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

   
   
Vol. 20, Issue 38: 10/8/2007   
Headlines

President Bush Vetoes Compromise SCHIP Bill

Briefing Highlights Potential Impact of Proposed Medicaid Regulation

Comment Period About to Close on Proposed Rehabilitative Services Regulation--Submit Your Comments NOW!

Foster Care MARC Report Released

Senator Baucus Addresses TANF Briefing

CWLA Testimony Before Civil Rights Commission Briefing on Transracial Adoption

CWLA Legislative Alerts Available to Subscribers

Key Upcoming Dates for Congress



President Bush Vetoes Compromise SCHIP Bill

After weeks of threats, President Bush stuck to his guns and on October 3 vetoed the compromise, bipartisan bill Congress passed to reauthorize the State Children's Health Insurance Program (SCHIP, H.R. 976). As Medicaid's essential companion, SCHIPs exist in every state and provide 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.

H.R. 976 would maintain coverage for children currently enrolled in SCHIP and provide the capacity to enroll nearly 4 million additional children in either SCHIP or Medicaid--most of whom are already eligible for the programs. It also would improve children's benefits by mandating dental coverage and requiring mental health parity in SCHIP programs. Especially important for the child welfare and foster care communities, Section 616 of the bill would impose a six-month moratorium on a proposed regulation that would severely restrict access to Medicaid rehabilitative services.

In a statement issued shortly after the veto, CWLA President and CEO Christine James-Brown said, "President Bush's veto of the Children's Health Insurance Program was short-sighted and a serious blunder that will have a major detrimental impact on an already fragile and at-risk population." CWLA will continue working with members of Congress to override the President's veto. The Senate passed H.R. 976 with a veto-proof majority of 67-29. Though approximately 19 votes shy of a veto-proof majority, the House passed the bill by a vote of 265-159. A recent ABC News/Washington Post poll reveals that 72% of the American public support Congress's package, which would cost an additional $35 billion over five years.

Members of Congress spoke out about their hopes for final passage. Senate Finance Chair Max Baucus (D-MT) said that by vetoing SCHIP, "the President is saying that millions of low-income, uninsured American children must continue to live with no health coverage while he presses his ideological concerns." In a bipartisan press conference, Senator Charles Grassley (R-IA) indicated he would be working to convince House Republicans to override the veto. In discussing how he would do that, he said, "I intend to use rationale, particularly to overcome either the wholly wrong or intellectually dishonest arguments that were used against" the bill.

The bill will now returns to the House of Representatives. House Speaker Nancy Pelosi (D-CA) has indicated she will use the week of October 8 to try and persuade both Democrats and Republicans who voted against the bill to change their votes. The House would then attempt to override the President's veto as early as the week of October 15. In the meantime, because SCHIP technically expired September 30, Congress included funds in a stopgap spending bill that will continue state programs until November 16.

Back to Headlines

Briefing Highlights Potential Impact of Proposed Medicaid Regulation

On October 3, CWLA joined with the mental health and disability communities to sponsor a briefing for members of Congress and their staff on a recently proposed regulation that would greatly change the contours of Medicaid rehabilitative services and possibly restrict access to the individuals who rely on them. The panel presentation included comments by Twila Costigan from CWLA member Intermountain Children's Home and Services in Montana.

Currently, rehabilitative services may be used in a variety of settings to reduce physical or mental disabilities and restore the recipient to the best possible functional level. Not only do these services positively impact the recipients' day-to-day and long-term living, but they permit individuals who otherwise may have to be institutionalized to remain in the community, in line with both the President's New Freedom Commission on Mental Health and the U.S. Surgeon General's recommendations.

Speaking to an overflow crowd, panelists expressed their surprise and dismay at what the Center for Medicare and Medicaid Services (CMS) is attempting to do through the rulemaking process. Althought the regulation is expected to save $2.2 billion in federal Medicaid dollars over five years, the panelists reminded the audience of the dire situation in which it would leave states and, more importantly, how the proposed regulation would harm the Medicaid beneficiaries who are eligible for and vitally need these services, including children in foster care.

Costigan, Adoption and Family Support Program Manager for Intermountain, spoke first of the extreme uphill battle many children in the foster care system face due to severe trauma, abuse, abandonment, and removal from family of origin. She then spoke of one saving grace for these vulnerable children--Medicaid rehabilitative services provided in both therapeutic foster care and therapeutic group home care.

These rehabilitative services help seriously emotionally disturbed children develop personal skills, identify and communicate feelings rather than acting out in destructive ways, and incorporate important concepts such as trustworthiness, respect, and good citizenship into their daily lives. If the proposed regulation goes into effect as written, Costigan believes therapeutic foster care and group homes would be essentially eliminated, meaning that children who cannot be maintained in regular foster care would be forced into the more restrictive and more expensive residential treatment center option.

Ron Brand, Executive Director of the Minnesota Association of Community Mental Health Programs, discussed how the proposed rehabilitative services regulation would undermine essential life-giving services for individuals with a diagnosis of major depression, schizophrenia, bipolar, or anxiety disorders, such as post-traumatic stress disorder or severe phobias. "The three-legged stool of therapy, rehabilitation and medications [on which these populations depend] will not stand with one leg shortened," he said.

Finally, Bonnie-Jean Brooks, President and CEO of OHI, a nonprofit in Maine, discussed how the proposed regulation's exclusion of federal Medicaid dollars from habilitation services will take leaps backward in terms of progress for persons with mental retardation. Public comments on the proposed regulation are due Friday, October 12. (See the next article for further information.)

Back to Headlines

Comment Period About to Close on Proposed Rehabilitative Services Regulation--Submit Your Comments NOW!

