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

   
   
Vol. 20, Issue 42: 11/5/2007   
Headlines

CWLA Member Testifies on Proposed Medicaid Rehabilitative Services Regulation

Bipartisan, Bicameral Attempts to Complete CHIP Reauthorization

Combined Labor-HHS-Education, Defense, and Veterans Appropriations Bill to Go to President

CWLA Legislative Alerts Available to Subscribers

Key Upcoming Dates for Congress



CWLA Member Testifies on Proposed Medicaid Rehabilitative Services Regulation

After providing a thorough, effective overview of the importance of Medicaid rehabilitative services to children involved with the child welfare and foster care systems at an October 3 Capitol Hill briefing, Twila Costigan was invited back last week to testify before the U.S. House of Representatives Committee on Oversight and Government Reform. Costigan has served as the Program Manager for the Adoption and Family Support Program at CWLA member agency Intermountain in Helena, Montana, since 1997. She has 27 years experience in child welfare as a group home parent, milieu counselor in residential treatment, child protective services social worker, and licensing and adoption worker.

The hearing, entitled, "The Administration's Regulatory Actions on Medicaid: The Effects on Patients, Doctors, Hospitals, and States," took place November 1 and examined a range of regulatory changes that have been proposed or implemented recently by the U.S. Department of Health and Human Services (HHS). When calling the hearing to order, Committee Chair Henry A. Waxman (D-CA) stated that the proposed regulations' aggregate federal savings of $11 billion amounts to a "reckless amputation" because it forces states to make a difficult choice--raise taxes or cut vital services.

Costigan responded specifically to a proposed regulation (CMS 2261-P/72 Fed. Reg. 45201) that would significantly change the contours of Medicaid rehabilitative services--vital services that offer a realistic opportunity to, in the least restrictive setting possible, treat physical and/or mental disabilities of children in care and restore them to optimal functioning levels.

For instance, the proposed regulation would take away federal Medicaid dollars for rehabilitative services that are deemed "intrinsic to" other programs, including child welfare and foster care. As an example, federal Medicaid dollars would not be available for rehab services provided in a therapeutic foster care setting unless they are medically necessary, clearly distinct from packaged therapeutic foster care services, and given by a qualified provider.

Costigan testified that for Intermountain and the seriously emotionally disturbed children it successfully treats, if the regulation went into effect as proposed, their program would simply be "gone." It would severely disrupt the continuum of care, program staff would no longer be able to teach effective interventions to parents and children, and the children themselves would no longer receive necessary personal and social skills training.

Read about CWLA's concerns with the proposed rehabilitative services regulation.

Other knowledgeable individuals also testified, including David Parrella, Director of Medical Care Administration for the Connecticut Department of Social Services and Chair of the Executive Committee for the National Association of State Medicaid Directors. Parrella said that although integrity is a legitimate concern, this is not a "runaway train" situation and that it is "simply wrong" for the Centers for Medicare and Medicaid Services (CMS) to allege that certain rehabilitative services are not Medicaid's responsibility, despite decades of providing the services.

Representative Christopher Murphy (D-CT) similarly said that such separation of responsibility for payment may hold in a philosophical world but does not make sense in the real world. Murphy highlighted the difficulty of unbundling therapeutic foster care services and argued that stripping federal funding in a blanket manner is not a properly tailored response to any abuses that may or may not be occurring.

Dennis Smith, Director of the Center on Medicaid and State Operations at CMS, testified that Medicaid pays for services that are medically necessary, for Medicaid beneficiaries, and when the match rate is accurate. Medicaid runs into a problem, however, when state and local programs "push the edges of the envelope even further." Waxman asked Smith to point to specific language in the Medicaid statute that permits CMS to act in such a forward fashion, Smith cited various provisions, only to have Waxman respond he believes CMS is "taking matters into its own hands" and acting beyond Congress's intentions. Waxman concluded the hearing by reassuring those in attendance that the committee would continue to monitor these issues--both CMS's proposals and their impact on vulnerable populations.

