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

   
   
Vol. 22, Issue 18: 5/11/2009   
Headlines

Carmen Nazario to Lead Administration for Children and Families

Obama FY 2010 Budget Hopeful for Child Welfare

Mandatory Funding for Home Visiting Included in Budget

Spending Plans for Health Reform and Medicaid

Kinship Navigator and Other Fostering Connections Grants Posted

HHS Seeks to Partially Rescind Medicaid TCM Regulation

Request for Information on Parity Law

The Path to Juvenile Justice Reform

Senator Landrieu Introduces Mentoring Legislation

Key Upcoming Dates for Congress



Carmen Nazario to Lead Administration for Children and Families

On Tuesday, May 5, President Obama announced his selection of Carmen Nazario to become the new leader of the Administration for Children and Families (ACF). Formally, her title is the Assistant Secretary for Children and Families, which makes her the head of the ACF. Nazario is not unfamiliar with the position, as during the second term of the Clinton Administration, she served as ACF's Associate Commissioner for Child Care and was later appointed ACF's Principal Deputy Assistant Secretary.

Nazario brings with her a great deal of human service program experience. Before serving in the Clinton Administration, Nazario served as Secretary of Health and Social Services for the state of Delaware and was the Director of Social Services in Norfolk, Virginia and Loudoun County, Virginia. After leaving the Clinton Administration, Nazario was the Administrator of the Administration for Children and Families in Puerto Rico. More recently, she has served as an Assistant Professor at the Inter American University of Puerto Rico, where she teaches social policy and coordinates the Social Work Practicum at the School of Social Work.

ACF is the critical department for child welfare and other vital children's programs. It includes not just the Administration on Children, Youth and Families and its oversight of child welfare programs, but also the Office of Family Assistance (which includes child care and Temporary Assistance for Needy Families), the Administration for Native Americans (in charge of tribal issues), the Office of Child Support, the Office of Community Services (which covers the social services block grant), Office of Head Start, and the ten regional HHS offices.

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Obama FY 2010 Budget Hopeful for Child Welfare

On Thursday, May 7, the Administration released the details of their fiscal year 2010 budget. While new administrations tend to have limited ability to craft a budget to their priorities in the first few weeks, the Obama budget has numerous initiatives and hopeful signs for child welfare advocates. The new budget is based on 2009 spending levels (with stimulus funding increases dealt with separately). Overall there were not dramatic increases in key child welfare programs such as the Child Abuse Prevention Treatment Act (CAPTA) and other key services such as child care, but the new budget does raise child welfare as an important issue and there is one major new initiative, home visiting, that if crafted in a comprehensive fashion can represent a significant investment in prevention services.

The President is proposing a major new home visiting program that is based on successful models states are currently using (see the following article). In addition, the Administration proposes a new $20 million child welfare innovative fund that is designed to support demonstration projects to improve the outcomes for children and families. The new five-year grants would provide dollars to state and local governments and tribes to address both up-front services as well as those that can reduce long-term foster care placements. The Obama budget also eliminates the abstinence-only approach to preventing teen pregnancies, which some research has shown to be ineffective, and instead proposes a new $110 million teen pregnancy prevention fund that would support evidence-based methods and proven programs to reduce teen pregnancy.

While most of the small child welfare programs remain at the same level of funding as in 2009, some items that had been regular components of past budgets have been dropped, including recent budget proposals to cut the social services block grant (SSBG) by half a billion, as well as proposals to create a block grant out of Title IV-E funding. The Administration does call for new staffing at the Department of Health and Human Services, citing specific new initiatives that will require greater attention. The Administration points to the need to oversee the new Fostering Connections to Success Act (110-351), particularly the new tribal Title IV-E expansion, the kinship care option and the extension of foster care to 21. They also highlight the need to provide oversight of the new $20 million child welfare initiative. Language referencing rigorous evaluation and evidence-based research and models can be found in several areas in the President's budget and appears to signal the approach the Obama Administration will emphasize.

Innovation appears to be a key part of the new budget found in several departments. For example, within housing, the President proposes a "Choice Neighborhoods Initiative" that would provide $250 million, which is $130 million over the level appropriated for the HOPE VI program. The budget indicates that the initiative would challenge public, private, and nonprofit partners to extend neighborhood transformation efforts beyond public housing and link housing interventions more closely with school reform and early childhood innovation. It is intended as an effort to alleviate the intense concentration of poverty in inner city neighborhoods. The Administration also proposes a $50 million new Strengthening Communities Fund designed to assist nonprofits in their innovative approaches to addressing social problems, including child abuse and neglect. The fund is actually part of the new national service program. There is an additional and similar initiative in the juvenile justice section of the budget that calls for $25 million to be provided for community based prevention initiatives.

For a breakdown of key child welfare and children's programs view the FY 2010 budget PDF.