On August 13, the Centers for Medicare and Medicaid Services (CMS) published a proposed regulation in the Federal Register that would greatly impact Medicaid rehabilitative services (CMS 2261-P/72 FR 45201). The proposed rule is available online. Or read CWLA's summary and analysis.

The comment period ends this Friday, October 12. CWLA will be submitting its own comments but urges all members and affected parties to submit their own comments as well. As this is a proposed rule, CMS must taken into consideration the public's concerns and suggestions before moving the process forward, so it is incredibly important for everyone to speak up. You may submit comments to CMS electronically or by regular mail--further instructions are included in CWLA's summary and analysis. If you have any questions, contact Laura Weidner, CWLA Government Affairs Associate at lweidner@cwla.org.

In one of its most egregious moves, the proposed regulation would take away federal Medicaid dollars 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 would surely be affected by the proposed rule, as it excludes federal rehab dollars for therapeutic foster care services unless they are medically necessary, clearly distinct from packaged therapeutic foster care services, and given by a qualified provider. By denying federal financial participation, this appears to effectively revoke the option for states to bundle rates for therapeutic foster care.

The proposed rule would also exclude federal dollars from services provided to residents of an institution for mental disease who are under the age of 65, including residents of community residential treatment facilities with more than 16 beds. This, of course, will only drive costs up and force children into more restrictive environments.

Back to Headlines

Foster Care MARC Report Released

A new report, Hitting the MARC, analyzing the rates and rate setting for foster care in all 50 states, was released October 3. The report was the subject of a Capitol Hill briefing that day, sponsored by CWLA and the report's authors, Children's Rights, the National Foster Parent Association, and the University of Maryland.

The MARC (minimum adequate rates for children) report is a calculation of the real cost of raising and caring for a foster child. The authors developed an economic formula on what the true costs of care are, then conducted a survey and analysis of what states are actually paying. The report concludes that, on average, rates need to increase 36% to meet the standard. The differences and the need to raise rates vary dramatically among the states and the District of Columbia.

Under the MARC analysis, the national average rates for a 2-year-old should be $629 per month, $721 per month for a 9-year-old, and $790 a month for a 16-year-old. The current average, however, is $488 for a 2-year-old, $509 a month for a 9-year-old, and $568 for a 16-year-old. The report includes a state-by-state breakout by age group.

In writing the report, the authors surveyed 21 states and 5 local jurisdictions. Only Arizona and the District of Columbia currently meet the standards, whereas five states--Idaho, Missouri, Nebraska, Ohio, and Wisconsin--need to raise their rates by more than 100% to meet the standard. The report is available on CWLA's website along with a PowerPoint presentation. The Children's Rights website, includes more of the technical information used to develop the economic model.

Back to Headlines

Senator Baucus Addresses TANF Briefing

Senate Finance Chair Senator Max Baucus (D-MT) spoke at a briefing on Temporary Assistance for Needy Families (TANF) on October 2. The event was sponsored by CWLA, Catholic Charities USA, and the Rebecca Project. The Senate forum, "An Update for Congressional Staff on TANF, Barriers to Work, and Vulnerable Families," included presentations by Beth Cribb, representing CWLA member PathWaysPA; Imani Walker, Rebecca Project, representing Human Rights' Sacred Authority; and Georgena Liranzo, Catholic Charities of Brooklyn Queens. Candy Hill, Senior Vice President for Social Policy and Government Affairs, Catholic Charities USA moderated the panel.

Senator Baucus indicated that as Finance Committee Chair he wanted to take a closer look at the provisions in the law related to work requirements. In 2005, Congress reauthorized TANF with stricter work requirements. Critics have argued TANF has limited state program flexibility at a time when states need to better address the barriers to work for certain hard-to-place families.

Baucus indicated his support for the original law but also said the 2005 reauthorization may be flawed by providing insufficient support to address barriers to work. Baucus said the Finance Committee had developed a consensus bill, but it was never debated in the last Congress. He said he cared very much about the issue and that nothing of consequence could happen unless members work together.

Panelists provided their recommendations on ways to improve this critical work support program, based on their recent experiences. Panelists' focus was on the challenges for people with substance abuse problems, mental health issues, and the challenges of single working mothers.

Cribb, from PathWaysPA's Earn Center, said the latest reform restricts the amount time people can spend in training activities, education, and removing barriers to finding employment. She described some of the parents Earn Center works with and how it has become more difficult to get the kind of support and services for families with mental health issues, compared with the old law.

Back to Headlines

CWLA Testimony Before Civil Rights Commission Briefing on Transracial Adoption

In last week's edition of Children's Monitor, we reported on the September 21 briefing of the U.S. Commission on Civil Rights on "The Multiethnic Placement Act: Minority Children in State Foster Care and Adoption." CWLA's testimony for this briefing is available online.

Back to Headlines

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.

Subscribe to Legislative Alerts.

Subscribe to Children's Monitor.

Back to Headlines

Key Upcoming Dates for Congress

  • October 1: 2008 Federal fiscal year begins
  • October 26: House target adjournment date
  • November 16: Senate target adjournment date
    Continuing resolution to fund the government runs out
    Temporary extension of SCHIP expires


Back to Headlines

Click here to see the list of previous issues

If you know of others who would like their names added to this list, please have them visit www.cwla.org/advocacy/monitoronline-optin.htm. To remove yourself from this list, send an e-mail to monitor@cwla.org with "Remove from Monitor Online List" in the subject line.

© Child Welfare League of America. The content of this publication may not be reproduced in any way, including posting on the Internet, without the permission of CWLA. For permission to use material from CWLA's website or publications, contact us using our website assistance form.