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

   
   
Vol. 22, Issue 34: 9/21/2009   
Headlines

CWLA Testifies on Fostering Connections To Success Act

Chairman Releases Senate Finance Mark; Committee to Begin Markup

Finance Mark Includes Home Visiting

HHS Gives $35 Million in Adoption Incentives Funds to 38 States

GAO Releases Report on Prevention and EPSDT

Early Learning Fund Bill Passes House

Key Upcoming Dates for Congress



CWLA Testifies on Fostering Connections To Success Act

On Tuesday, September 15, Linda Spears, CWLA Vice President for Policy and Public Affairs testified before the House Ways and Means Subcommittee on Income Security and Family Support. The subcommittee hearing focused on what action has taken place since the enactment of the Fostering Connections to Success Act of 2008 (PL 110-351). The act was signed into law on October 7, 2008, with several provisions taking effect upon enactment and others phased in over several years. CWLA's testimony provided an overview of the progress and made recommendations for Congress and the new administration that would help facilitate implementation of the law. Spears's comments, like those of other witnesses, stressed two primary factors that have hampered a more rapid implementation of the new law: the state of the economy and the transition to a new administration.

CWLA was joined by child welfare directors from member agencies—Secretary Brenda Donald from Maryland and Director Erwin McEwen of Illinois; Jacqueline Johnson Pata from the National Conference of American Indians; Margaret Anderson, former foster care youth from Wisconsin; and Kathleen McNaught from the American Bar Association. Seven states plus the District of Columbia have amended their state plans to extend Title IV-E to kinship-guardianship placements while several others are considering taking the option. Both Maryland and Illinois indicated they could use more extensive guidance on the kinship provisions as well as other parts of the law. McNaught focused her comments on the education requirements that became effective last year. She noted some progress but called on Congress to extend the new mandate on child welfare agencies to the education community. The new law requires that children remain in their same school when they are placed or be enrolled immediately in a new school if that is in their best interest. Johnson Pata focused on the tribal provisions of the law which are scheduled to take effect on October 1. She outlined the hurdles that tribes face in attempting to run their own Title IV-E programs but also highlighted some of the positive actions that have taken place so far as some tribes consider that option under the law. Margaret "Greta" Anderson captured the attention of members by recounting her experiences and challenges as a child in foster care with several subcommittee members praising her perseverance.

Chairman Jim McDermott (D-WA) indicated that the subcommittee would continue its oversight. There was no representative from the Department of Health and Human Services (HHS) due to the fact that the nominee for the head of the Administration for Children and Families (ACF) Carmen Nazario is still awaiting a final full Senate vote. President Obama nominated Nazario on May 6.

The full subcommittee testimony is available online. CWLA is holding a series of roundtables around the country to better educate CWLA members and others on the provisions of the Fostering Connections to Success act; find more details online.


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Chairman Releases Senate Finance Mark; Committee to Begin Markup

Last Wednesday, September 16, Chairman of the Senate Finance Committee Max Baucus (D-MT) released the long-awaited Chairman's Mark on health reform. The Senate Finance Committee is the final immediate body of jurisdiction to introduce and approve health reform legislation. The three House Committees with jurisdiction over health reform each independently approved the House health reform bill (H.R. 3200) before leaving for August recess. The Senate Health, Education, Labor, and Pensions (HELP) Committee approved its health reform legislation on July 15.

Chairman Baucus's bill, the America's Healthy Future Act of 2009, would cover an estimated 94% of Americans at a total cost projected by the Congressional Budget Office (CBO) of $774 billion over 10 years, which is fully offset and does not add to the federal deficit. While not including an employer mandate, the act would require individuals to purchase health insurance, with a penalty for those who do not. Hardship and religious exemptions would be available to individuals for whom purchasing health insurance is not feasible. Medicaid would be expanded to parents, children, pregnant women, and childless adults under 133% of the federal poverty level beginning in 2014, with the federal government helping states fund the expansion to newly eligible beneficiaries. To help individuals be able to afford coverage, sliding scale subsidies would be available to those between 100% and 300% of federal poverty and premiums would be capped for those between 300% and 400% of federal poverty. Beginning in 2013 when the Children's Health Insurance Program reauthorization phases out, states would be required to provide children between Medicaid eligibility and 250% of the federal poverty level with wraparound services equivalent to the Medicaid early and periodic screening, diagnostic and treatment services under Medicaid. Amendments are expected that would help ensure children get the coverage and comprehensive benefits that they need. State-based exchanges would be created where insurance could be purchased, but unlike the current House version of health reform legislation (H.R. 3200), the Senate Finance Chairman's Mark would not include a public option and instead creates a co-op system.

The Senate Finance Committee is expected to begin its markup process on September 22. Senate Majority Leader Harry Reid (D-NV) has stated publicly that he would like a health reform bill on the Senate floor by September 28, but many hurdles have yet to be passed as opposition and concerns exist on both sides of the aisle. Last week, Senator John D. Rockefeller (D-WV) indicated that he will not support the mark in its present form and none of the three Republicans who have been working and negotiating alongside Baucus for months voiced support when the mark was introduced.

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Finance Mark Includes Home Visiting

There is still a lot of work to be done within the committees that have jurisdiction over health reform, but the release of last week's Senate Finance Mark provided reassurance to many home visiting advocates. The mark outlined a provision that would add a new section under Title V, the Maternal and Child Health Block Grant. The provision would establish a new state grant program for early childhood home visitation. States applying for this grant would be required to conduct a needs assessment to identify communities that are at risk for poor maternal and child health, and those with few quality home visiting programs and resources. States would also be required to demonstrate that they have the capacity to provide appropriate services in the communities where there is need. Eligible programs would have to meet certain outcome related benchmarks, in addition to addressing maternal and child health, including childhood injury prevention, school readiness, juvenile delinquency, family economic factors, and coordination with community resources.

