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

   
   
Vol. 22, Issue 25: 6/29/2009   
Headlines

Tri-Committee Discussion Draft Includes Home Visiting Legislation

Samuels Chosen as ACYF Commissioner

Committees Work on Health Reform, with October Target

Addressing Disproportionality and Disparities in Child Welfare

$6 Billion of CHIP Funds Released

Appropriations Update

CWLA Posts White House Conference Survey on Prevention

Letter Clarifies Medicaid, CHIP Provisions of Recovery Package

Key Upcoming Dates for Congress



Tri-Committee Discussion Draft Includes Home Visiting Legislation

The three House committees with jurisdiction over health policy--Energy and Commerce, Ways and Means, and Education and Labor--unveiled draft legislation last week that included two home visiting elements. The chairmen of these committees have been working for months to develop a joint proposal that reflects President Barack Obama's health reform principles. The language that was included in the draft is very similar to the Early Support for Families Act, HR 2667, which was introduced a few weeks ago by Representatives Jim McDermott (D-WA), Danny Davis (D-IL), and Todd Platts (R-PA). The new language strengthens the provisions around outcomes, assurances, and evaluation that were included in HR 2667. The main difference was in the proposed funding levels, which is more than likely a result of the chairmen trying to find cost savings in some areas. In addition, the Medicaid and Child Health Insurance Program (CHIP) Prevention section includes a provision for the optional coverage of nurse home visitation services, which also calls for an enhanced federal medical assistance percentage (FMAP) to cover the cost of these services.

CWLA will continue to follow the discussions on health reform, as we anticipate that the Senate Finance Committee mark will contain a home visitation element as well.

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Samuels Chosen as ACYF Commissioner

President Obama announced last week that he has selected Bryan Samuels as Commissioner of the Department of Health and Human Services Administration on Children, Youth and Families (ACYF). ACYF is part of the Administration for Children and Families and is divided into two bureaus--the Children's Bureau and the Family and Youth Bureau. ACYF administers the major federal programs supporting social services that promote the positive growth and development of children and youth and their families; protective services and shelter for children and youth in at-risk situations; and adoption for children with special needs.

A Chicago native, Samuels was Director of Illinois's Department of Children and Family Services, a CWLA member agency, where he focused on achieving permanency for children and youth and supporting the child welfare workforce. Since 2006, Samuels has held various positions for Chicago Public Schools including chief of staff to then-head of Chicago Public Schools and now-U.S. Education Secretary Arne Duncan. Having a long career of public service before either affiliation, Samuels served under Illinois Governor James Thompson on human service issues and also served as Deputy Director of Health and Human Services in Nebraska.

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Committees Work on Health Reform, with October Target

Each of the three House committees with jurisdiction over health reform held at least one hearing last week on the tri-committee bill to overhaul our nation's health care system. The House bill, which was released the previous week, would create an insurance market exchange where individuals and small businesses could shop for a policy. The exchange would include a public health insurance option. Medicaid would be expanded to cover all individuals at up to 133% of the federal poverty level (FPL), and individuals and families up to 400% of the FPL would be given sliding scale subsidies to purchase health insurance. Employers, with some exceptions for small employers, would be required to provide coverage or contribute to an insurance fund. Home visiting language is also included in the House proposal, as discussed above.

Last week, the HELP Committee continued marking up its health reform legislation. The panel managed to complete work on the prevention and wellness sections of its bill and began to walk through sections that would improve the health care workforce. Meanwhile, the Senate Finance Committee largely met behind closed doors last week. Still working in a bipartisan fashion, Finance Chairman Max Baucus (D-MT) was not prepared to give a definite date for release of his mark or draft legislation. This means that the Finance Committee will not start marking up legislation until after Congress returns from the July 4 recess.

All committees are still operating on the timeline to have a health reform bill on President Obama's desk in mid-October for signature. Many details remain to be resolved, but how to finance the package and whether it will include a public health insurance option remain two of the largest spots of contention. A public plan would be a government-run or government-overseen plan that individuals could buy into as an alternative to private insurance. Opponents worry that a government plan would have too much of an advantage in the market and could hurt the private insurance sector. Proponents got support with the recent release of a New York Times/CBS poll finding that over 70% of Americans are in favor of the creation of a public plan.

