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

   
   
Vol. 20, Issue 37: 10/1/2007   
Headlines

Congress Heads Toward Passing SCHIP Reauthorization, President Says No Way

Congress Provides Temporary FY 2008 Funding Until November 16

Gang Bill Passes Senate

President Asks for $42 Billion More for War, Total $190 Billion for 2008

CWLA Continues to Gather Feedback on Rehabilitative Services Regulation

Civil Rights Commission Conducts Briefing on Transracial Adoption

Mental Health Parity Clears Another House Committee

CWLA Legislative Alerts Available to Subscribers

Key Upcoming Dates for Congress



Congress Heads Toward Passing SCHIP Reauthorization, President Says No Way

On September 25, the House of Representatives passed H.R. 976, which would reauthorize the State Children's Health Insurance Program (SCHIP), the successful program that provides much needed coverage to more than 6 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.

The final House vote was 265-159, indicating widespread support for the bill, and included 45 Republicans, but unfortunately fell 19 members short of a veto-proof majority. At press time, the Senate was expected to vote and pass H.R. 976, but President Bush has firmly stood his ground and pledges to veto it.

The bill closely resembles the Senate's SCHIP package, which was ushered through in an extremely bipartisan fashion. Members of Congress from both sides of the aisle may have slight qualms about the final bill, but it would maintain coverage for the children currently enrolled in SCHIP and provides the capacity to enroll approximately 3.8 million additional children in either SCHIP or Medicaid--most of whom are already eligible for the programs. It would also improve children's benefit packages by mandating dental coverage and requiring mental health parity in SCHIP programs.

In addition, the bill would give states an option to accept and verify Social Security numbers as proof of applicants' identification and citizenship in order to address previously implemented citizenship documentation requirements that have proved incredibly onerous. Section 616 of the bill would impose a six-month moratorium on a proposed regulation that would severely restrict access to Medicaid rehabilitative services, which is especially important for the child welfare and foster care communities.

Should the seemingly inevitable veto occur, H.R. 976 would return to the House, its chamber of origin, where Democratic leaders are making plans and considering voting over and over until the bill becomes law. Speaker Nancy Pelosi (D-CA) says, "It's not going away, because the children are not going away." In the meantime, to help ensure that those currently enrolled do not experience interruptions in coverage in light of SCHIP's expiration date of September 30, $5 billion was included for SCHIP in the stopgap spending bill (H.J. Res. 52). This provides funding to state SCHIP programs at current funding levels through November 16.

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Congress Provides Temporary FY 2008 Funding Until November 16

With Congress still working on all 12 FY 2008 appropriations bills, and the new fiscal year beginning today, members approved a short-term extension late last week. The continuing resolution (CR) will extend funding for all federal departments until November 16, 2007, at fiscal year 2007 levels.

The President has said he would veto 9 of the 12 bills, including funding for the Departments of Labor, Health and Human Services, and Education (Labor-HHS). The House Labor-HHS bill (H.R. 3043) allocates $151 billion in discretionary spending, an increase of 4.6% from the FY 2007 total of $144 billion. The Senate committee bill for Labor-HHS (S. 1710) provides a 3% increase over FY 2007, at $149 billion in overall discretionary funding, which is also 6% more than the President's budget request.

The $7 billion increase for Labor-HHS has been labeled as too much of an increase. The Administration's budget would require cuts in some HHS programs, especially if Congress attempted to increase funding in popular programs such as health research and K-12 education funding. The President argues the proposed spending levels in the 12 appropriations bills are too high. The initial spending levels that have passed provide $23 billion more in discretionary spending than the President requested. Total discretionary spending including the $459 billion for the Defense Department is $923 billion.

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Gang Bill Passes Senate

On September 21, the Senate passed the Gang Abatement and Prevention Act, S. 456. The legislation is heavily slanted toward a federal law enforcement approach to reduce gang violence, emphasizing incarceration and longer sentences for convictions, and lacks focus on prevention and early intervention.

Improvements were made to the legislation earlier in the congressional session, including increased authorized funding for prevention. The punitive provisions in the bill would apply to youth and potentially result in many more young people incarcerated in adult prisons and jails. Incarcerating gang members does not necessarily curb reoffending.

The House is expected to take up the measure in the coming weeks.

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President Asks for $42 Billion More for War, Total $190 Billion for 2008

While the White House cited the five-year total increase of $35 billion as a reason to veto SCHIP, the President is asking for an increase to $190 billion for the cost of the war in 2008. Earlier this year, President Bush requested just under $150 billion for 2008. An additional request of $42 billion, to continue the increase in troop levels started earlier this year, came last week when the Secretary of Defense testified before Congress.

The $190 billion cost for war in 2008 is separate from what is included in the Defense Department budget. Although the defense budget has not been finalized, it is expected to total more that $450 billion. Indications are that funding for the war will remain separate from defense funding and could split into several supplemental appropriations over the next 12 months.

The increased funding for the war is not offset or paid for, whereas the $35 billion proposed for the SCHIP program would paid for through a tobacco tax increase.

