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

   
   
Vol. 22, Issue 21: 6/1/2009   
Headlines

Congress Returns for Summer Sprint

Examining Appropriations

Congressional Committees to Debate Health Reform

CWLA Submits Comments on Medicaid TCM Regulation

HHS Announces Tribal Consultation on Head Start

HHS Issues Interim Final Rule on Use of TANF Carry-Over Funds

$75 Million Available to States to Expand Health Insurance Coverage

Key Upcoming Dates for Congress



Congress Returns for Summer Sprint

This week, Congress returns for the summer work period, which will be punctuated by the July 4th break, but promises to be one of the most intense stretches of the year. The House plans include, in addition to passing all 12 appropriations bills by the end of July, working on a bill to address global warming. The Senate will focus its attention on the new Supreme Court nominee, Judge Sonia Sotomayor. The Senate will also be working on its version of 12 appropriations bills. In addition, the health care debate (see article below) will be front and center in both the House and Senate. As a part of that debate, Congress may act on a CWLA priority--passage of a major home visiting program. It is also likely that the new administration will start to fill some of the key lower-level positions in various cabinet departments.

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Examining Appropriations

Since appropriations bills are initiated in the House, that body attempts to get all bills out of committee for a final floor vote and debate by the end of July. The Senate will work a little behind that timetable, with a goal of getting approximately half of their bills passed so the differences can be negotiated over the August break. September is generally the time for voting on conference agreements and finishing any other bills. The appropriations bill from the Subcommittee on Labor, Health and Human Services, Education, and Related Agencies has typically been the last to be addressed, although last year House Committee Chairman David Obey (D-WS) put it near the front of the list.

The total budget for 2010 is expected to reach $3.6 trillion and includes more than $1.4 trillion in discretionary funds. This includes spending for domestic programs, with the two biggest portions allocated to the Defense Department and Homeland Security. The Defense Department receives $728 billion, an increase of more than $30 billion from FY 2009. Unlike recent budgets, this figure includes funding for the wars in Afghanistan and Iraq. After discretionary spending, the remainder is made up of entitlements and mandatory spending. Total mandatory spending is expected to reach $2.014 trillion. The largest of these entitlement and mandatory programs are Social Security ($695 billion,) Medicare ($453 billion), and Medicaid ($290 billion). CWLA has put together a detailed analysis of the President's budget, available online.

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Congressional Committees to Debate Health Reform

Both the House and the Senate will be working diligently on crafting comprehensive health reform legislation. The two Senate Committees of jurisdiction, the Finance Committee and the Health, Education, Labor, and Pensions Committee, hope to mark up their respective bills in committee by the end of June. The Senate Finance Committee has held a series of roundtable discussions on improving health care delivery, expanding coverage, and financing health reform, and following these discussions the committee published policy options papers for public comment. These roundtables will inform their ultimate bill. In the House, three committees share jurisdiction over health reform legislation--the Energy and Commerce Committee, the Ways and Means Committee, and the Education and Labor Committee. These committees have been collaborating to some extent and their chairmen, along with House Democratic leaders, have pledged to have a vote on the House floor on health care legislation before the August recess. Many groups, including CWLA, are advocating for the Medicaid program to be significantly strengthened as part of health care reform.

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CWLA Submits Comments on Medicaid TCM Regulation

Today, June 1, was the deadline to submit comments in support of the Department of Health and Human Services (HHS) proposal to largely rescind the restrictive Medicaid Targeted Case Management (TCM) regulation. The TCM regulation would have threatened access to health care and other needed services for our most vulnerable citizens, including children and youth in America's foster care system, and would have shifted significant cost to states and localities in a time of serious economic downturn.

HHS's proposed rescission was published in the Federal Register on May 6. CWLA submitted written comments to HHS in support of the partial rescission, particularly pointing out the original regulation's problematic cost shift to child welfare and foster care, its single case manager requirement, and its requirement to unbundle Medicaid TCM services. On top of the new restrictions, CWLA President and CEO Christine James-Brown pointed out the human impact of the interim final regulation. "Most importantly, the regulation as written threatened the continuance of TCM services for several needy populations, including children and youth with physical and/or mental health issues that are involved with our nation's child welfare and foster care systems," she said. "Some of our most vulnerable children's needs are already not being met and were the [rule]...to have been implemented, the already dire situation would have gotten worse." James-Brown also signaled CWLA's support for rescission of two other controversial Medicaid regulations issued by the Bush Administration: the school-based services and outpatient services rules.

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

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HHS Announces Tribal Consultation on Head Start

On May 28, HHS published a notice of three consultation meetings on tribal Head Start programs. The meetings will be in Denver, Colorado on July 7; in Kansas City, Missouri on July 21; and in Mystic Lake, Minnesota on July 23. The goal is to have a discussion on better ways to meet the needs of Indian children and families with the Head Start program. The consultation meetings are the result of the recent reauthorization of the Head Start program, the Improving Head Start for School Readiness Act of 2007 (P.L. 110-134). The gathering will include HHS, the Administration for Children and Families, the Office of Head Start and the leaders of tribal governments operating Head Start and Early Head Start programs. More information is available online.

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HHS Issues Interim Final Rule on Use of TANF Carry-Over Funds

On May 27, HHS issued an interim final rule on the use of "carry-over" Temporary Assistance for Needy Families (TANF) funds. As a result of changes included in the American Recovery and Reinvestment Act of 2009 (ARRA; P.L. 111-5), states can use federal TANF funds reserved from a previous federal fiscal year for a broad range of TANF services and do not have to spend it on cash assistance. States receive an entitlement of $16.5 billion annually in federal TANF funds. States have the option of not spending all the federal dollars and can hold them in reserve at the federal level for future TANF-related expenses. Current regulations required that funds that had been carried over only be used to cover the cost of cash assistance. In the initial years of TANF at the turn of this century, states had held several billion dollars in reserve but in the last five years, few states have had that ability. TANF funds not only provide cash assistance payments to families that qualify, but they can also be used for additional child care, some child welfare services, programs to subsidize employment, and other targeted services. Depending on how the calculation is determined, in 2007 alone, approximately 40% of available TANF funds were spent on cash assistance with nearly 60% spent on other categories or held in reserve. The original regulation, written shortly after TANF's creation, required reserved funds to be used only for cash assistance as a way to assure that a portion of federal funds would continue to be spent on basic assistance to poor families. Comments on the Interim Final Rule are due by July 27, 2009. More information is available online.

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$75 Million Available to States to Expand Health Insurance Coverage

On May 20, HHS announced that $75 million worth of grants will be made available to states to expand health insurance access to the uninsured. The funding was authorized as part of the Omnibus Appropriations Act (P.L. 111-8) signed by President Obama on March 11. Two types of grants exist. Target grants between $2 million and $4 million will be awarded to states with plans to target specific groups of uninsured Americans, such as children, seniors, or small business employees. Comprehensive grants between $7 million and $10 million will be awarded to states for extensive insurance coverage initiatives. The grants will be made over a five-year period and require a 20% match, unless a state is able to demonstrate financial hardship. States must also demonstrate their ability to sustain the program after federal funding has expired and applications must have support of the state's governor. The application deadline is June 15. More information can be found online.

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Key Upcoming Dates for Congress

June 27: Target date for House to complete work on appropriations
June27-July 5: Fourth of July congressional break
August 1-September 7: House summer break
August 8-September 7: Senate summer break
October 15: Deadline for budget reconciliation instructions


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