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

   
   
Vol. 22, Issue 38: 10/19/2009   
Headlines

Samuels Makes it Through Finance Committee

Senate Finance Approves Health Reform Bill

Parity Regulations Delayed until January 2010

Pamela Hyde Nominated as SAMHSA Administrator

Congress Likely to Stay Deep into December, Appropriations Delayed

Key Upcoming Dates for Congress



Samuels Makes it Through Finance Committee

On Thursday, October 15, the Senate Finance Committee held a hearing to confirm Bryan Samuels for Commissioner of Children, Youth, and Families (ACYF) in the Department of Health and Human Services (HHS). Samuels was formerly the director of the Illinois Department of Children and Family Services. He was one of three appointees considered by the committee, the others were Jim Esquea for Assistant Secretary for Legislation of HHS and Ellen Murray for Assistant Secretary for Resources and Technology at HHS. In their comments and questions to Samuels both Chairman Max Baucus (D-MT) and Ranking Member Charles Grassley (R-IA) emphasized their desire to see the new Assistant Secretary focus on implementation of the Fostering Connections to Success Act (PL 110-351). Baucus recounted his experience in mentoring a foster child and how a good program in Montana made a significant difference for that child. Grassley had several concerns about the new law and Temporary Assistance for Needy Families (TANF). He wants to see Fostering Connections effectively implemented, and expressed interest in seeing states take two options in particular, the kinship/guardianship option and the option to extend foster care to 21.

Samuels outlined his top three priorities. His first priority is implementation of the Fostering Connections to Success Act and he spoke specifically about making improvements in education outcomes, which are addressed in the new law. His second priority is to address the impact that exposure to violence and trauma can have on children. He argued that without dealing effectively with the impact, such exposure can have a serious negative long lasting impact on children. His third priority is to prevent child abuse and neglect. He indicated that he felt much could be done by integrating better practices and efforts into programs that already exist.

During the question and answer phase of the nomination hearing, Baucus asked Samuels how he might address implementation of Fostering Connections' tribal provisions that allow tribal governments to draw down Title IV-E funds directly. Samuels indicated that during his two years of working in Nebraska, his opportunity to visit reservations in that state had a lasting impression on him. Samuels went on to say that the best way to implement the new tribal provisions is to require a partnership between HHS and the tribal community, in addition to a lot of work and technical assistance to assist some tribes that may not have some of the necessary economic resources. Grassley also raised the issue of TANF reauthorization and the growth in child-only placements, expressing concern that some children may be moved into TANF child-only placements as a way to avoid foster care or kinship care and as a result, they would not get the support services they need. Samuels deferred on the issue and said he would like to examine it more closely. Samuels did say however that you have to examine the population and determine how many children might be in TANF due to child welfare issues or poverty issues. He also said you must set or determine what your outcomes or desired goals are. In response to that, Grassley said his goal was permanence and a lasting family for the children in care.

In a closing question, Grassley asked Samuels about his ideas on child welfare finance reform. Grassley described the current structure in need of an overhaul with eligibility tied to AFDC, with much of the funding going toward foster care, and not providing needed services and treatments such as substance abuse treatment. Samuels indicated that what was needed were more resources, but that that was unlikely to occur. He deferred but said he would like to look at the block grant option, noting that each state was different and in some states, each county might be different, and therefore flexibility would be needed to address needs based on what the states outcomes might be.

It is unclear when Samuels will be cleared by the full Senate. When and if Samuels is approved, he will take over an ACYF department with two bureaus--the Children's Bureau and the Family & 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.

President Barack Obama announced his selection of the Chicago native in June. Samuels was director of Illinois's Department of Children & Family Services 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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Senate Finance Approves Health Reform Bill

Last Tuesday, the Senate Finance Committee passed its health reform bill by a vote of 14-9. The most eye-catching vote in committee was that of Olympia J. Snowe (R-ME), the only Republican thus far to cross party lines and cast a vote in favor of health reform. Snowe did make it clear, however, that her vote supported the committee bill only and made no promises as to whether she would support the final package. The committee had marked up legislation for several days, considered about 150 amendments, and even delayed final vote for a week at the behest of Snowe's desire to have more time. The other Senate body with immediate jurisdiction over health reform--the Senate Health, Education, Labor, and Pensions (HELP) Committee--had passed its health reform bill before the August recess. Formal negotiations led by Senate Majority Leader Harry Reid (D-NV) will now take place to merge the Senate Finance bill with the Senate HELP bill.

