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

   
   
Vol. 20, Issue 43: 11/12/2007   
Headlines

CWLA Member's Medicaid Testimony Available Online

Sign Up to Support White House Conference on Children and Families

Congress Working to Reach Acceptable CHIP Deal

Labor-HHS-Education Ready for President, Veto Threatened

Higher Education Bill May Include Loan Forgiveness for Child Welfare

Head Start Negotiations Begin

Bill Would Delink AFDC from Adoption Assistance

Court of Appeals Rules SSI Benefits to Stay with Foster Youth

CWLA Legislative Alerts Available to Subscribers

Key Upcoming Dates for Congress



CWLA Member's Medicaid Testimony Available Online

As reported last week, Twila Costigan, Manager of the Adoption and Family Support Program at CWLA member agency Intermountain in Helena, Montana, recently testified on Capitol Hill about the potential effects of CMS's proposed Medicaid Rehabilitative Services regulation. House Oversight and Government Reform Chair Henry Waxman (D-CA) said in his opening remarks at the hearing that the Administration's proposals--including changing Rehabilitative Services--are "not about program integrity" and instead "seek to prohibit services that have been successful for decades and cut funding Congress has specifically preserved." Waxman urged CMS to listen carefully to the witnesses and go back to the drawing board because the committee would not support an "unauthorized regulatory offensive against the states, community providers, and Medicaid beneficiaries."

Medicaid Rehabilitative Services offer a realistic opportunity to, in the least restrictive setting possible, reduce physical or mental disabilities of children in care and restore them to optimal functioning level. The proposed regulation (CMS 2261-P/72 Fed. Reg. 45201) would significantly limit access by taking 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 currently successfully treats, their program would simply be "gone" if the regulation went into effect as proposed.

View the hearing on YouTube. Costigan's testimony is available online.

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Sign Up to Support White House Conference on Children and Families

Momentum for CWLA's campaign for a White House Conference on Children and Youth continues to build. Sign on to support the campaign.

This White House Conference on Children and Youth would be the first since 1970. Three decades have passed without the White House bringing the nation's focus to examine the state of our children. CWLA is calling on Congress to authorize such a conference so the next President will convene a conference in 2010. A White House Conference on Children and Youth is necessary to focus the nation's attention on the children who are, after all, our responsibility. The conference will examine the greatest needs and set the country on a path to reform. The commitment of the President and the power of the White House is necessary to once again make vulnerable children a national priority and point the way to significant reform and improvements.

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Congress Working to Reach Acceptable CHIP Deal

On November 1, following earlier passage in the House, the Senate passed by a vote of 64-30 the latest version of compromise legislation (H.R. 3963) to reauthorize the Children's Health Insurance Program (CHIP). As Medicaid's essential companion, CHIPs 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.

President Bush vetoed Congress's initial compromise CHIP reauthorization legislation (H.R. 976) at the end of September, and Congress was unable to override that veto. Although Congress made changes to address opponents' concerns when developing H.R. 3963, President Bush has already pledged to veto it if delivered to him without "significant changes," citing the bill's price tag and accusing it of running toward government-run health care. The Administration of late has especially voiced its refusal to sign any legislation paid for by a tobacco tax increase, which is exactly how H.R. 3963 would be funded.

A bipartisan group of Senate negotiators, including Finance Chair Max Baucus (D-MT) and Finance Ranking Member Charles Grassley (R-IA), have been meeting with several House Republicans to try and reach a more acceptable deal. Senate Majority Leader Harry Reid (D-NV) delayed the Senate's vote on H.R. 3963 to provide more time for negotiations. In an interesting procedural move, however, certain Senate Republicans objected--bringing the bill, which they ultimately voted against, to a final vote and temporarily ending the chance of negotiators' work to be offered as a substitute. After H.R. 3963 cleared both chambers, leaders agreed to wait to send the bill to the White House, hoping again that additional time could yield effective changes to the legislation and the needed two-thirds support of both houses.

As it passed the House and Senate, H.R. 3963 would maintain current enrollment of 6.6 million children and encompass nearly 4 million additional children who otherwise would go without coverage. It would provide mental health parity in CHIPs and guaranteed dental benefits, and would begin a child health quality initiative.

Section 616 of the bill would stop a restrictive proposed Medicaid Rehabilitative Services regulation until January 1, 2010. Among the alterations Democrats had already made in the name of compromise, H.R. 3963 would phase out childless adults from CHIP entirely within one year, would require all states to develop thoughtful plans that guard against crowd-out (individuals leaving private coverage for public programs such as CHIP), and includes specific language that federal dollars may not be used for undocumented immigrants.

The bipartisan, bicameral negotiations taking place sees to be focusing on many of these same objections to the CHIP bills--namely, that CHIP must not provide coverage to illegal immigrants, that the program's focus should be on the lowest-income children, and that comprehensive safeguards should be in place to avoid crowd-out. At press time, House Majority Leader Steny Hoyer (D-MD) told reporters, "We are close." Currently, CHIP funding continues until November 16. What happens beyond that hinges on the outcome of these negotiations.