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Mandatory Funding for Home Visiting Included in Budget

The President's budget proposes $8.6 billion over 10 years for a new mandatory program that provides funds to states for evidence-based home visitation programs for low-income families. As the budget argues, "When implemented properly, such programs have sizeable effects on child outcomes." The budget states that the policy is expected to save Medicaid $664 million over 10 years, including $189 million in 2019. Under the description provided in the budget, the Administration describes the proposal as a program that will
Provide matching grants to states and territories for home visits to low-income mothers and pregnant women. The initiative will give priority to models that have been rigorously evaluated and shown to have positive effects on critical outcomes for children and families. Grantees must submit a plan describing the program model they will follow, the evidence supporting their effectiveness, how they will ensure fidelity to the proven model, assessing implementation, and the manner in which the program will be operated prior to approval for federal reimbursement.
CWLA has been a part of a home visiting coalition that has sought a broad but effective approach to home visitation, recognizing the different models to target different family and community needs. If successful with this request, the dollars provided would be mandatory and would not require an annual fight for appropriations.

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Spending Plans for Health Reform and Medicaid

As indicated earlier, the President's budget establishes a health reform reserve fund of approximately $600 billion over 10 years. The reserve is funded by new revenue and savings from both Medicare and Medicaid. Building on recent steps to cover more uninsured Americans, Congress renewed the commitment to the Children's Health Insurance Program (CHIP), originally passed in 1997, by reauthorizing the program earlier this year with an additional $44 billion over five years, to cover approximately four million more children, many of whom already qualify for CHIP or Medicaid. CHIP funding is projected to be $10.095 billion in fiscal year 2010, an increase of $1.529 billion from FY 2009. As part of that reauthorization, Congress allocated $200 million for a new Child Enrollment Contingency Fund, which will alleviate future state funding shortfalls experienced as states enroll more and more children in Medicaid and CHIP.

The budget request projects Medicaid mandatory spending to be $289.764 billion for FY 2010, an increase of approximately $27 billion over FY 2009 spending. While the increase is largely due to more beneficiaries eligible for the program, it is important to note that the President's budget proposes to trim $1.5 billion from Medicaid in FY 2010 as a result of increased efficiency and accountability. This is done by reducing prescription drug payments for federal and state governments; increasing access to Medicaid family planning services, which actually saves money; and by improving Medicaid program integrity. Increased access to Medicaid family planning services in the form of a new state option to expand such services to nonpregnant women between the ages of 15 and 44 at or below 200% of the federal poverty level is expected to save money by decreasing the number of unplanned pregnancies. Additional details on mandatory programs will be released later this week.

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Kinship Navigator and Other Fostering Connections Grants Posted

On Monday, May 4, the Department of Health and Human Services (HHS) announced the application process for the Family Connection Discretionary Grants. The grants are the result of the Fostering Connections to Success Act (P.L. 110-351) and provide $15 million annually for state and local grants to fund four different programs: kinship navigator, intensive family-finding, family group decision making, and residential family treatment. At least $5 million of the funds must be allocated to kinship navigator proposals. The proposals are for three years, with the federal government providing 75% of the funding in first and second years, and 50% of the funding in the third year. Most of the proposals are likely to provide at least $450,000 a year, but there is the potential for a grant to be as high as $1 million. With the matching requirements, a project would provide a total of $600,000, with $150,000 from the local match. In year three, $600,000 would include $300,000 in local match. Additional requirements include the need for an evaluation that includes an evidence-based model with specific components or strategies that are based on theory, research, or evaluation data, or the proposal must replicate or test the transferability of successful program models. If the applicant is a private organization, there must be support from the state or local child welfare agency, or describe how services will be coordinated with that agency.

Kinship navigator programs currently exist in several states and localities. They attempt to provide assistance to any kin family (not just those in the child welfare system). They include information and referral services, support groups, and other resources that grandparents and other relatives may need when caring for a relative child. Family finding programs are efforts that use technology or other approaches to locate relatives and other family members for children or youth in the child welfare system. Family group decision making describes a variation of practices and programs that attempt to bring family members and others significant people together to address and provide what is in the best interest of children and youth in the child welfare system. Residential family treatment programs refer to some service programs (often substance abuse treatment programs) that are designed to meet the needs of the parent and the minor child in a safe 24-hour residential setting.

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HHS Seeks to Partially Rescind Medicaid TCM Regulation

Last Wednesday, the Department of Health and Human Services (HHS) published in the Federal Register notice of its plan to partially rescind the harmful Medicaid Targeted Case Management Regulation issued in December 2007 that has been under congressional moratorium since June 2008. The TCM regulation would have threatened access to health care and other needed services for the nation's most vulnerable citizens, including children and youth in the foster care system, and would have shifted significant cost to states and localities in a time of serious economic downturn.

