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

   
   
Vol. 20, Issue 49: 12/24/2007   
Headlines

Special Announcement

Medicare Package Extends CHIP, Freezes Rehabilitative Services Reg

CWLA Posts Summary of Medicaid TCM Interim Final Regulation

Congress Finalizes 2008 Budget Deal, Child Welfare Cut

Rep. Berkeley Introduces Bill to De-link Foster Care Adoption From AFDC

Join CWLA's Call for a White House Conference on Children and Youth

CWLA Legislative Alerts Available to Subscribers

Key Upcoming Dates for Congress



Special Announcement

Children's Monitor will not be published on New Year's Eve, December 31. The Monitor will return Monday January 7. The staff at CWLA wishes everyone a happy holiday season and the very best of New Years.

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Medicare Package Extends CHIP, Freezes Rehabilitative Services Reg

In the final hours before its holiday recess, Congress passed a package that addresses several health care issues important to the child welfare and foster care communities. The bill (S. 2499) extends the Children's Health Insurance Program (CHIP) through March 31, 2009, with sufficient funding to maintain current enrollment and avoid shortfalls, and places a moratorium on a proposed regulation that would restrict coverage and payment for Medicaid Rehabilitative Services.

CHIP exists in every state and provide much-needed health insurance to more than 6 million children whose families earn too much to qualify for Medicaid and those who are either not offered or cannot afford private coverage. This fall, Congress produced and passed two compromise bills (H.R. 976 and H.R. 3963) that would have reauthorized CHIP for five years, improved upon its initial successes, and provided coverage to millions more children, but President Bush vetoed both measures. Congress plans on attempting to override the President's veto of the CHIP reauthorization legislation next month, but for now, extending CHIP was viewed as the best possible avenue forward in a tense political environment.

The package also places a moratorium on a proposed regulation (CMS 2261-P/72 Fed. Reg. 45201) that would restrict coverage and payment for Medicaid Rehabilitative Services. In their current form, Medicaid Rehabilitative Services help fund community-based services that work to reduce physical and/or mental disabilities of children in care and restore them to optimal functioning level.

CWLA has been working arduously to educate Capitol Hill about the need to preserve rehab services for children in foster care, and, with the help of our members, has participated in and testified at corresponding briefings and hearings. Many other affected organizations have stood up in opposition to the rehab regulation, including the National Governors' Association. We are pleased that, as a first step, the regulation will be stopped until June 30, 2008.

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CWLA Posts Summary of Medicaid TCM Interim Final Regulation

Section 6052 of the Deficit Reduction Act of 2005 (DRA, P.L. 109-171) contained provisions that greatly affect case management and targeted case management (TCM) services and their relation to children in the child welfare and foster care systems. On December 4, 2007, the Centers for Medicare and Medicaid Services (CMS) published an interim final regulation (CMS-2237-IFC/72 Fed. Reg. 68077) that incorporates DRA's changes, thereby clarifying situations in which Medicaid will continue to help fund case management and TCM.

The entire interim final regulation can be downloaded from CMS's website. View CWLA's summary here.

Taking into account the vulnerability and complex needs of children in foster care, including health needs, at least 38 states employ the Medicaid TCM option to ensure a comprehensive approach and greater coordination of care for foster children. Children in foster care that receive TCM services do, indeed, fare better. Specifically, TCM recipients are more likely to receive physician services (68% compared with 44%), prescription drugs (70% compared with 47%), dental services (44% versus 24%), rehabilitative services (23% versus 11%), inpatient services (8% versus 4%), and clinic services (34% compared with 20%).

DRA specifically excluded from the definition of case management--and thus stated that federal Medicaid dollars are not available for--"the direct delivery of an underlying medical, educational, social or other service to which an eligible individual has been referred, including, with respect to the direct delivery of foster care services." Beyond the specific examples enumerated in DRA, the interim final regulation disallows federal Medicaid reimbursement for case management services deemed integral to the administration of foster care programs, child welfare, and child protective services.

The exclusion from Medicaid reimbursement appears to apply to child welfare and CPS workers, as well as case management services furnished by those who contract with the systems, even if the contractors are otherwise Medicaid-qualified providers. CMS estimates these adjustments will reduce federal Medicaid spending on TCM by $1.28 billion over five years. In doing so, costs are expected to overwhelmingly shift to the federal IV-E foster care program, increasing federal spending on IV-E by $369 million over five years. The public has until February 4, 2008, to submit comments to CMS. The interim final regulation's effective date is March 3, 2008.

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Congress Finalizes 2008 Budget Deal, Child Welfare Cut

Congress and President Bush have agreed to a final budget that shuffled funding around to meet the President's overall budget limits while adding $70 billion in war funding and $11 billion in emergency funding, both of which result in an increase in the annual deficit. The overall package of $550 billion increased funding for some programs above what the President asked, while reducing funding for some others, including a few of his requests.