State CHIPs continue to hope for the best but are preparing for the worst-case scenario. The Sacramento Bee reported on November 5 that the Managed Risk Medical Insurance Board, which administers California's CHIP, Healthy Families, adopted rules that would permit the state to create a waiting list for CHIP or remove children from the rolls. Removing children may have to occur at some point, because California estimates that if the CHIP impasse is not overcome, and if CHIP is merely flat-funded, the state would enter shortfall around the summer of 2008. California is not alone, unfortunately; the Congressional Research Service estimates that at flat funding, 20 other states would exhaust all available federal CHIP funds by the end of FY 2008.

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Labor-HHS-Education Ready for President, Veto Threatened

Congressional conferees attempted to combine the appropriations for Labor-HHS-Education (H.R. 3043) with the Military Construction-Veterans bill (H.R. 2642), but because of a Senate rule the two bills were split. The President has said he would veto the Labor-HHS-Education bill because it exceeds his budget request by approximately $9 billion. In fact, the President has issued veto threats against most of the 2008 spending measures--the Military Construction and Defense bills being the exceptions. Both of these bills increase spending beyond last year's total. In fact, the defense measure increases non-war spending by $40 billion over 2007, yet the bill is still $3.5 billion below the President's request.

The conference report for Labor-HHS-Education increases spending by approximately $7 billion over last year. Total discretionary or annually appropriated funds for the three federal departments total $150 billion, compared with the $459 billion appropriated for non-war defense spending.

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

Despite the increases provided by Congress to the overall bill, funding for vital children's programs are increased only slightly, or are frozen. Funding for child care is increased by approximately $30 million, for a total of just over $2 billion. Head Start is increased by $150 million, to just over $7 billion. Funding for the Child Abuse Prevention and Treatment Act and the Promoting Safe and Stable Families program is frozen at current levels.

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Higher Education Bill May Include Loan Forgiveness for Child Welfare

Loan forgiveness for child welfare workers could be on the table for discussion again as the House Committee on Education and Labor is scheduled to take up a bill to reauthorize the Higher Education Act.

Earlier this year, the House passed legislation to reform the nation's student loan system and lower lending costs for students attending colleges and universities. This bill included language to provide $1,000 in loan forgiveness for each year a social worker worked in a child welfare agency, up to $5,000 over five years. It also provided similar benefits to child care and Head Start teachers. The final version of the bill, the College Cost Reduction Act of 2007, did not include the House provision, however, after some members of the Senate balked at the proposal.

This loan forgiveness language could be included in the new legislation dealing with higher education. At press time, the House bill was still being discussed, but a formal debate was planned for this week.

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Head Start Negotiations Begin

Senate and House negotiators have been talking on and off for months about their competing Head Start reauthorization bills, but negotiations are to become more formal now that the House has appointed conference committee members. Both houses acted on Head Start reauthorization (H.R. 1429/S. 556) earlier this year, but the work has not been finished largely because of other priorities the key committees have had to focus on, including the No Child Left Behind legislation. With a delay in discussions over No Child Left Behind, the committees are now focusing on other pending work,including the Higher Education Act (see above) and Head Start.

The gaps between the two Head Start bills are not significant. Negotiations will focus on differences in the use of parent councils, ability to cover children above the federal poverty line, teacher standards, and other areas. Both bills propose gradual increases in funding, including funding of $7.3 billion in the first year. Congress is considering increasing Head Start to $7 billion in FY 2008. After more than five years of near level funding, Head Start has not been able to expand its coverage and invest in quality improvements as it had in previous years.

If the conferees agree to a Head Start reauthorization, it will be the first time since 1998. Head Start was to be reauthorized in 2003, but debate was stifled when the administration promoted controversial ideas such as conversion to a state block grant, moving the program out of the Department of Heath and Human Services (HHS), and proposals to require testing of Head Start kids. All of those ideas have been rejected.

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Bill Would Delink AFDC from Adoption Assistance

On November 6, Representative Jim Cooper (R-TN) introduced the Adoption Equality Act of 2007, H.R. 4091, as a companion bill to S. 1462. This legislation would amend Part E of Title IV of the Social Security Act to promote the adoption of children with special needs. The proposal delinks the 1996 Aid to Families with Dependent Children (AFDC) income eligibility requirement from special-needs adoption. The House bill has eight original cosponsors. Senator John D. Rockefeller (D-WVA) introduced the Senate bill in May.

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Court of Appeals Rules SSI Benefits to Stay with Foster Youth

The North Carolina Court of Appeals has ruled the state did not act properly or in the best interest of a child in foster care when it took Supplemental Security Income (SSI) payments provided to the child as an offset for the foster care payments the child welfare system made on his behalf. This case is related in part to an ongoing debate that dates back to a 2003 Supreme Court decision (Keffeler) that ruled states could withhold SSI payments as a way to offset some of the costs of foster care payments.

The case came to light in an article about the young man in the New York Times. He was in foster care and had been receiving SSI as a survivor. He had also inherited a home that had been purchased through Habitat for Humanity. Without the SSI money to help him make the low-cost house payment, he was in danger of losing the house just at the time he was getting ready to leave foster care and become independent.

The court ruled the state had not acted in his best interest in handling his SSI benefits. How many children in care are eligible for SSI, and how many states collect any of these payments, is unclear, although the number is thought to be small.

Representative Pete Stark (D-CA) has introduced the Foster Children Self-Support Act (H.R. 1104), which would reverse the practice allowed by the Supreme Court ruling. When Congress might consider this bill is also unclear.

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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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