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

   
   
Vol. 20, Issue 39: 10/15/2007   
Headlines

All Hands on Deck to Get SCHIP Passed

Energy and Commerce Subcommittee Approves Mental Health Parity Bill

Emotional Hearing Focuses on Deaths at Residential Youth Camps

CWLA Submits Comments on Proposed Rehabilitative Services Regulation

Senate Takes Up Labor-HHS Bill This Week, White House Rejects Meeting

CWLA Legislative Alerts Available to Subscribers

Key Upcoming Dates for Congress



All Hands on Deck to Get SCHIP Passed

After President Bush's veto of legislation to reauthorize the State Children's Health Insurance Program (SCHIP or CHIP, H.R. 976)--which is only the fourth veto of his presidency--House supporters of the bill are working arduously to persuade Democrats and Republicans who voted against the bill to change their mind and vote for kids. The House is expected to attempt to override the veto October 18.

CHIP programs 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. Because CHIP technically expired September 30, funding was provided in a stopgap spending bill to continue state-run CHIP programs at current levels through November 16. But a longer-term reauthorization--and therefore children's health care coverage and state CHIP programs--still hang in limbo due to the President's rejection of Congress's bipartisan package.

In his quick and quiet veto, President Bush reiterated his concerns with the legislation Congress produced, many of which are misguided. The President desires the program to "focus on poor children, not adults or families earning up to $83,000 a year." Approximately 70% of the children who would be enrolled if H.R. 976 passed would belong to families making less than 200% of the federal poverty level (200% FPL is $41,300 for a family of four). Childless adults would be completely transitioned off of CHIP within the next couple of years, and no new waivers would be granted for states to cover parents through CHIP. States that already cover parents could continue, but at a lower match rate.

Regarding the $83,000 a year allegation, many members of Congress, including Senator Charles Grassley (R-IA), have pointed out the President is simply wrong. No state currently uses CHIP to cover children in families at that income. New York, which has an extremely high cost of living, did make such a request, but the Bush Administration recently denied that request. Under H.R. 976, the focus stays on low-income children. And regardless, discretion to grant or deny states' applications to go up the income eligibility ladder remains with the Administration, so it always has the last word. H.R. 976 actually includes a disincentive for additional states to cover children in families above 300% FPL because they, too, would receive a lower match rate.

The President and opponents of the bill also label it "government-run health care," but 77% of CHIP enrollees are actually covered in private managed care health plans. Another concern, termed "crowd-out," is that the bill will cause children covered by private insurance to leave that insurance for CHIP. Congressional Budget Office Director Peter Orszag, however, has testified that crowd-out is inevitable and the carefully crafted approach taken by Congress is as efficient as you can possibly get per new dollars spent to get a reduction in the number of uninsured children.

Which brings us back to the real issue that should be guiding this debate--that providing accessible, affordable, and quality health care to our nation's children is not only cost-effective in the long term, but the right thing to do.

H.R. 976 is a compromise, bipartisan bill that would provide health insurance to 3.8 million children who otherwise would go without--many of whom are already eligible for CHIP or Medicaid, but just not enrolled. It also contains a moratorium on a dangerous proposed regulation that would greatly restrict access to Medicaid rehabilitative services.

The Senate cleared H.R. 976 by a veto-proof majority of 67-29, including 18 Republicans; the House passed the bill 265-159--19 votes shy of a veto-proof majority, including 45 Republicans. The House will try to override the President's veto on October 18, and MORE VOTES are needed to accomplish this. CWLA strongly urges all of you to call your Representatives via the U.S. Capitol switchboard at 1-800-828-0498 and make sure that he or she is voting in favor of the CHIP bill, H.R. 976. Children are relying on us, and we cannot let this monumental opportunity to provide them with much-needed health coverage pass us by!