The $550 billion figure includes approximately $70 billion for the war, which is lower than the $200 billion the President says is needed. As such, the debate over war funding is expected to resume early next year.

In regard to human services, the biggest child welfare victory was rejection of the President's half billion cut to the $1.7 billion Social Services Block Grant. Congress also inserted first-time funding of $10 million for home visiting programs, and broadened this funding beyond the Administration's proposed restriction to just the Nurse Family Practitioner model.

Other child welfare program funds were cut too. Promoting Safe and Stable Families (PSSF) took one of its most dramatic cuts and was reduced for the third time in the last four years. Although the President came into office with a pledge to increase funding by $200 million a year, for a total of $505 million ($305 million in mandatory, plus $200 million in appropriated funds), that figure has never been reached. Funding reached its highest level of just under $405 million ($305 million mandatory, $100 million appropriated) in 2003.

In this budget, PSSF took a very large cut of $25 million and is now down to $368 million ($305 million mandatory, $63 million appropriated). PSSF funds four types of services or families: families being reunified from foster care, families needing adoption services, families with children at risk of being placed into foster care, and families at risk of abuse and neglect.

Other programs saw across-the-board cuts of 1.7% below 2007 spending: Child Welfare Services cut by $6 million to $281 million, Mentoring Children of Prisoners reduced by $800,000 to $48.6 million, Child Welfare Training cut by $100,000 to $7.2 million, Child Abuse Prevention and Treatment Act (CAPTA) Community Based Grants reduced by $800,00 to $41.6 million, CAPTA state grants reduced by $500,000 to $26.5 million, Abandoned Infants reduced by $200,000 to $11.6 million, Adoption Awareness reduced by $200,000 to $12.4 million, and Adoption Opportunities grants cut by $500,000 to $26.3 million. Although the reductions seem small, the programs have not received much in the way in increases in this decade.

Overall funding for juvenile justice activities received an increase of $43 million. This is due mostly to a $60 million increase for juvenile mentoring, while other programs were cut. The Title II formula grants were reduced by $5 million $74.3 million, and the Title V Delinquency Prevention Grant program was cut $3.3 million to $61.1 million. The Juvenile Accountability Block Grant was increased slightly from $49.5 million to $51.7 million.

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Rep. Berkeley Introduces Bill to De-link Foster Care Adoption From AFDC

Representative Shelley Berkeley (D-NV) has introduced the Partnership for Children and Families Act (H.R. 4207). She serves on the House Ways and Means Subcommittee on Income Security and Family Supports, which has jurisdiction over this bill.

The bill aims to reform and expand eligibility for adoption assistance and foster care while reinvesting child welfare funding into state family preservation services, family support services, time-limited family reunification, and adoption promotion and support services. Additionally, the reinvestment fund provides dollars for training staff of state and local agencies and other related service providers. The reinvestment fund would take into account foster care maintenance payments savings achieved by reducing the total number of days children in the state experience foster care during the fiscal year.

CWLA applauds Berkeley's for introducing this Act. The legislation is a vital component of an overall reform effort outlined in the child welfare finance reform proposal set out by the Partnership to Protect Children and Strengthen Families. The partnership comprises organizations representing public human services directors, public child welfare directors, private child and family services agencies, child welfare workers, and advocates for children.

To access H.R. 4207, click here. To access the Partnership to Protect Children and Strengthen Families reform proposal, click here.

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Join CWLA's Call for a White House Conference on Children and Youth

Holding a White House Conference on Children will bring together a cross-section of policymakers, advocates, professionals (including the courts), and families and children directly affected by the child welfare system to create recommendations for policy and change. Much positive change has come from previous White House conferences for children, the last one being held in 1970. CWLA is calling on Congress and the next President to reestablish this important policymaking tradition, and the time to act is NOW.

Your support and involvement with this effort is crucial to its success. As experts in the field, we look to you for your leadership in asking Congress and others to support this important campaign for children.

Sign On in Support

CWLA is calling on members and supporters to sign on in support of a White House Conference on Children in 2010.

Pass a Board Resolution

If your organization requires you to pass a board resolution to officially support such an effort, CWLA has created a sample resolution to assist you in this effort.

Let Congress Know of Your Support

The League encourages you to send your resolutions and letters of support to your Congressional delegation. Without their support, a White House conference is not possible.

In keeping with CWLA's tradition of nonpartisanship, the letter has been sent to all presidential candidates in the two major parties. View the website, read the letter, and sign on to support the campaign.

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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.

Subscribe to Legislative Alerts.

Subscribe to Children's Monitor.

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Key Upcoming Dates for Congress

January 15: Start of second session 110th Congress; House Returns
January 22: Senate Returns
January 28: President's State of the Union Address
February 4: President submits proposed FY 2009 budget to Congress
February 25-27: CWLA National Conference


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