The announcement seeks to rescind the following controversial portions of the TCM regulation: the single case manager requirement; the "integral component" test that would have shifted cost to nonmedical programs such as child welfare and foster care; the unbundling requirement; and the restriction on Medicaid coverage for individuals transitioning to the community. The announcement would restore the status quo and leave in place provisions of the Deficit Reduction Act (DRA, P.L. 109-171) that prohibit foster care from billing Medicaid for the direct delivery of foster care services such as research gathering, assessing adoption placements, recruiting or interviewing potential foster care parents, serving legal papers, home investigations, and making placement arrangements.

CWLA has worked in collaboration with a diverse coalition of child welfare, disability, and mental health organizations at the national, state, and local level on rolling back this harmful regulation, and we thank these partners and our members for their consistent advocacy on this matter!

In the same proposal, HHS seeks to entirely rescind two other controversial Medicaid regulations issued by the Bush Administration: the school-based services and outpatient services rules. HHS is seeking public comment on the rescission; comments are due by June 1, 2009. To view the entire proposal and to learn how to submit your comments in support of the rescission, download the PDF.

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Request for Information on Parity Law

The Departments of Health and Human Services, the Treasury, and Labor, have issued a request for information regarding the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (P.L. 110-343). Signed into law on October 3, 2008, the act requires group health plans with 50 or more enrollees that choose to offer mental health and addiction benefits, to provide those benefits on the same terms as other medical conditions. The law prohibits insurers from setting more restrictive financial requirements or treatment limitations on mental and addiction illnesses, requires any out-of-network benefits to be at parity, and permits stronger state laws to stand. The request asks the public, in advance of parity regulations, for comments on the law's expected economic impact and administrative burdens. To view the entire parity request for information, download the PDF. Public comments are due by May 28, 2009.

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The Path to Juvenile Justice Reform

On Tuesday, May 5th, the W. Haywood Burns Institute, the Center for Children's Law and Policy, the NAACP, and the Campaign for Youth Justice hosted a congressional briefing on African American youth in the juvenile justice system. Panelists discussed the implications of Disproportionate Minority Confinement/Contact and other inequities within the juvenile justice system, as well as policy recommendations for addressing the problem. In addition, panelists detailed the statistics on the youth involved in the system, and one panelist gave his personal account of life behind bars as a juvenile. Representative Bobby Scott (D-VA) explained why simply locking up youth is counterproductive to correcting their behaviors. He also stressed the need for legislative reform and cited his bill, The Youth PROMISE Act, as a start. Representative Yvette Clarke (D-NY) described some of the racial profiling tactics that are being used in her home state. She criticized these practices for the damaging effects they have on minorities and because they criminalize young people.

The Youth PROMISE Act (H.R. 1064) was introduced on February 13, 2009 in the House of Representatives by Congressmen Scott and Michael Castle (R-DE); the Senate equivalent, S. 435, was introduced by Senators Bob Casey (D-PA) and Olympia Snowe (R-ME). The act implements the advice from over 50 crime policymakers, researchers, practitioners analysts, and law enforcement officials from across the political spectrum concerning evidence- and research-based strategies to reduce gang violence and crime. Under the Youth PROMISE Act, communities facing the greatest youth gang and crime challenges will form a local council. This council will include representatives from law enforcement, court services, schools, social service, health and mental health providers, and community-based organizations, including faith-based organizations. The council will develop a comprehensive plan for implementing evidence-based prevention and intervention strategies. These strategies will be targeted at young people who are at-risk of becoming involved, or involved in, gangs or the criminal justice system to redirect them toward productive and law-abiding alternatives. Read more about the Youth PROMISE Act.

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Senator Landrieu Introduces Mentoring Legislation

In recognition of Foster Care Month, Senator Mary Landrieu (D-LA) held a press conference with actress and talk show host Rosie O'Donnell, the Congressional Coalition on Adoption Institute (CCAI), and Representative Joe Crowley (D-NY). At the press conference Senator Landrieu and Representative Crowley unveiled the Foster Care Mentoring Act of 2009. Senator Landrieu said that the legislation could lead to recruiting more prospective parents because it will introduce people to a system that they do not know much about. Representative Crowley echoed that point and also discussed the importance of mentoring, as well as the positive impact that these mentors can have in these children's lives. O'Donnell shared her experience with the foster care system--she's adopted two children from the system--and explained why she advocates on behalf of these children.

The Foster Care Mentoring Act of 2009 proposes to connect children in foster care with responsible caring adults by authorizing $15 million to establish statewide foster care mentoring programs, providing $4 million to begin a national public awareness campaign for mentor recruitment programs and allowing loans up to $20,000 in federal student loan forgiveness for those who volunteer to mentor a child in care. Senator Landrieu is set to introduce the bill in the Senate, and Representative Crowley will be the lead sponsor in the House.

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Key Upcoming Dates for Congress

May 15: Detailed agency financial reports under recovery plan released
May 15: Target date for House to begin passage of 12 appropriations bills
May 20: Competitive grants and contracts under recovery plan available
May 23-31: Memorial Day congressional break
June 27: Target date for House to complete work on appropriations
October 15: Deadline for budget reconciliation instructions


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