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

   
   
Vol. 22, Issue 29: 8/3/2009   
Headlines

House Finishes FY 2010 Appropriations On Deadline

Health Reform to Wait Until After Recess

Therapeutic Foster Care Amendment Added to House Health Reform Bill

Rhode Island Approved for Kinship-Guardianship Option, More Pending

Webinar Explores Fostering Connections Act's Impact on Older Youth

Study Reaffirms Mental Health Needs for Transitioning Youth

CWLA Continues Survey on Prevention

Key Upcoming Dates for Congress



House Finishes FY 2010 Appropriations On Deadline

Before leaving for the August break, the House of Representatives completed action on the last of the 12 appropriations bills when they approved the Defense appropriations. The Senate has one more week before they break until Labor Day and they are likely to approve all twelve bills out of committee and approve at least four bills by the full Senate. So far, Congress appears to be on track to complete action on appropriations by the start of the federal fiscal year on October 1.

The House approved H.R. 3293, the appropriations bill for the Departments of Labor, Health and Human Services, and Education (Labor-HHS), on Friday, July 24 by a vote of 264 to 153. The spending totals in the bill are close to what the Administration had requested. Overall, the bill spends $160 billion in discretionary dollars, an increase of $5.6 billion from this year's funding level. The bill also provides $567 billion in mandatory funding, most of which applies to HHS and represents mandatory funding for Medicare and Medicaid. Part of the mandatory funding is for entitlements under Title IV-E foster care, adoptions assistance, and subsidized guardianships. Title IV-E is expected to total $7.2 billion, an increase of $146 million from 2009. According to budget projections, $4.6 billion will be spent on foster care including administrative costs, $2.4 billion will be spent on adoption assistance along with administration costs, and $49 million will be spent on the new subsidized guardianship program (kinship care). Adoption assistance is the fastest growing of the three, and the guardianship program is still in its start-up phase. All the cost projections for the Title IV-E programs are just projections since claims could increase or decrease according to need and the number of eligible children.

The House Labor-HHS bill also funds Head Start at $7.2 billion, an increase of $120 million, while child care remains at the 2009 level of $2.1 billion in discretionary funding. Child care receives an allocation of $2.9 billion in mandatory funds for a total of slightly more than $5 billion. Both Head Start and child care received $2 billion each as part of the stimulus package enacted earlier this year, and that is not included in these totals.

The Senate was also moving on the Labor-HHS bill with the full Appropriations Committee voting out its bill by the end of last week. There will be some differences in spending levels and priorities when the Senate completes action on their bill and writes the final committee report.

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Health Reform to Wait Until After Recess

As Congress begins to leave for its month-long August recess, it became clear last week that neither the full Senate nor the full House will vote on comprehensive health reform legislation before returning in September. Lawmakers do not seem particularly rattled by the slipping timeline, and vow to continue significant work and movement on health reform in the fall.

The House bill that was produced by the three committees with jurisdiction over health reform, the America's Affordable Health Choices Act (H.R. 3200), was introduced on July 14 and has since been voted out by the Ways and Means Committee and the Education and Labor Committee. H.R. 3200 would place shared responsibility on individuals, employers, and the government to ensure that the vast majority of Americans have health coverage. Exceptions to the requirement would be available for individuals facing hardship and the smallest businesses, with other small businesses able to get a tax credit. Effective in 2013, Medicaid would be expanded by the House bill to cover all individuals falling below 133% of the federal poverty level ($14,400 for an individual). To cover more of the uninsured and provide choice, an insurance exchange would be created whereby individuals and small businesses could purchase coverage, with the option to buy a public plan. Certain benefits would be mandatory--including preventive services, rehabilitative and habilitative services, mental health and substance abuse services--and, for children, vision, hearing, and oral health services.

The third committee to approve the House bill, the Energy and Commerce Committee, postponed markup for the majority of last week to hold behind the scenes meetings between committee leadership and members of the fiscally conservative Blue Dog Coalition. A deal was reached Wednesday afternoon and the committee resumed consideration of H.R. 3200. The deal slashes the total price tag of the bill by decreasing subsidies to low-income families and exempting additional small businesses from the employer mandate to provide coverage, among other changes. During markup, Representative Tammy Baldwin (D-WI) offered an amendment that was accepted on therapeutic foster care (see article below).

Meanwhile, a bipartisan group of six senators from the Finance Committee continued discussions to finalize the committee's health reform package. The committee was leaning towards not including a public option, as both the Senate HELP and House tri-committee reform bills have. Also different is that the Senate Finance reform plan will not include an employer mandate in the form of penalties, but rather will offer incentives for employers to provide coverage to their employees. The Finance Committee negotiators had not yet come to consensus on how to finance its package, but a possibility gaining traction is to tax high-end insurance policies totaling over $25,000. Late last week, the Finance Committee received a preliminary score from the Congressional Budget Office (CBO) indicating that their plan would cover nearly 95% of Americans at a cost of less than $900 billion over 10 years, all of which is fully offset.

The Finance Committee reform package, once voted out of committee, will have to be merged with the Senate Health, Education, Labor and Pensions (HELP) Committee bill, which the HELP Committee passed on July 15. Lawmakers are hoping that this reconciliation would be possible over the August recess.