Many differences exist between the two bills, including the presence or absence of a public option and an employer mandate to provide health insurance. Many hypothesize that the final deal will more closely resemble the Senate Finance bill, as it is the more moderate of the two and the Senate's goal is to achieve 60 votes to pass the package. Leaders are hoping to bring the final health reform bill to the Senate floor next week. The House is also working behind the scenes to merge versions of its health reform bill, H.R. 3200, that passed out of the three committees of jurisdiction--Energy and Commerce, Ways and Means, and Education and Labor. The House bill would then be taken to the House floor for a vote.

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Parity Regulations Delayed until January 2010

Secretary of Health and Human Services Kathleen Sebelius has sent a letter to lawmakers informing them that while the agencies of jurisdiction are working diligently, regulations on the new mental health and addiction parity law will likely not be issued until January 2010. The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (P.L. 110-343) was signed into law on October 3, 2008 and requires group health plans with 50 or more enrollees that choose to offer mental health and addiction benefits, to provide those benefits on the same terms as other medical conditions. The law prohibits insurers from setting more restrictive financial requirements or treatment limitations on mental and addiction illnesses, requires any out-of-network benefits to be at parity, and permits stronger state laws to stand.

Sebelius's letter responds to inquiries from Capitol Hill led by Senator Al Franken (D-MN) and Representative Patrick Kennedy (D-RI), since the parity regulations by law were supposed to be promulgated by October 3, 2009--a year after the law's enactment. The delay is likely a result of the continued transition brought about by the new Administration and also because the three departments--HHS, the Department of Labor, and the Department of the Treasury--first have to work through over 400 comments received by the public in response to an earlier request for information. In the meantime, the American Psychological Association Practice Organization has released very helpful initial guidance for employers affected by enactment of the parity law.

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Pamela Hyde Nominated as SAMHSA Administrator

President Obama has nominated Pamela Hyde to be the Administrator of the Substance Abuse and Mental Health Services Administration (SAMHSA). As administrator of SAMHSA, Hyde would oversee the Center for Mental Health Services, the Center for Substance Abuse Prevention, and the Center for Substance Abuse Treatment. Hyde has 30 years of experience managing and consulting health and human service public systems, including most recently serving as Secretary of the New Mexico Human Services Department. Hyde also brings a wealth of knowledge from having been Director of the Ohio Department of Mental Health, the Ohio Department of Human Services, and the Seattle Department of Housing and Human Services. She has also consulted for or been involved with the John D. and Catherine T. MacArthur Foundation, the American College of Mental Health Administration, and the President's New Freedom Commission on Mental Health.

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Congress Likely to Stay Deep into December, Appropriations Delayed

House leadership has indicated the possibility that Congress may remain in session deep into December to finish this year's work. House Majority Leader Steny Hoyer (D-MD) made the comments last week when discussing the long list of issues Congress is facing. Health care reform is of course at the forefront and is expected to take significant time this month on both the House and Senate floors. In addition to that top issue, Congress continues to work on two other priorities: global warming and financial regulation. Against that backdrop, Congress and the Senate in particular continues to struggle with appropriations. Last week, the Senate was attempting to overcome a filibuster of the Commerce, State, and Justice Appropriations. Three of the 12 annual bills are finished and on their way to or already signed by the President, with four more appropriations bills still awaiting debate: individual bills which fund the Departments of Defense, the Interior, and Transportation, as well as a bill which combines the budget for the Departments of Labor, Health and Human Services, and Education (Labor-HHS). For the first time there was also discussion of the possibility of combining some bills into an omnibus spending bill, although the goal still remains to pass each of them separately.

In regard to the Senate and House versions of the Labor-HHS bill, there are not large differences in funding. Overall, the Labor-HHS bills spend between $160 and $163 billion in discretionary dollars. The bills also provide $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 (which are the same in both bills) for the Title IV-E programs are just projections, since claims could increase or decrease according to need and the number of eligible children.

Both bills fund 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 (the amounts are not included in these totals).

Both Labor-HHS bills also agree to President Obama's request to create two new innovations. The 2010 budget will include a new $20 million in competitive grants for programs that can reduce long term foster care placements. Additionally both bills include $10 million in start-up application funds to create Promise Neighborhoods. These Promise Neighborhoods are modeled after the Harlem Children's Zone. The Children's Zone is a comprehensive school-based program. It seeks to improve a child's educational achievement by targeting children at an early age. It provides not just education support and services but also community-based services for the family and provides these services starting from pregnancy through preschool.

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Key Upcoming Dates for Congress

October 30: Target adjournment date for the House of Representatives (Senate TBA)
November 11: Veterans Day
December 11: Hanukkah Begins
December 25: Christmas Day

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