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CWLA Continues to Gather Feedback on Rehabilitative Services Regulation

CWLA continues to advocate aggressively for a six-month moratorium on the proposed Medicaid rehabilitative services regulation contained in H.R. 976 (Section 616 of the Children's Health Insurance Program Reauthorization Act). Should this bill pass, the language specifically states that until May 28, 2008, HHS would be stopped from engaging in "any action...to restrict coverage or payment under [Medicaid] rehabilitation 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--in the least restrictive setting possible--to reduce the physical and mental disabilities many children in foster care have, in a person-centered, evidence-based manner.

Until SCHIP's and the moratorium's fates are determined, CWLA is still analyzing and gathering feedback from concerned stakeholders on the proposed regulation. The public has until October 12, 2007, to submit comments to CMS. CWLA will submit its own comments to CMS and urges other individuals and groups to do the same. To assist in that process, CWLA has posted its working summary and analysis of the proposed regulation online. The document is not CWLA's final statement, but is intended rather to provide a thorough starting point for discussion and analysis. Please send further feedback on how the proposed regulation would affect children and families, and the agencies and providers who serve them, to Laura Weidner, CWLA Government Affairs Associate for Health, at lweidner@cwla.org.

The proposed rule (CMS 2261-P/72 FR 45201) is online. Among other provisions CWLA is concerned about, the regulation would establish a fairly strict qualified provider standard and written rehabilitation plan requirement. It would also exclude payment from Medicaid for services deemed "intrinsic to" other programs, including child welfare and foster care. This "intrinsic to" test appears to want to ensure that Medicaid does not pay for services that CMS deems are the responsibility of other programs, but no specific guidance is provided as to 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.

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Civil Rights Commission Conducts Briefing on Transracial Adoption

On September 21, the U.S. Commission on Civil Rights held a briefing, "The Multiethnic Placement Act: Minority Children in State Foster Care and Adoption." The commission held three panels including federal officials, researchers, national organizations, and advocates. Specifically, the Commission heard testimony from Commissioner Joan Ohl, U.S. Children's Bureau, Department of Health and Human Services (HHS); Kay Brown, Government Accountability Office (GAO); Joseph Kroll, North American Council on Adoptable Children; Rita Simon, American University; J. Toni Oliver, National Association of Black Social Workers (NABSW); Thomas Atwood, National Council For Adoption; Ruth McCoy, Evan B. Donaldson Adoption Institute; Elizabeth Bartholet, Harvard School of Law; and Linda Spears, CWLA.

Views varied among panelists as to whether the Multiethnic Placement Act (MEPA) has achieved its desired outcomes. NACAC accused HHS of enforcing only one of the MEPA/Interethnic Adoption Provisions--the "delay or deny" provision--and ignoring diligent recruitment. Whereas, HHS said it can and should be credited with decisive action on the enforcement front--finding states in violation, and imposing the financial penalties mandated by MEPA. The National Council for Adoption indicated the problem is not MEPA or HHS guidelines, but rather, misinterpretation of the law by state agencies, and that such misinterpretation has led agencies to abandon good social work practices.

NABSW expressed that MEPA assumes the answer to the length of time children wait to be adopted is to promote transracial adoption; however, overwhelming evidence exists that the problem begins with disproportional entry and continues with racial disparities at every level of child welfare decision-making.

GAO highlighted content and recommendations of its July 2007 report, African American Children in Foster Care: Additional HHS Assistance Needed to Help States Reduce the Proportion in Care, which concluded that 22 states have exhibited challenges recruiting a racially and ethnically diverse pool of foster and adoptive parents. GAO noted states report being constrained by the lack of federal subsidies for legal guardianship similar to those provided for adoption. This is considered a particularly important way to help African American children exit foster care.

CWLA argued for a more comprehensive approach to reforming and addressing the problems in our nation's child welfare system, which includes an investment at the front end in prevention services when a family comes in contact with protective or other services, and greater investment in out-of-home care (foster care, adoption, and kinship families).

View CWLA's testimony for this briefing.

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Mental Health Parity Clears Another House Committee

The full House Ways and Means Committee this week approved, by a vote of 27-13, the Paul Wellstone Mental Health and Addiction Equity Act of 2007 (H.R. 1424). The bill had cleared the Ways and Means Health Subcommittee last week.

The bill, much like its Senate companion (S. 558), would erase longstanding discriminatory limitations by requiring group health plans with 50 or more enrollees and that offer mental health benefits to provide them on the same terms as other medical conditions. The entire Senate passed its mental health parity bill by unanimous consent on September 18, after an amendment that permits stronger state mental health laws to stand. The House bill, too, acts as a floor, preempting only existing state mental health parity laws that are lower than the federal law.

The two versions of the legislation have come closer together in terms of substance, but differences do still exist. The House bill, for example, uses the encompassing definition of illness contained in the American Psychiatric Association's Diagnostic and Statistical Manual, whereas the Senate bill would leave it up to employers and insurers to negotiate covered conditions.

Having already cleared the House Education and Labor Committee and now the Ways and Means Committee, H.R. 1424 has one more stop--the Energy and Commerce Committee--before the entire House takes up the 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 30: SCHIP reauthorization expires
  • October 1: 2008 federal fiscal year begins
  • October 26: House target adjournment date
  • November 16: Senate target adjournment date
  • November 16: Continuing resolution to fund the government runs out


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