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

   
   
Vol. 23, Issue 19: 6/1/2010   
Headlines

Congress Struggles with FMAP Extension

Hearing on Early Childhood Education Focuses on Expanding Child Care

New Study on Building Strong Families Recommends Better Approach, Access

ARRA Expenditures Report Details Child Welfare Spending

Health Care Reform: Examining High Risk Pools and Medicaid Expansion

Key Upcoming Dates for Congress



Congress Struggles with FMAP Extension

At the end of the week Congress struggled with legislation on the budget, including an extension of the federal medical assistance percentage (FMAP). The legislation, the American Jobs, Closing Tax Loopholes and Preventing Outsourcing Act (H.R. 4213) includes a variety of tax credits, an extension of federal aid for the unemployed, and the FMAP extension. The bill provides much needed assistance to states, but that has not made the price tag of the legislation any easier for members of Congress to accept, let alone vote for. Most concerning for Congress, perhaps, is the fact that the majority of the legislation's cost is not offset with revenue-generating provisions and therefore adds to the overall deficit. The largest of the spending provisions is one that would delay a scheduled 21% decrease in Medicare reimbursement rates for doctors, commonly known as the "doc fix." Leaders in both the House and the Senate have struggled with ways to lower the overall cost of the final bill.

House leadership spent much of last week finding ways to shrink the nearly $200 billion package of extenders and proved to be successful in some aspects. One reduction in cost was attributed largely to the extension of unemployment benefits through the end of November, rather than the end of the year, as originally planned. Congress also struggled to determine how to deal with the costly "doc fix" provision and considered delaying the doctors' pay cut until 2012 instead of 2014.

At press time, the plan was for the House to consider a two-bill package of tax extenders. The first bill will include $39.5 billion for an emergency extension of unemployment benefits through November, and is not offset with other spending cuts or tax increases. The first bill will also include various tax extender provisions and funding for summer jobs programs and that would be paid for with offsets. The total cost of this bill is expected to be around $92.5 billion, with the majority being paid for. Unfortunately the bill doesn't include spending for FMAP, which is expected to be considered separately when the House recess ends on June 7. The second bill was expected to contain $23 billion for a 19-month extension of the doc fix.
At one point last week, Senate leadership suggested keeping the chamber in session throughout the weeklong Memorial Day recess unless they completed action on the extenders bill and the $60 billion war supplemental bill. Late Thursday night, the Senate voted and passed the Supplemental Appropriations Act of 2010, H.R. 4899. That bill now has to go to conference with the House once they return from recess. Since the House is the only chamber likely to make any progress on the extenders package, those bills will also remain at the top of the agenda when Congress returns.

As the weeks pass, the need for action on unemployment insurance, tax credits, and other social service programs grows severe. Unless lawmakers act soon, millions of people could cease to be eligible for up to 99 weeks of jobless benefits, doctors' Medicare payments could fall by 20%, and states may have to face some serious decisions regarding budget cuts, including child welfare programs.

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Hearing on Early Childhood Education Focuses on Expanding Child Care

On May 25, the Senate Committee on Health, Education, Labor and Pensions held its 10th hearing on the Elementary Secondary Education Act (P.L. 89-10). The hearing focused on the early education needs of children and families. Giving opening remarks, Chairman Tom Harkin (D-IA) acknowledged that the current funding mechanisms and programs available for early education need to be reanalyzed. Harkin referenced the book The Unfinished Agenda: A New Vision for Child Development and Education put forward by the Committee for Economic Development in 1990. Senator Christopher Dodd (D-CT) also mentioned this publication during his remarks, and also recognized Helen Blank, director of leadership and public policy at the National Women's Law Center, for her efforts and contributions in expanding child care. He asked her to stand to be acknowledged for her work.

Senator Bernard Sanders (I-VT) was incredibly passionate about the need for early education, and said that every child from birth should have access to quality child care. He went on to say that he understood the poor state of the economy, but that an investment in early education would see an economic return. Child care offered from birth to elementary school prepares children to do better in school, which then leads to better jobs and fewer children in jail or on the streets. Senator Al Franken (D-MN) mentioned that his state has implemented the "Healthy Families" program, launched by Prevent Child Abuse America. In terms of affordability, it is a home visitation program that pays for itself by the reduced number of social workers hired to investigate child abuse cases. Senator Michael Bennett (D-CO) then spoke about how his state funds child care based on parents' income and the quality of the day care center. He maintained it is a sensible approach to using tax revenue to pay for quality day care for at-risk families.

