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

   
   
Vol. 21, Issue 5: 2/4/2008   
Headlines

Bipartisan Bill to Create White House Conference Ready for Introduction

Bills Would Impose Moratorium on Medicaid Case Management/TCM Regulation

Cost of Child Abuse Set at $104 Billion

President Gives Final State of Union

Hearing Examines Lost Opportunities to Cover Uninsured Children

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

CWLA Legislative Alerts Available to Subscribers

Key Upcoming Dates for Congress



Bipartisan Bill to Create White House Conference Ready for Introduction

On January 25, Representatives Chaka Fattah (D-PA) and Jon Porter (R-NV) sent a Dear Colleague letter to members of the House of Representatives asking them to sign on as original cosponsors of a bill to hold a White House Conference on Children and Youth. Once the letter has circulated and Fattah and Porter feel they have a good number of original cosponsors, the legislation will be introduced and assigned a bill number.

The legislation is similar to previous bills to hold a White House Conference on Children and Youth and White House Conferences on Aging. It establishes a policy committee with members selected by the President and leaders from both parties and both houses of Congress. The policy committee would oversee an eventual agenda for the actual 2010 event and a series of regional and national meetings leading up to the convening in Washington.

The legislation focuses on collecting issues that fall under child welfare, including prevention and intervention of abuse and neglect; permanence for children in foster care, including kinship care, adoptions, and reunification; as well as cross-cutting issues such as access to health care and mental health services, the role of substance abuse, overrepresentation of certain populations in the system, access and support for tribal governments and communities, and the role of key partners, including the courts and state and local child welfare systems.

There has not been a White House on Children and Youth since 1970, but if this conference follows the more recent Conferences on Aging (1994-1995 and 2004-2005), the actual White House event will be preceded by a series of regional, state, and local meetings. Some of these meeting may actually receive federal support and be an official part of the conference activities, whereas others may be independent gatherings of interested parties and partners. These meetings usually result in recommendations on the issues that are then given to the policy committee.

Past Conferences on Aging have resulted in hundreds of such local gatherings. In past Aging Conferences, delegates to the White House event have been selected by each state's governor based on population factors. In addition, each member of Congress has selected a delegate. Policy committees have also selected representatives from national organizations to participate and attend the conference. If this conference is held, many events will take place in 2009.

CWLA is excited about the potential impact of not just an event at the White House but the great transformative potential so many meetings at the state and local level could have on child welfare. This would be especially important if Congress could be moved to make improvements in the current financing of child welfare services and in fact help with the implementation of such reforms.

To have an impact on the outcome of this effort, call the U.S. Capitol switchboard at 202-224-3121, ask for your member of Congress, and ask them to be an original cosponsor of the Fattah-Porter bill to create a White House Conference on Children and Youth.

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Bills Would Impose Moratorium on Medicaid Case Management/TCM Regulation

Bills have been introduced in both the House and Senate that would impose a moratorium on all administrative action (promulgation of regulation, issuance of regulatory guidance, use of federal payment audit procedures, or other administrative action, policy, or practice) surrounding an interim final regulation issued by the Centers for Medicare and Medicaid Services (CMS) afecting Medicaid case management and targeted case management (TCM).

Representative Keith Ellison (D-MN) introduced the House version (H.R. 5173) with eight additional, bipartisan original cosponsors; Senators Norm Coleman (R-MN) and Amy Klobuchar (D-MN) introduced the Senate bill (S. 2578). Both would stop the restrictive regulation until April 1, 2009. CWLA, working in conjunction with other child- and family-serving organizations and the broader mental health and disability communities, has been advocating for such legislation and is extremely thankful these members of Congress are working aggressively to protect case management/TCM.

A state option under Medicaid, case management and TCM services assist beneficiaries on a statewide or targeted basis in accessing much-needed medical, social, educational, or other services. 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 children in foster care receive a comprehensive approach and greater coordination of care. The immediate and long-term impact of TCM services is overwhelmingly positive and cost-effective, as children in foster care who receive TCM services are more likely to receive prescription drugs and physician, dental, rehabilitative, inpatient, and clinic services.

Through Section 6052 of the Deficit Reduction Act (DRA, P.L. 109-171), Congress clarified the scope of the case management/TCM benefit, excluding from the definition the direct delivery of certain underlying medical, educational, or social services, all the while prominently iterating that many case management services remain allowable, legitimate Medicaid expenses. CMS's interim final regulation seeking to interpret DRA, however, appears to go far beyond the statutory provisions on numerous fronts.

For instance, the regulation vaguely disallows Medicaid reimbursement for case management/TCM services that are deemed "integral to" the administration of another nonmedical program, such as child welfare and child protective services. The regulation's preamble says this exclusion could extend to case management services furnished by contractors to state child welfare and CPS agencies, even if they are otherwise qualified Medicaid providers. This dissection obliterates the goal and need for systems to work together toward the well-being of children in care and seems directly contradictory to the very purpose of case management and TCM. The regulation also contains several provisions that would negatively affect other vulnerable populations, including adults with serious mental illnesses, low-income pregnant women, and individuals living with HIV/AIDS.

As an interim final regulation, the rule is moving on a speedy schedule. It was published in the Federal Register on December 4, 2007. Its comment period closes today--February 4, 2008, and CMS expects the regulation to be fully implemented on March 3, 2008. CWLA has submitted comments to CMS and sincerely hopes our concerns will be heard. In the meantime, CWLA urges its members to call their elected officials and urge them to cosponsor the moratorium bills. Although not a permanent solution, the bills would slow down this process so members of Congress can ensure their intent behind DRA is upheld, sound policy is developed, and states have adequate time to react and plan.