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Therapeutic Foster Care Amendment Added to House Health Reform Bill

On Thursday, July 30, when the House Energy and Commerce Committee resumed markup of its health reform legislation, H.R. 3200, Representative Tammy Baldwin (D-WI) offered an amendment that was accepted by voice vote on therapeutic foster care. Therapeutic Foster Care (TFC) provides intensive, individualized services in a community-based environment for children with severe mental and behavioral health needs. It is an evidence-informed placement that has produced positive outcomes including improved social skills and psychological adjustment, reduced behavioral problems, and placement stability. The U.S. Surgeon General's 1999 report on mental health recommended TFC as a promising, effective intervention for children with serious emotional disorders.

Baldwin's amendment provides a basic definition of TFC and protects reimbursement for TFC by stating that nothing in the Medicaid statute prohibits Medicaid for paying for the treatment contained in TFC. CWLA worked in strong partnership with organizations such as the Foster Family-based Treatment Association, the Alliance for Children & Families, the Bazelon Center for Mental Health Law, and the National Council for Community Behavioral Healthcare and thanks Baldwin for her strong support of vulnerable children and youth and TFC programs.

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Rhode Island Approved for Kinship-Guardianship Option, More Pending

The Children's Bureau has approved Rhode Island's amended state plan that will allow that state to utilize Title IV-E funds for the new kinship-guardianship option as provided for through last year's Fostering Connections Act (P.L. 110-351). Seven other plan amendments have been submitted. In addition to Rhode Island, the others that have submitted a plan amendment are the District of Columbia and the states of Connecticut, Maine, Missouri, Oregon, Pennsylvania, and Tennessee. Connecticut is the most recent plan amendment submitted. More states are expected to take the option.

The kinship-guardianship option became effective shortly after Fostering Connections was signed last October, but there is no timeframe or deadline for states to take the option. While some were expecting states to act more quickly, it has been less than one year since enactment of Fostering Connections, and that enactment coincided with the recession. Factors that may inhibit states include some states requiring legislative changes, other states contemplating dramatic cuts in human service funding, and other states awaiting greater instruction and clarification from HHS on issues such as whether or not children already in kinship placements and otherwise eligible being covered once a state has taken the option or whether coverage extends only to new kinship arrangements established after a state plan has been amended.

A state has to first submit an amended plan and then it must be approved. There are a number of actions states must take to use Title IV-E funds for the kinship placements including: outlining how they will assure the child and the relative's eligibility, meeting new case plan requirements, and meeting background check requirements. There are also major budget considerations for states depending on how they currently fund kinship care or if they even have a kinship placement option in place.

The official calculation by the CBO anticipated savings from the kinship care option due to expected shifts in reduced administrative costs. Such results may vary by state circumstance. Some states have used all federal Temporary Assistance for Needy Families (TANF) funds to pay for kinship placements. In those instances, since TANF is an entitlement of federal funds that a state receives annually at the same fixed level, a state may have to spend state general fund dollars to match the new kinship option. Kinship care is an important permanency option and the goal of advocacy groups including CWLA is that eventually all 50 states will take the Title IV-E kinship-guardianship option.

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Webinar Explores Fostering Connections Act's Impact on Older Youth

The National Foster Care Coalition, in conjunction with the National Court-Appointed State Advocate Association, is hosting a webinar on the Fostering Connections Act provisions impacting older youth. This is a free, one-hour webinar review of the provisions for older youth, and an opportunity to discuss strategies to support and effectively advocate for older youth. Much of the discussion will be based on a new report on the frequently asked questions on these provisions, available through the link below.

The webinar will be held on August 5 at noon Eastern (11 am Central, 10 am Mountain, 9 am Pacific) and will be held again on August 19 at 4 pm Eastern (3 pm Central, 2 pm Mountain, 1 pm Pacific).

Register for the August 5 session.

Register for the August 19 session.

Download the FAQ Report.

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Study Reaffirms Mental Health Needs for Transitioning Youth

A study funded by the U.S. Department of Health and Human Services that will be published in Children and Youth Services Review found that 45% of youth with prior involvement with the child welfare system had at least one mental health problem as they transitioned to adulthood. The study sampled over 5,000 children from 92 child welfare agencies across the country. More than a quarter of the youth were in the clinical range for depression.

The study also examined the youths' surrounding life circumstances, finding that at least 60% lived in households at or below the national poverty line and over a quarter were living with at least one child. The study's authors call for researchers, policymakers, clinicians, and service system administrators to acknowledge these extreme needs and work better with this vulnerable population.

One piece of legislation that Congress is working on to address this is the Healthy Transition Act, H.R. 2691. The bipartisan bill, reintroduced by Representatives Pete Stark (D-CA), Mary Bono Mack (R-CA), and Dave Camp (R-MI), was first introduced in the 110th Congress in conjunction with a Government Accountability Office report finding that in 2006, at least 2.4 million young adults aged 18 to 26 experienced a serious mental illness.

To help this population access needed services and make a successful transition to adulthood, the bill would provide planning and implementation grants to states to develop statewide coordination plans to help adolescents and young adults with serious mental illness. States would be urged to target specific populations, including but not limited to those involved with the child protection and juvenile justice systems. The legislation would establish a federal committee to coordinate service programs helping young adults with mental illness, and provide technical assistance to states. A Senate companion bill has not yet been reintroduced. CWLA strongly supports this legislation, along with our friends at the Bazelon Center for Mental Health Law, the American Psychological Association, First Focus, and Mental Health America.

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CWLA Continues 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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Key Upcoming Dates for Congress

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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