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New Study on Building Strong Families Recommends Better Approach, Access

The U.S. Department of Health and Human Services (HHS) last week released findings from the Building Families Initiative, which provides relationship and marriage education, case management, and referrals to other services. The findings were included in a report assessing the effectiveness of programs designed to help low income, unmarried parents build and sustain healthy relationships. The study measured the living arrangements, relationship status, relationship quality, extent of father involvement, existence of domestic violence, and economic well-being of approximately 5,000 couples who were randomly assigned to either a control group or a group that had access to a Building Strong Families program. This report's findings indicated a need to strengthen approaches for families and provide better access to support services.

Carmen R. Nazario, assistant secretary for children and families at HHS, commented that ''these findings are very timely as Congress considers the more comprehensive Fatherhood, Marriage and Families Innovation Fund, proposed in the President's 2011 budget." She pointed out that the results of the study show that it is possible to positively influence and strengthen families with support programs, but also suggest that the current approach isn't adequate. "Couples often face several compounding challenges. A broader effort will provide the comprehensive support that parents and couples need to succeed in their relationships as well as in their roles as workers, providers, and engaged parents. Such efforts should be tailored to individual circumstances and extend to include effective mental health resources and services to address domestic violence," she said.

For the report on Building Strong Families, mothers and fathers were interviewed about 15 months after they volunteered for the program. The status of these couples and the well-being of their children will be measured again 36 months after they signed up for the program. The longer term results are expected in 2012.

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ARRA Expenditures Report Details Child Welfare Spending

Last week, the Government Accountability Office (GAO) issued a report on the use of funds by states and localities from the American Recovery and Reinvestment Act (ARRA). This legislation, also called the Stimulus Act, was enacted in 2009 with the intention of creating jobs and triggering other economic activity to reverse the recession. The report is the latest in a series of reports on the uses of and accountability for Stimulus Act funds in 16 selected states, certain localities in those jurisdictions, and the District of Columbia.

Included in the bill were many investments to support struggling children and families. Increases in the Federal Medical Assistance Percentage (FMAP) have helped states cover increasing caseloads, which were found to be mainly attributable to children. As of March 31, 2010, the 16 states and the District have drawn down about $12.7 billion in increased FMAP funds for the first two quarters of fiscal year 2010, representing more than 92% of the total grant award available for this time period.

Findings regarding Head Start and Early Head Start were included in the report. More than 90% of dedicated funds for these programs have been awarded to expand capacity, and grantees have begun to drawn down the awards. Investments have resulted in a greater increase in Early Head Start participants served.

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Health Care Reform: Examining High Risk Pools and Medicaid Expansion

Under the new health care law states are required to set up high risk pools designed to provide affordable health insurance coverage to people who are uninsured because of preexisting conditions. As states prepare for the implementation of the high risk program, a recent study found that as few as 200,000 people will be covered (out of the 7 million who may qualify) with the $5 billion Congress has allocated for the program. The Health and Human Services Department continues to assure people that those who are most in need will be covered under this program and that the actual target population may not be as large as anticipated.

The Kaiser Family Foundation's Commission on Medicaid and the Uninsured recently released the report on the expansion of Medicaid under the Patient Protection and Affordable Care Act (PPACA). The report included the results of a state-by-state study of the impact of health care reform's Medicaid expansion on coverage levels and state spending. Findings suggested that across the country, Medicaid expansions will significantly increase coverage and reduce the number of uninsured. In addition, the federal government will carry the majority of the financial responsibility, providing 100% of the total cost of expansion from 2014 to 2016 and phasing out the costs, ultimately reaching 90% in 2020 and subsequent years. Although PPACA extends Medicaid coverage to adults under 65 with incomes at or below 133% of the federal poverty level, there is no way to know how many individuals will actually enroll. Therefore, the report models two scenarios, one which assumes 57% participation among newly eligible individuals, and the other assuming 75% participation, with state-by-state projections available for each scenario.

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Key Upcoming Dates for Congress

May 31-June 4: Memorial Day recess
July 3: Target date for House to pass all 12 appropriations bills
July 4-9: Independence Day break
August 7: Target date for Senate to pass all 12 appropriations bills
August 9-September 10: Summer recess

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