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Addressing Disproportionality and Disparities in Child Welfare

On Tuesday, June 23, the Alliance for Racial Equity in Child Welfare hosted a congressional briefing on racial disproportionality and disparities in the child welfare system. The mission of the Alliance is to address the institutional polices, patterns, and practices that contribute to racial disparities, including those that stem from the legacy of structural racism in this country. The panel included Carol Spigner, Antonia Ybarra, Joyce James, and Representative Eric Pettigrew. Dr. Spigner directs the social policy program at the University of Pennsylvania School of Social Policy and Practice. She has vast experience in child welfare, including time as the Associate Commissioner at the Children's Bureau. Ybarra shared her struggle with the Iowa child welfare system when trying to obtain custody of two her granddaughters. James is the Deputy Commissioner at the Texas Department of Family and Protective Services, a CWLA member agency, where she leads efforts to resolve disproportionality. Pettigrew serves in the Washington State House of Representatives where he chairs the House Health and Human Services Appropriations Committee.

While the statistics regarding disproportionality and disparities in the child welfare system are alarming, unfortunately they do not represent a new phenomenon. In 2007, the Government Accountability Office reported that factors contributing to racial disproportionality included poverty, access to services, cultural bias, and distrust. The panel examined how the federal policies of the past and present have led to minority children making up the majority of child welfare case loads. In addition, they talked about how systemic change can be achieved at all levels of the system, and many of the panelists shared some of the great work that is taking place in their home states. There were recommendations proposed for ways to address and hopefully combat racial disparities and disproportionality within the system. Specific recommendations included the need to fund demonstration projects that address the issue by using discretionary funding from the Child Welfare Research and Development Funds under Title IV-B, IV-E, and CAPTA; the need to conduct an annual report from HHS on racial equity in child welfare performance; and modifying the Federal Child and Family Services Review (CFSR) to assess racial disparities in outcomes for children and youth in the child welfare system.

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$6 Billion of CHIP Funds Released

On June 19, HHS Secretary Kathleen Sebelius announced the release of $6 billion to states for their Children's Health Insurance Programs (CHIP). CHIPs exist in every state and provide health coverage to millions of children whose families earn too much to qualify for Medicaid and those who are either not offered or cannot afford private coverage. The reauthorization of CHIP was signed into law by President Obama earlier this year as P.L. 111-3. The reauthorization maintains coverage for over seven million children and contains funding to expand CHIP or Medicaid coverage to four million more children. The reauthorization guarantees dental benefits and mental health parity, offers states the option to implement express lane eligibility, has grants for outreach and enrollment, and establishes a child health quality initiative.

The $6 billion, available through the recent reauthorization, will be released in two pieces--the first $1 billion has been dispensed to states and the remaining $5 billion should be released by the end of September. An estimate of how much each state will receive is available online.

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Appropriations Update

It will be a very busy schedule for Senate and House Appropriations Committee members when they return from the July 4 break. Currently, the House appropriators have voted on 9 of the 12 appropriations bills and moved three of those bills to a floor debate. The three remaining to be voted out of a subcommittee or committee are Labor-HHS, Defense, and Transportation. The Commerce-Justice, Homeland Security, and Legislative Branch funding bills have been sent over to the Senate. The Senate has also been clearing bills through the committee but, following procedure, is behind the House in the annual process.

Leadership still hopes to pass all 12 appropriations bills by October 1, the start of the fiscal year. If they stick to that timetable, it will be the first time since October 1996 (FY 1997) that all the appropriations bills were passed and signed by the President by the start of a new fiscal year. The House schedule for appropriations calls for all 12 bills to be out of the House by the end of July. The Labor-HHS bill is scheduled to be taken up for consideration in the subcommittee on July 8, with full committee consideration on July 14, and debate on the House floor between July 22 and July 24. Download CWLA's analysis of President Obama's proposed FY 2010 budget.

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CWLA Posts White House Conference Survey on Prevention

Last fall, CWLA posted a brief poll on our website asking what the White House Conference on Children and Youth should focus on. In the poll, individuals were asked to select three top issues. Prevention of child abuse and neglect was ranked by 16% of respondents as the number one priority--coming in ahead of other critical areas such as strengthening child protective services (14%) and youth transitioning out of foster care (11%). As a result and to continue the process, CWLA is going to use these survey findings to gather more information on each of the critical issues. We are asking you to take a new three-minute survey focused on prevention. Take the prevention survey and tell us what prevention services exist in your community. Are there waiting lists? How would you describe prevention?

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Letter Clarifies Medicaid, CHIP Provisions of Recovery Package

The Centers for Medicare and Medicaid Services (CMS) has issued a letter to state Medicaid directors with further explanation of the Medicaid and CHIP provisions contained in the economy recovery package signed into law in late January. The recovery package included a 6.2% increase for all state-run Medicaid programs, which applied retroactively from October 1, 2008 and lasts until December 31, 2010. The law also extended certain moratoria on Medicaid regulations, which have since been largely rescinded by the new Administration. This letter supplements guidance released in late March on requirements for drawing down the recovery package's Medicaid funds. The new letter encourages questions be sent to CMSOARRAQuestions@cms.hhs.gov and states that the agency will continuously post responses on their website.

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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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