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Bipartisan, Bicameral Attempts to Complete CHIP Reauthorization

Lawmakers continue to grapple over the long-term reauthorization of the Children's Health Insurance Program (CHIP). As Medicaid's essential companion, CHIP programs exist in every state and provide much-needed coverage to low-income children whose families earn too much to qualify for Medicaid and those who are either not offered or cannot afford private coverage.

Unable to override President Bush's veto of the original compromise, bipartisan bill (H.R. 976), the House passed its latest version (H.R. 3963) October 25. The new CHIP bill, like its predecessor, would maintain current enrollment of 6.6 million children and encompass nearly 4 million additional children who otherwise would go without coverage. It also similarly provides mental health parity in CHIP programs and guaranteed dental benefits, and begins a child health quality initiative.

Democrats reworked certain components of the original bill, however, to address opponents' concerns and garner more Republican support. For instance, H.R. 3963 for the first time in CHIP's history, largely sets the income eligibility limit at 300% of federal poverty level (or $61,950 for a family of four). In addition, it phases childless adults entirely out of CHIP within one year (as opposed to the original bill's phase-out of two years), requires all states to develop thoughtful plans that guard against crowd-out, and includes specific language that federal dollars may not be used for undocumented immigrants and accompanying enforcement measures.

The changes were apparently not substantive enough, however, as the House again failed to reach a veto-proof majority. Several members were also upset by the bill's rushed process. The day following the vote, 36 Republicans signed a letter to House Speaker Nancy Pelosi (D-CA) and Majority Leader Steny Hoyer (D-MD), insisting that "true bipartisan discussions have not yet occurred on the House side" and again outlining their principles for movement forward.

The letter, and likely the lingering, overarching desire of so many to reach a viable agreement on CHIP, have spawned recent conversations across party lines and across chambers. Ranking Member of the Senate Finance Committee Charles Grassley (R-IA), Senate Finance Chair Max Baucus (D-MT), and Finance Committee members Orrin Hatch (R-UT) and John D. Rockefeller IV (D-WV) are leading negotiations with House members such as Minority Leader John Boehner (R-OH) and Minority Whip Roy Blunt (R-MO) to better accommodate desires.

On October 31, the Senate voted 62-33 to invoke cloture and limit debate on the motion to proceed with the CHIP bill. If the bipartisan, bicameral discussions yield an agreement that would please more members, it could be offered as an amendment to the bill. At press time, it remained uncertain when the Senate would officially resume work on CHIP.

The Administration in an October 25 statement warned "the President will veto [H.R. 3963] if it is presented to him without significant changes." It remains to be seen whether such significant changes are made or whether Congress would be able to override his veto. Regardless, the Administration recently declared yet another fundamental problem it has with Congress's CHIP legislation. To reach more Medicaid- and CHIP-eligible children, H.R. 3963 would be paid for by a 61 per pack increase in the federal tobacco tax. The Associated Press reported on October 31 that President Bush told Republican lawmakers he would not agree to the health insurance bill if it included a tobacco tax increase.

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Combined Labor-HHS-Education, Defense, and Veterans Appropriations Bill to Go to President

Last week, congressional conferees were working on combining the appropriations for Labor-HHS and Education (H.R. 3043), Defense (H.R. 3222), and Military Construction-Veterans (H.R. 2642). The bill would include approximately 70% of all discretionary spending--spending that must be appropriated by Congress each year. Of that total, Defense is more than $450 billion. The President has indicated he would veto it even though he has said he approves of the Defense and Military Construction bills. He objects to the funding for Labor-HHS and says it exceeds his request.

Senate and House members were finalizing a bill that addressed the spending differences between the two versions. The House provided an increase of 4.6% from the FY 2007 total of $144 billion. The Senate bill provides $149 billion in overall discretionary funding, which is 6% more than the President's budget request.

If Congress were to adopt the President's request, it would mean real cuts to programs, not just a freeze. The President had requested, and repeated in his early veto threat, that the Social Services Block Grant (SSBG) be cut by a half billion dollars or 30%. SSBG provides approximately 11% of child welfare funding nationally and much more than that in some states.

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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

  • November 16: Senate target adjournment date, Continuing resolution to fund the government runs out, Temporary extension of CHIP expires



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