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

   
   
Vol. 21, Issue 3: 1/22/2008   
Headlines

House, Senate Leaders Denounce Applying Income Eligibility Policy to Medicaid

Medicaid Hearing Highlights Need to Amend or Stop Recent Regulations

HHS Proposes AFCARS Data Collection Reforms

State Fiscal Aid Could Be Part of Stimulus Package

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

CWLA Legislative Alerts Available to Subscribers

Key Upcoming Dates for Congress



House, Senate Leaders Denounce Applying Income Eligibility Policy to Medicaid

Congressional leaders, including Senate Finance Committee Chair Max Baucus (D-MT), House Energy and Commerce Committee Chair John Dingell (D-MI), and House Oversight and Government Reform Committee Chair Henry Waxman (D-CA) have sent Health and Human Services Secretary Michael O. Leavitt a letter questioning the legality of a policy that will deny or severely limit access to health insurance to low-income children.

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 State Children's Health Insurance Programs (SCHIPs) and Medicaid programs, including the ability to set income eligibility limits.

In a sharp departure from that sound policy, however, the Centers for Medicare and Medicaid Services (CMS) issued a policy directive in the form of letter to state health official last August that makes it next to impossible for state SCHIP programs that are already covering or desire to cover children in families who earn more than 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.

In recent weeks, it has become apparent the Bush Administration plans to extend this policy directive to Medicaid. Ohio, for instance, was told by the Administration in late December that its application to increase Medicaid income eligibility from 200% FPL to 300% had been denied for failing to meet the policy's stringent thresholds.

"Despite repeated warnings about the legality of the Aug. 17, 2007, directive, and the absence of a formal rulemaking process, your administration has continued to pursue a policy that is contrary to federal law and that limits children's access to health care," the lawmakers wrote to Leavitt. "Federal law does not authorize CMS to effectively impose an income eligibility cap in [SCHIP] or Medicaid." The authors of the letter requested CMS to reverse its decision immediately and, specifically, for Leavitt to respond to their demands by January 31.

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Medicaid Hearing Highlights Need to Amend or Stop Recent Regulations

On January 16, the House Energy and Commerce Subcommittee on Health held its first hearing of the second session of the 110th Congress, entitled, "Helping Families with Needed Care: Medicaid's Critical Role for Americans with Disabilities." In addition to urging swift passage of legislation such as the Community Choice Act (S. 799/H.R. 1621), which would work to end institutional bias by granting eligible individuals the choice of community-based attendant services and supports, several subcommittee members and witnesses highlighted the danger of certain regulations that CWLA, our members, and others have actively been trying to amend or stop.

In his opening statement, Subcommittee Chair Frank Pallone (D-NJ) discussed how the Bush Administration has launched an "all-out attack" on Medicaid by issuing a series of harmful rules--including ones on Medicaid Rehabilitation Services and Case Management/Targeted Case Management (CM/TCM)--that jeopardize vital services. Representative Hilda Solis (D-CA) specifically mentioned the regulations' likely negative impact on children in foster care, as did Celine Fortin, Associate Executive Director of the Arc of New Jersey. Fortin testified that the CMS's interim final regulation on CM/TCM goes "well beyond" the policies established by Congress in the Deficit Reduction Act.

As explained in CWLA's summary, the CM/TCM regulation would prohibit federal Medicaid funds for CM/TCM services provided by child welfare and child protective services agencies and contractors of those agencies in most instances. Fortin also mentioned discriminatory and arbitrary exclusions contained in CMS's proposed rule on Medicaid Rehabilitation Services. CWLA's comments on this proposed regulation may be viewed here.

CWLA and numerous other advocates secured a six-month moratorium that shuts down the administrative process on the Rehabilitation Services regulation until June 30, 2008, in the Medicare, Medicaid, and SCHIP Extension Act of 2007, which was recently signed into law (P.L. 110-173). Because of its potentially catastrophic impact, Fortin's testimony strongly urged Congress to extend the moratorium on Rehabilitation Services and, when doing so, to include a stop on the CM/TCM rule.

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HHS Proposes AFCARS Data Collection Reforms

On February 11, the Administration for Children and Families in the U.S. Department of Health and Human Services published a notice of proposed rulemaking (NPRM) in regard to the Adoption and Foster Care Analysis and Reporting System (AFCARS). These regulations dictate how states are to gather data on children in foster care and adoptive placements. Information about the number of children in care, such as the annual number of 506,483 children in foster care in 2005, is generated by these individual state data collection systems.

The NPRM proposes changes that will affect the ability to generate more information on children in the child welfare system. Critics have argued the system could do a better job of giving information on children in care and children adopted and could take greater advantage of newer information technology. The new regulations would be more focused on all children in out-of-home care, including those in guardianship settings, some psychiatric treatment facilities, and juvenile justice facilities, populations that may be missed under the current data collection standards.

CWLA will conduct a greater analysis of the NPRM and submitting comments. The NPRM is available online in PDF format.

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State Fiscal Aid Could Be Part of Stimulus Package

With both houses of Congress now back in Washington, action on an economic stimulus package is expected to take center stage. Economists are talking about a package that would meet the "three Ts" test: timely, targeted, and temporary. A state fiscal relief package that would provide states with several billion dollars to offset rising state budget deficits would meet the test. In 2001, when the last recession occurred, Congress did provide such a package. That stimulus package passed through assistance to states by increasing each state's federal match in Medicaid funding.

Another component of a stimulus package being discussed is a tax rebate, which was also used in the last recession. Congressional Republicans seem willing to drop their support for including an extension of the Bush tax cuts, whereas Democrats have shown some willingness to include tax cuts that would target business. Last month, there was talk that a stimulus package would be unveiled in the President's State of the Union Address scheduled for the last week of January, but the recent bad news on the economy has pushed up the discussions.

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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 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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