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Cost of Child Abuse Set at $104 Billion

On January 29, 2008, a news conference was held at the National Press Club by Prevent Child Abuse America and the Kids Are Waiting campaign on the need for more preventive services in child welfare. One of the key issues was the recent work and analysis by Prevent Child Abuse America that calculates the annual cost of child abuse and neglect at $104 billion. The figure includes direct costs of abuse, long-term costs, and indirect costs.

The two groups emphasized the need for more flexible federal funds to help children remain in their homes and prevent further abuse and neglect. A second report released by the campaign at the event outlines some promising efforts that seek to prevent abuse and neglect. Currently, the major designated child welfare funding source for states is Title IV-E, which is used primarily for children in foster care and adoption assistance. The report indicates that in 2007, $7.2 billion in federal funds were specifically allocated to child welfare, with 90% allotted to children in out-of-home placements. States were only allowed to use 10% of funds toward preventive services.

A panel of witness spoke in support of the campaign for finance reform. Jim Hmurovich, President/CEO of Prevent Child Abuse America, emphasized that investments in prevention are paramount to counteracting the long-term affect on children, deterrence of abuse and neglect, and placements in fosterer care. David Sanders, Vice President of Casey Family Programs, highlighted the positive outcomes of prevention programs in which he has been involved in California and Minnesota.

Prevention services provide alternative responses that help impede or prevent initial abuse or neglect of children, as opposed to action taken after the occurrence. Marc Cherna, Director of the Allegheny County (Pittsburgh) Department of Human Resources, elaborated on the effectiveness of family prevention services in which he has been involved in Pennsylvania. Through implementing community-based services, the rate of child deaths, foster care placements, and cases of child abuse and neglect were reduced in Allegheny County.

Foster care alumnus Jennifer Gibson voiced how the lack of family supports and prevention services resulted in permanent separation from her mother and siblings. Senior Family Support Worker and former parent participant Cheryl D'Aprix of Healthy Families America shared how she was able to overcome post-partum depression and parent her children through a community prevention program.

A copy of the Prevent Child Abuse America study is available for download in PDF format. The Investing in Prevention report is online.

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President Gives Final State of Union

On January 28, President Bush delivered his final State of the Union address to a joint session of Congress. In his speech, he highlighted his proposed budget for fiscal year 2009. He indicated that the budget, due out this week, includes domestic spending cuts of $18 billion. Although Congress did not agree to all of the President's specific program funding requests for the current 2008fiscal year budget, it did agree to his spending levels, resulting in reductions in some child welfare prevention and intervention programs for this year.

The President once again called on Congress to pass a permanent extension of his signature tax cuts that began in 2001. Those tax reductions have been extended generally in four- or five-year increments as a way to keep down the 10-year projected costs that are always developed by the Congressional Budget Office (CBO).

President Bush also used the occasion to denounce the use of congressional earmarks, and he called on Congress to pass a reauthorization of the education bill, No Child Left Behind. The education debate is likely to occupy the Senate Health, Education, Labor, and Pension Committee and the House Education and Labor Committee for the next several weeks. These two committees also have jurisdiction over the Child Abuse Prevention and Treatment Act, which is scheduled for reauthorization this year. Progress on this reauthorization is likely to be delayed due to the education debate.

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Hearing Examines Lost Opportunities to Cover Uninsured Children

On January 29, the House Energy and Commerce Subcommittee on Health held a hearing entitled, "Covering Uninsured Kids: Missed Opportunities for Moving Forward." Several committee members and witnesses talked about the negative effect of President Bush's veto of two bills that passed Congress and would have reauthorized the State Children's Health Insurance Program (SCHIP) for five years (H.R. 976 and H.R. 3963), and other issues affecting uninsured children, including the idea of "express lane eligibility."

SCHIP 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.

In his opening statement, Subcommittee Chair Frank Pallone (D-NJ) discussed the negative impact of President Bush's veto of the SCHIP program. Representative Nathan Deal (R-GA) countered that SCHIP should focus on covering children instead of families and that it, "should not be a springboard for universal health care coverage for everyone."

Representative Diana Degette (D-CO) spoke about the impact of a new CMS policy directive 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). Ann C. Kohler, Deputy Commissioner with the New Jersey Department of Human Services, reminded the subcommittee that the August 17, 2007, directive from CMS would require children to remain uninsured for one year before they could receive health care coverage. She testified this would cause havoc with her program and could jeopardize coverage for thousands of children.

Bruce Lesley, President of First Focus, spoke on the importance of express lane eligibility, which uses the data collected by needs-based public programs to help identify and enroll children in Medicaid and SCHIP. According to the Urban Institute, 70% of children who are eligible but unenrolled in Medicaid or SCHIP would get coverage if express lane eligibility were implemented. Both reauthorization bills that passed Congress last session had provisions that would have granted states an option to use express lane eligibility.

Many members of 110th Congress placed reauthorizing and improving SCHIP at the top of their agendas, and some vow to keep broaching the issue in 2008. In the meantime, Congress did pass, and the President signed into law, a measure (P.L. 110-173) that extends SCHIP through March 31, 2009, with sufficient funding to maintain current enrollment and avoid shortfalls.

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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

  • February 4: President's proposed FY 2009 budget submitted to Congress
  • February 18-24: President's Day break
  • February 25-27: CWLA National Conference
  • March 15-30: Congressional Spring break
  • April 1: Start of Child Abuse Prevention Month


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