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

   
   
Vol. 22, Issue 23: 6/15/2009   
Headlines

Key Committee Hearing on Home Visiting

Health Reform Progressing: More Details, Some Legislative Language

Senator Stabenow Reintroduces Bill for Medicaid Rehab and TCM Services

Appropriations Update: New Allocations Released

Key Upcoming Dates for Congress



Key Committee Hearing on Home Visiting

On Tuesday, June 9, the House Ways and Means Subcommittee on Income Security and Family Support held a hearing on proposals to provide federal funding for early childhood home visitation programs. The focus was largely placed on how to produce the best practical, cost-effective home visiting programs. Chairman Jim McDermott (D-WA) began the hearing by bringing attention to the startling fact that less than 15% of families in need of home visitation actually receive services. He also indicated the possibility of the legislation, the Early Support for Families Act, HR 2667, moving as part of health care reform.

The hearing included many expert witnesses. The first witness, Joan Sharp, Executive Director of the Council for Children and Families of Washington in Seattle, echoed the appropriateness of thinking about home visiting in the context of health care reform, as there are many negative health outcomes for children who are victims of child abuse and neglect. Dr. Jeanne Brooks-Gunn, a developmental psychologist, centered her testimony on the outcomes that should be associated with any form of intervention, strategies for enhancing the lives of children and their families, the factors that determine the effectiveness of a given program, and how to best invest in home visiting. Cheryl D'Aprix, a Family Support Worker with the Starting Together Program in Canastota, New York, described her experience with home visiting as both a participant and a home visitor, and expressed the life changing possibilities of home visiting. Finally, Sharon Sprinkle, a Nurse Consultant with the Nurse Family Partnership (NFP) shared her success with the NFP model and asked that Congress look closely at this program as a way to improve the lives of low-income, vulnerable families. For a complete copy of the testimonies from the hearing, visit the Ways and Means Committee website.

A number of themes dominated the hearing, including the cost for this new initiative and how to meet it, as well as determining how to reach the most vulnerable families, finding approaches for including fathers, and understanding that no one program will reach all families because different families have different needs. CWLA has endorsed HR 2667 and will continue to work with Congress to refine and to pass this initiative.

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Health Reform Progressing: More Details, Some Legislative Language

Last week, the Senate HELP Committee and the three House Committees with jurisdiction over health reform released more specifics about their respective legislation to overhaul our nation's health care system. The Senate HELP Committee's details came in the form of a more than 600-page bill entitled the Affordable Health Choices Act, while the House released a simple 3-page document containing key features of the tri-committee health reform draft proposal.

Both the Senate HELP and House tri-committee plans would require individuals to have health insurance and place responsibility on employers as well, expand the Medicaid program, and create a "public plan" in some shape or fashion. The public plan option, which has been the subject of much debate, would provide a public government plan that individuals could buy into as an alternative to private insurance options. Opponents are concerned that a government plan would have too much of an advantage in the market and could hurt the private insurance sector.

Legislative language is expected from the three House Committees shortly. The Senate HELP Committee hopes to start marking up its bill this week. The Senate Finance Committee, which earlier this year held a series of roundtables to inform its health care reform legislation, also continues its diligent work and will be moving forward to mark up in the near future. Large questions remain, particularly regarding the public plan and how health reform will be paid for, but all involved committees are working tirelessly to try and get legislation voted on by the House and Senate before Congress's August recess.

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Senator Stabenow Reintroduces Bill for Medicaid Rehab and TCM Services

Last Tuesday, Senator Debbie A. Stabenow (D-MI) re-introduced the Medicaid Services Restoration Act (S. 1217) that would protect vital Rehabilitative and Targeted Case Management (TCM) services for vulnerable populations, including children in the child welfare and foster care systems. Stabenow first introduced the legislation in the 110th Congress in response to a series of extremely restrictive Medicaid regulations. Even though some of the regulations are in the process of being rescinded, the legislation is necessary to clearly define the TCM options and to provide a transparent funding stream for therapeutic foster care (TFC), an evidence-informed and highly effective placement for children and youth with serious medical, psychological, emotional, and social needs.

The Medicaid Rehab Services option reduces physical and mental disabilities that many children in care experience and restores them to optimal functioning levels through the delivery of clinical treatment services. At least 38 states employ the Medicaid TCM option to ensure children in foster care receive a comprehensive approach and greater coordination of care. S. 1217 would help protect the rehab and TCM options for vulnerable populations by enabling the child welfare and foster care systems to continue draw down Medicaid dollars for important clinical treatment and/or case management as appropriate; permitting states to use reasonable and efficient payment methodologies for Medicaid rehab and TCM services; and allowing the use of multiple case managers when necessary.

A critical and forward-moving piece of S. 1217 is its creation of a medical assistance option for therapeutic (or treatment) foster care. TFC provides services in a least-restrictive, community-based environment for children with severe mental and behavioral health needs. While states often rely currently on a patchwork of funding for TFC, under the legislation, they would have the option to specifically draw down Medicaid funds for TFC services, thus using a streamlined, transparent system of reimbursement. Read a summary of the legislation on CWLA's advocacy page.

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Appropriations Update: New Allocations Released

The appropriations process for FY 2010 began to pick up speed last week first with updated subcommittee allocations and then with several more subcommittees in the House passing their bills. The allocations, referred to as "302 (b)" allocations, determines how much of the more than $1 trillion in discretionary spending will be divided between 12 subcommittees. Overall Congress will spend approximately $9 billion less than the President had requested in his budget for FY 2010. The House also released a schedule for appropriations calling for all 12 bills to be out of the House by the end of July. The schedule for the Labor-HHS bill is for it to be taken up for consideration by the subcommittee on July 8, by the full committee on July 14, and presented for debate on the House floor from July 22 through July 24. Congressional leadership is attempting to avoid an omnibus bill this year. Such bills have been used in recent years to wrap unfinished appropriation into one large measure. The omnibus bills also tend to pass after the start of the federal fiscal year on October 1. If the House keeps to its posted schedule, 7 of the 12 appropriations bills should have been passed by their subcommittees by the end of this week. For a full budget analysis, visit Back to Headlines

Key Upcoming Dates for Congress

June 27-July 5: Congressional break
July 8: Target date for House subcommittees to pass Labor-HHS appropriations
July 15: Target date for House committee to pass Labor-HHS appropriations
July 22-24: Target date for House to debate and pass Labor-HHS appropriations
August 1-September 7: House summer break
August 8-September 7: Senate summer break
October 15: Deadline for budget reconciliation instruction

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