The core components for the home visiting programs require, amongst other things, that in order for programs to be eligible that they adhere to an evidence-based model that has been in existence for at least three years and is linked to the aforementioned program-determined outcomes. The Chairman's Mark permits funding for promising new programs and would appropriate $1.5 billion between FY2010 and FY2014 to carry out the home visiting grants program. Funding is also included for research, evaluation, and technical assistance.

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HHS Gives $35 Million in Adoption Incentives Funds to 38 States

On Monday, September 14, the Department of Health and Human Services (HHS) released $35 million in adoption incentive funds to 38 states. Both numbers reflect a significant increase over the past several years. Generally, less than 20 states have been qualifying for the funds and HHS has given out less than $15 million per year. The awards represent recent changes enacted as part of the Fostering Connections to Success Act (PL 110-351). In announcing the release of the funds Secretary Kathleen Sebelius said, "Adopting a child from foster care is a wonderful way to enrich any family's life. We congratulate the states that performed so well this year and we thank the parents who are providing loving and permanent homes."

The new law made several changes. The incentive fund has always provided awards based on whether a state exceeds their highest number of adoptions over the previous five years. The changes reset that baseline to 2007 so that more states can qualify if they increase the number of adoptions above the 2007 level. Secondly, the law increased the award for both older child adoptions and special needs adoptions. Incentives for an increase in the number of older child adoptions (defined as children 9 and older) is now set at $8,000 per child, and incentives for adoptions of special-needs children under age 9 are set at $4,000, both doubled from the previous law. The new law also creates a $1,000 incentive if a state exceeds its adoption rate. The rate allows states that may have reduced the number of children in foster care and awaiting adoption to receive an award. In the past, some states have continued to place children in adoptions at high rates but because their caseloads have gone down, they have not received an incentive grant. The funds for the states are to be spent on child welfare services and, as a result of the new law, have up to 24 months to spend the funds instead of one year.

"We are pleased with the positive results states have achieved under the new adoption incentive guidelines," said David Hansell, acting assistant secretary for children and families. "Older children with special needs are the hardest to find homes for, but they are especially deserving of the safety and stability of an adoptive family." States receiving funding at this point are Alabama, Alaska, Arizona, Arkansas, California, Connecticut, Florida, Georgia, Hawaii, Idaho, Illinois, Indiana, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, North Carolina, North Dakota, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, West Virginia, and Wyoming. Puerto Rico also qualified for an incentive award.

For more, visit the HHS website.

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GAO Releases Report on Prevention and EPSDT

An August 2009 report from the Government Accountability Office (GAO) stresses the need for more concerted efforts to ensure that Medicaid beneficiaries receive services to which they are entitled. Children under 21 who receive Medicaid are entitled under federal law to periodic screening services (otherwise known as well-child checkups) that include a comprehensive health and developmental history, a comprehensive physical exam, appropriate immunizations, laboratory tests, and health education. This is known as the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit under Medicaid. The Centers for Medicare and Medicaid Services (CMS) has a goal that each state provide EPSDT well-child checkups to at least 80% of Medicaid-eligible children in the state, but GAO found that on average, only 58% of Medicaid children received at least one EPSDT well-child checkup. Some states were as low as 25%, with the high state reaching 79%. An estimated 41% of Medicaid children did not receive a well-child checkup over a two-year period. GAO recommended in its report that EPSDT programs be more regularly reviewed so that improvements can be made and children receive the EPSDT services to which they are entitled.

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Early Learning Fund Bill Passes House

Last week the House of Representatives held two days of debate on the Student Aid and Fiscal Responsibility Act of 2009, H.R. 3221 with final passage on Thursday. The debate started on Wednesday, September 16 and finished with a vote of approval of 253 to 171 on Thursday, September 17. Although the main focus of the bill is reform of the college loan system it includes the important Early Learning Challenge Fund. The bill is sponsored by Representative George Miller (D-CA). Title IV of the legislation includes the Early Learning Challenge Fund, which would provide an early down payment on President Barack Obama's efforts to better coordinate services and support to very young children. The goal is better coordination and greater funding between Head Start, child care, and state pre-K programs. The bill would provide competitive grants to states to coordinate services and standards for and between those early childhood programs. The grants are competitive between the states and coordination is actually required as part of the state application and planning process. The overall goal of the new initiatives is to improve early learning standards across programs, program review and monitoring, comprehensive professional development, support for parents who may use or enroll their children in one or more of the programs and outcomes for children participating in these early learning programs. The legislation also directs the U.S. Department of Health and Human Services (HHS) and the Department of Education to jointly administer the program. The funding is set at $1 billion a year from 2010 through 2019. Funds are raised through the changes to the overall college loan system, with most of the savings of $87 billion redirected to the Pell grant low-income student loan program and community colleges. It also directs $10 billion toward deficit reduction. The bill had passed the House Committee on Education and Labor in mid-July. The Senate has yet to act on its version but committee action is expected soon.

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Key Upcoming Dates for Congress

October 1: Start of federal fiscal year 2010
October 15: Deadline for budget reconciliation instruction
October 30: Target adjournment date for the House of Representatives (Senate TBA)

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