. S. 1970 would also establish a National Resource Center on Children and Disasters, which would serve as a clearinghouse for information and resources and would maintain a corresponding website for use by federal, state, local, and tribal governments and nongovernmental agencies. Advocates are working to have an identical measure introduced in the House.

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Proposed Regulation for Medicaid Rehabilitative Services Still Open for Comment

CWLA continues to collect feedback from members and concerned stakeholders surrounding CMS's proposed rule that would affect Medicaid rehabilitative services. Many states implement rehabilitative services for various populations, including children in foster care. Rehabilitative 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." These 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 and/or mental disabilities that many children in foster care have, in both a person-centered, evidence-based manner.

The proposed rule (CMS 2261-P/72 FR 45201) is available online. Most notably, the proposed regulation takes on an "intrinsic elements" test, specifically excluding from federal Medicaid financial participation services "furnished through a non medical 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."

This "intrinsic to" test appears to want to ensure that Medicaid does not pay for services CMS deems are the responsibility of other programs, including foster care and child welfare, but no specific guidance is provided on what "intrinsic to" really means. Therapeutic foster care services would surely be affected by the proposed rule, as it excludes rehabilitative services from the definition 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 submitting its own comments for review by CMS and urges other individuals and groups to do the same by the deadline of October 12, 2007 at 5:00 p.m.

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Appropriations Status

The federal fiscal year begins October 1. By press time, the appropriations for Military Construction and Veterans Affairs (H.R. 2642) had become the second bill, along with Homeland Security, to pass both houses. There are 12 appropriations bills. The Defense Department bill has passed the House, but a Senate version has not yet been voted on. Of the remaining nine, all have been debated and passed by the House, and all have been passed 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. The Military Construction bill has not drawn a veto threat, and possibly another appropriations bill could be attached to it as a way to avoid a presidential veto.

The House appropriations for the Departments of Labor, Health and Human Services, and Education (Labor-HHS/H.R. 3043) 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 in 2007; funding for CAPTA state grants stayed at $27 million--and at $42 million for the community-based prevention grants, also the same as 2007. Discretionary grants did increase by $10 million to $35 million.

The President has indicated he will veto the bill due to its funding levels. If Congress followed the President's budget request, it would result in actual cuts from the 2007 spending levels in addition to any impact inflation would have.

The full Senate has not debated its bill for Labor-HHS (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 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 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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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 24-26: CWLA Mid-Atlantic Region Training Conference
  • September 30: SCHIP reauthorization expires
  • October 1: 2008 Federal fiscal year begins


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