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

   
   
Vol. 22, Issue 43: 11/23/2009   
Headlines

Senate Health Reform Bill Released; Debate Expected to Begin

Medicaid Rehab Rule Withdrawn

Congressional Baby Caucus Event

CWLA's 2010 National Conference Program Available Online

Key Upcoming Dates for Congress



Senate Health Reform Bill Released; Debate Expected to Begin

Late last Wednesday night, Senate Democratic leadership revealed its merged comprehensive health reform bill, the Patient Protection and Affordable Care Act. The release came after receiving a long-awaited cost estimate and accompanying figures from the Congressional Budget Office (CBO). CBO estimates that the bill--which will reduce the number of uninsured eligible individuals by 31 million--will cost $849 billion over ten years and would reduce the deficit by $127 billion over 10 years. That price tag is well below President Barack Obama's cap of $900 billion.

Effective January 1, 2014, the bill would expand the Medicaid program to cover all individuals below 133% of the federal poverty level, with the federal government wholly paying for newly eligible individuals from 2014 to 2016. A health insurance exchange will be created for individuals and small businesses to purchase health insurance, with tax credits available for individuals up to 400% of the federal poverty level to help make coverage affordable. The Senate bill would create a public option (a government-run health plan to compete with private insurers), but would permit states to opt out of participating. The Senate bill is less stringent on employers than the House bill, only requiring employers with 50 or more full-time employees to pay $750 per employee who receive federal subsidies to purchase health coverage through the exchange.

Home visiting support is included in the Senate bill. Unfortunately, the therapeutic foster care provision included in the House health reform bill (H.R. 3962) and in the Senate Finance Committee bill was dropped, but efforts are being made to re-insert it. The merged Senate bill does include several provisions that would help vulnerable children and youth though, including providing Medicaid coverage for youth formerly in foster care for six months or longer who are not otherwise eligible for Medicaid up to the age of 25. This provision would take effect January 1, 2019.

The issue now becomes whether the Senate has the 60 votes necessary to begin debate on the bill and to ultimately pass it. At least three fairly moderate Democrats have raised serious questions and issues of contention with the bill. At press time, the Senate was expected to vote on the motion to proceed with the bill this past Saturday, which would begin the actual debate on the bill.

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Medicaid Rehab Rule Withdrawn

Today, official notice will be published in the Federal Register that the Centers for Medicare and Medicaid Services (CMS) is withdrawing the Medicaid Rehabilitative Services rule that was first proposed on August 13, 2007 (CMS 2261-P/72 Fed. Reg. 45201). CWLA, working in close collaboration with the remainder of the child welfare, mental health, and disability advocacy communities, was at the forefront of advocating that the Rehab rule be delayed. CWLA participated in briefings on Capitol Hill and CWLA member agency Intermountain in Helena, Montana testified at a November 2007 U.S. House of Representatives hearing regarding its concerns over the rule.

Over a span of two years, due to the controversial nature of the rule, Congress placed the Medicaid Rehab regulation under two separate Congressional moratoria, first through the Medicare, Medicaid, and SCHIP Extension Act of 2007 (P.L. 110-173) and in the Supplemental Appropriations Act, 2008 (P.L. 110-252). Earlier this year, as part of the economic recovery legislation, Congress enacted a "Sense of the Congress" that the Secretary should not issue the Rehab rule in final form (P.L. 111-5).

Medicaid Rehabilitative Services help fund community-based services that work to reduce physical and mental disabilities of children in care and get them on a healthy trajectory. The proposed regulation would have significantly limited access to these vital services by taking away federal Medicaid dollars for rehabilitative services deemed "intrinsic to" other programs, including child welfare and foster care. For example, federal Medicaid dollars would have no longer been available for rehab services provided in therapeutic foster care settings unless they were medically necessary, clearly distinct from packaged therapeutic foster care services, and offered by a qualified provider. CWLA sees this as an important victory and thanks our close national partners, our state and local member agencies who advocated for the moratorium and rescission, and our champions on Capitol Hill.

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Congressional Baby Caucus Event

On November 18, 2009, Representatives Denny Rehberg (R-MT) and Rosa DeLauro (D-CT), co-chairs of the Congressional Baby Caucus, hosted a briefing to discuss comprehensive and coordinated systems for health care, education, and family support services for young children. They were joined by U.S. Department of Health and Human Services Secretary Kathleen Sebelius; Ruth Friedman from the House Committee on Education and Labor staff; Billie Warford, former Director of the Montana Early Childhood Project at Montana State University; Barbara Gebhard from Zero to Three; and Janice Gruendel, who recently served as the Senior Advisor on Children and Youth for Governor Jodi Rell of Connecticut.

DeLauro opened the event with comments on the importance of early investment in programs like child care that have positive outcomes for children. She also cautioned against social services cuts that disproportionately affect young children. Secretary Sebelius highlighted the importance of collaboration at the federal, state, and local levels as a tool to dealing with the challenges families with young children face. She pointed to the role of Joan Lombardi, Deputy Assistant Secretary, who serves as a liaison between HHS and the Department of Education, as an example of such collaboration. Both Sebelius and Friedman mentioned the efforts of Congress and the Obama Administration to really engage in some innovative work around the Early Learning Challenge Fund. Warford advised against a one-size-fits-all approach to early childhood, pointing out that different communities face different challenges and have varying needs. She also spoke specifically to some of the unique needs of families in rural America as it pertains to social services in general.

The challenges that lie ahead are political, economical, and cultural, but all of the panelists brought great expertise to the table and shared many ideas that hopefully will serve as an asset to those charged with creating, implementing, or evaluating the early childhood initiatives.

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CWLA's 2010 National Conference Program Available Online

The registration program for CWLA's national conference, Children 2010: Leading a New Era, is now available online. The program gives details about the conference, which this year features more than 120 child and family experts reporting on timely and important topics like adoption, foster care, technology, executive leadership, early childhood and mental health, juvenile justice, and residential services. The national conference is a month earlier this year--January 24-27, 2009--so it is important to register soon! Early-bird rates are still available online (http://www.cwla.org/conferences/conferences.htm).

Advocacy Day will be held in the middle of the national conference, on Tuesday, January 26. CWLA's Advocacy Day (http://www.cwla.org/advocacyday/) is the largest national advocacy event of the year for child welfare advocates and CWLA encourages all conference attendees to go to Capitol Hill and carry the message for the children, youth, and families you serve.

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Key Upcoming Dates for Congress

November 25: Thanksgiving break
December 11: Hanukkah begins
December 18: Second continuing resolution expires
December 25: Christmas Day

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