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

   
   
Vol. 21, Issue 2: 1/14/2008   
Headlines

Economic Stimulus Package Likely to Be on Congressional Agenda

President Signs SCHIP Extension Containing Moratorium on Rehab Regulation

Administration Applies Restrictive Income Eligibility Policy to Medicaid

Legislation Introduced to Slow Down TCM Regulation

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

CWLA Legislative Alerts Available to Subscribers

Key Upcoming Dates for Congress



Economic Stimulus Package Likely to Be on Congressional Agenda

The House of Representatives reconvenes this week for the start of the second session of the 110th Congress; the Senate returns next week. All unfinished legislation carries over and does not have to be reintroduced, so much of the CWLA Legislative Agenda will also carry over from 2007.

One item likely to be front and center will be the economy. With rising concern over housing and employment markets, the White House is talking about the possibility of some proposals to stimulate the economy. These would be unveiled in the President's State of the Union Address, scheduled for the last week of January. The package will likely include something to support slumping house sales and some type of tax proposals. The President will likely call for a continuation of his past tax cuts, some of which are due to expire in the next decade.

Early indications are that, with a slumping economy, the deficit will also increase. Reports from the first quarter of the federal fiscal year, which started October 1, are that the deficit is increasing. Congress has attempted to abide by a "PAYGO" rule, which requires any increase in spending and tax cuts to be offset with other program reductions or changes in tax law to raise revenue. Congress did bypass this rule recently, however, when it passed the one-year $50 billion fix of the Alternative Minimum Tax (AMT). How the President's budget will respond to the need for economic stimulus, rising deficits, and his past efforts to cut some domestic programs is unclear.

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President Signs SCHIP Extension Containing Moratorium on Rehab Regulation

President Bush on December 29 signed into law the Medicare, Medicaid, and SCHIP Extension Act of 2007 (P.L. 110-173), extending the State Children's Health Insurance Program (SCHIP or CHIP) through March 31, 2009, with sufficient funding to maintain current enrollment and avoid shortfalls.

CHIP programs exist 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. Last fall, Congress passed two compromise bills (H.R. 976 and H.R. 3963) that would have reauthorized CHIP for five years, improved on its initial successes, and provided coverage to millions more children, but President Bush vetoed both measures, citing an array of reasons. The House failed to override the President's veto of the first bill. Congress is expected to try and override the veto of the second bill after it returns from recess and some, including Speaker Nancy Pelosi (D-CA), have vowed to keep fighting during 2008 to cover more low-income children.

A true sign of the positive impact that CWLA, its members, and collaborating organizations can have in Washington, was the inclusion in this law of a moratorium that will stop administrative action on a proposed restrictive Medicaid Rehabilitation Services regulation until June 30, 2008.

In their current form, Medicaid Rehabilitation Services help fund community-based services that work to reduce physical and mental disabilities of children in care and get them on a healthy trajectory. The proposed regulation (CMS 2261-P/72 Fed. Reg. 45201) would significantly limit access to these vital services by taking away federal Medicaid dollars for rehabilitative services deemed "intrinsic to" other programs, including child welfare and foster care. For example, federal Medicaid dollars would no longer 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.

Our efforts to educate Capitol Hill about the need to preserve funding for rehab services resulted in initial, longer moratoriums in the SCHIP reauthorization bills. Due to the President's veto of those measures, and considering competing issues, we see the six-month moratorium as a significant first step. CWLA thanks leadership for acknowledging the importance of rehab services and will continue working to protect them.

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Administration Applies Restrictive Income Eligibility Policy to Medicaid

In recent weeks, it has become apparent the Bush Administration plans on applying a fairly recent policy directive, issued in the form of an August 17, 2007, letter to state health officials, that effectively caps income eligibility levels of state SCHIP programs at 250% of federal the poverty level to Medicaid.

Recognizing that states are very differently situated in terms of costs of living, for example, the federal government, including the Bush Administration through the approval of state waiver applications, has long afforded states flexibility to uniquely tailor certain aspects of their programs, including the ability to set income eligibility limits.

In a sharp departure from that sound policy, however, the August 2007 directive makes it next to impossible for state SCHIP programs that are already covering or desire to cover children in families who earn over 250% of the federal poverty level (FPL) to do so (250% of FPL is $51,625 for a family of four). To cover children in families above 250% FPL through SCHIP, the directive, among other exceedingly high bars, requires states to prove individuals--in this case, children--have been uninsured for at least an entire year. Such states would also have to show they have enrolled at least 95% of their children below 200% FPL who are eligible for either SCHIP or Medicaid.

Although the letter announcing this policy was directed at state-run SCHIP programs, states recently seeking to cover more low-income children by increasing the income eligibility limit of their Medicaid programs have received notice from the Centers for Medicare and Medicaid Services (CMS) that the stringent requirements also must be met for Medicaid applications. Ohio, for example, whose Republican-controlled General Assembly overwhelmingly approved expanding Medicaid to provide health insurance to approximately 20,000 children, was told by the Administration in late December that its application to increase Medicaid income eligibility from 200% FPL to 300% had been denied.

The Administration's policy, which was developed and announced without input from Congress and without going through the formal notice-and-comment rulemaking process, has already drawn fire, with members of Congress attempting to completely halt or at least more realistically tailor the requirements to their supposed goals of first insuring the most low-income children and not causing individuals to drop private insurance for public.

A couple of states have also filed suit against the federal government for the policy's application to SCHIP. In regard to the Administration's application of the policy to Medicaid, Representative John Dingell (D-MI) has said, "The restrictions the Administration is imposing--on both SCHIP and Medicaid--are arbitrary, shameful, and harmful."

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Legislation Introduced to Slow Down TCM Regulation

On December 4, 2007, CMS published an interim final regulation (CMS-2237-IFC/72 Fed. Reg. 68077) that incorporates the Deficit Reduction Act's (DRA) impact on Medicaid case management and targeted case management (TCM), thereby clarifying situations in which Medicaid will continue to help fund these important services. The entire interim final regulation is online in PDF format. CWLA's summary is online.

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 who 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%).

The regulation appears to go beyond what DRA intended and thus threatens the future of TCM services by elaborating that Medicaid cannot be used to fund TCM services of state child welfare and child protective services workers, TCM services of contractors to the state child welfare and child protective services agencies, all administrative activities that are "integral to the administration of the foster care system," and case management activities included under therapeutic foster care programs. It seems the regulation would permit Medicaid federal financial participation toward TCM in very limited circumstances, such as to fund state-plan-approved TCM services from a qualified Medicaid provider operating entirely outside the child welfare system.

Senator Norm Coleman (R-MN) and Representative Keith Ellison (D-MN) have introduced bills (S. 2280/H.R. 3940) that CWLA has endorsed to delay the TCM regulation, permitting more time for public comment, sound policy development, and state reaction and planning. Coleman, whose state faces losing up to $17 million per year in health care funds for foster children, the elderly, and the mentally ill should the regulation to go into effect, remarked, "Minnesota has been a good steward of these dollars. TCM is a vital program that helps the poorest of the poor and the sickest of the sick gain access to the medical, social, and educational services they are entitled to."

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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 of 110th Congress, House Returns
  • January 22: Senate Returns
  • January 28: President's State of the Union Address
  • February 4: President's proposed budget for FY 2009 submitted to Congress
  • February 25-27: CWLA National Conference


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