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Energy and Commerce Subcommittee Approves Mental Health Parity Bill

On October 10, the House Energy and Commerce Subcommittee on Health approved the Paul Wellstone Mental Health and Addiction Equity Act of 2007 (H.R. 1424). The legislation has already cleared both the full House Education and Labor and the full Ways and Means Committees. Similar to its Senate companion (S. 558), H.R. 1424 would erase longstanding discriminatory limitations by requiring group health plans with 50 or more enrollees who choose to 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 bills 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 (DSM), whereas the Senate bill would leave it up to employers and insurers to negotiate covered conditions. House Republicans have repeatedly tried to substitute the Senate's language on this and other issues, but have failed. The House is trying to bring its bill up to speed with the Senate's, process-wise, and hopes to have the entire Energy and Commerce Committee vote on it as early as October 16. Various parity bills have been considered and conquered in Congress for years, so all involved and those who would be affected are hoping for victory this year.

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Emotional Hearing Focuses on Deaths at Residential Youth Camps

On October 10, the House Committee on Education and Labor held a hearing on residential facilities used to treat troubled youth. The facilities sometimes described as "boot camps," "wilderness camps," or other terms, are generally unlicensed or unregulated in many states. The hearing included testimony from Gregory D. Kutz, Government Accountability Office (GAO), Jane Moss, National Association of Therapeutic Schools and Programs (NATSAP), and Allison Pinto, University of South Florida. Also testifying were three parents whose children died after enrolling in these facilities.

Kutz testified on preliminary results from their investigation of these facilities. In particular he reported on a study of 10 cases where teenagers died after being enrolled in these programs by their parents. Most dramatically, committee members focused on testimony from the parents, who discussed how they had come to make the decision to place their troubled teenage children in such facilities only to have them die while in residence.

GAO indicated that its investigations of information and data from 1990 to 2007 found "thousands of allegations of abuse and deaths." GAO could not develop a specific number, however, because although states report incidence of abuse in licensed residential facilities through the National Child Abuse and Neglect Data System, no data or reporting exist for private programs.

GAO found four characteristics in the deaths they examined: untrained staff, false and deceptive marketing practices, instances of abuse to the victim before the death occurred, and negligent operations of the facility involved. The three families testified about their decisions to admit their teenage children and how each were dead within a matter of days after being sent to the camps. In each instance, the parents testified their children were dealing with mental health issues. The parents also testified they had consulted medical or other officials before placing their children in these facilities.

Jane Moss, representing NATSAP, which has nearly 200 facility members, came under intense scrutiny for how her organization treats complaints against its member programs. Moss said NATSAP was working to get more states to regulate these facilities and camps.

CWLA will be working with the committee as it considers what action or legislation may be warranted. In a letter to the committee in 2005, the last time this issue was considered in Congress, we expressed concerns about the growing number of unlicensed residential programs and support for state licensing and monitoring of all residential programs that provide services to children, youth, and their families.

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CWLA Submits Comments on Proposed Rehabilitative Services Regulation

On August 13, the Centers for Medicare and Medicaid Services (CMS) published a proposed regulation in the Federal Register that would hugely impact Medicaid rehabilitative services (CMS 2261-P/72 FR 45201). The comment period ended October 12. CWLA submitted its own comment's which can be viewed along with a summary on it's website.

As 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 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 younger than 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.

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Senate Takes Up Labor-HHS Bill This Week, White House Rejects Meeting

This week, the Senate will take up the appropriations for the Departments of Labor, Health and Human Services, and Education (Labor-HHS). This is the first time the bill has been debated on the Senate floor in several years. The bill could be one of the first sent to the White House, where the President has threatened a veto. Last week, House Majority Leader Steny Hoyer (D-MD) suggested in a personal conversation with President Bush the possibility of a meeting between leaders of Congress and the President. There seemed to be some interest by the President, but a White House official later rejected the idea, saying discussion before the bills were passed was premature.

The Senate Labor-HHS bill (S. 1710) provides a 3% increase over current FY 2007, at $149 billion in overall discretionary funding. This is 6% more than the President's budget request. The Senate numbers, however, are slightly lower than the House bill, which would spend $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 provided 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.

The House bill allocates $151 billion in discretionary spending. 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, and 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. These grants are awarded in a competitive process or are sometimes allocated by earmark. The $10 million increase is expected to promote the use of home visiting programs.

The President has indicated he may veto either of the bills due to funding levels. If Congress followed the President's budget request, it would result in actual cuts from 2007 spending levels.

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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

  • October 26: House target adjournment
  • November 16: Senate target adjournment
  • November 16: Continuing resolution to fund the government expires
  • November 16: Temporary extension of SCHIP expires


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