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

   
   
Vol. 24, Issue 5: 2/14/2011   
Headlines

A Message from CEO Christine James-Brown on Budget Campaign

HHS Issues RFP on Evidence-Based Home Visiting Models

Ensuring the Stability of Medicaid and CHIP

GAO Examines Health Coverage Status for Parents and Children

SNAP Reports Increase in Food Assistance

Key Upcoming Dates for Congress



A Message from CEO Christine James-Brown on Budget Campaign

Over the next few weeks the U.S. Congress will be deciding whether or not to slash federal support for poor children and families, despite the fact that the child poverty rate is now at a 50-year high. This is one fight CWLA does not intend to miss out on. I am writing to let you know that we will be launching and leading a budget campaign in the coming weeks to organize our membership in unified opposition to the harmful cuts that some in Congress are pushing. We need all of you to join us in this campaign. Your participation is essential in ensuring that CWLA remains an effective member leadership organization and in safeguarding our nation's vulnerable children and families.

The House will be starting the process this week by bringing to the floor a continuing resolution (CR) that cuts more than $100 billion in domestic funding from President Obama's budget. Programs dedicated to child and maternal health, substance abuse and mental health services, family planning, poverty prevention, juvenile justice, and food assistance for low-income women, infants, and children are all singled out under this bill for major cuts. Even worse, a series of amendments throughout the week will be voted on in the House that could cut funding deeper and imperil the effectiveness of the social safety net even further. After the House has passed its final product, it will be debated and likely amended in the Senate where another series of important votes will be held.

I believe the outcome of this process could very well prove to be a defining event. The final budget that emerges will set the tone and the substantive framework for all subsequent battles on the nation's spending priorities. If we sit idly by and allow critical programs to be cut, they will eventually be gutted. That is why I am asking all of you who care deeply about the safety, permanence, and well-being of children to join us in this fight.

We will be kicking off this campaign with an important webinar for CWLA members on Friday, February 18 at 3 p.m. Eastern. It is critical that all CWLA members, CEO's and policy staff participate in this event. Following the webinar, we will be holding a series of weekly calls where our government affairs team will provide updates on the latest developments with regard to the budget battle while explaining how to get involved.

Again, this is the opening salvo in a budget dispute that might last much of the next two years, and we believe it is essential that we join together now and speak out. Congress must not leave poor children out in the cold! Thank you for your support and commitment to this effort.

CWLA members are invited to register for this webinar.

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HHS Issues RFP on Evidence-Based Home Visiting Models

The long-anticipated grant guidance on evidence-based home visiting models was released by HHS on February 8. This document, a Supplemental Information Request (SIR), was issued in regards to the Affordable Care Act Maternal, Infant, and Early Childhood Home Visiting Program. Last summer CWLA and other interested groups submitted comments that helped inform this SIR.

States submitted applications for home visiting funding in July, followed by state needs assessment in September. The SIR offers guidance for the last step, submission of an Updated State Plan for a State Home Visiting Program. The SIR covers components required to be included in the plan as well as supporting resources for its completion. The plan is due within 90 days of the SIR release. Topical and technical assistance webinars will soon be announced to assist in completing the state plans.

State plans are required for distribution base funding through FY 2015. Competitive funds, which will start to be awarded in FY 2011, will be based on the state's "capacity and commitment to improve child outcomes specified in the statute through improvements in service coordination and the implementation of home visiting programs with fidelity to high-quality, evidence-based models." Criteria for competitive funds will be forthcoming. The amount of competitive funding will depend on FY 2011 appropriations.

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Ensuring the Stability of Medicaid and CHIP

Despite the economy over the last few years, statistics indicate that Medicaid and CHIP (Children's Health Insurance Program) coverage for low-income children and families has held steady for most while increasing for others. One large factor in the stability of coverage is the maintenance of effort (MOE) requirement under the Affordable Care Ace (ACA) that prohibits states from adopting more restrictive eligibility rules or enrollment procedures. In particular, states are required to keep coverage stable for adults in Medicaid until January 1, 2014 and for children in Medicaid and CHIP until September 30, 2019. States that cover adults above 133% of the federal poverty level can reduce eligibility for these adults prior to January 1, 2014 if they have a budget deficit.

Recently, a number of states have asked Congress to repeal the stability protections so that they can cut back coverage and save their budgets. The Georgetown Center for Children and Families released a fact sheet on the consequences of repealing the ACA. The fact sheet points out that if the federal government rescinds the stability provisions under the law that states could eliminate Medicaid for anyone who is covered at state option, including many vulnerable children and families. In addition, states would be allowed to drastically reduce eligibility and even terminate their programs completely. If the MOE provisions are rescinded states could add barriers to the application and renewal process that discourage people from enrolling. This would significantly undermine the work of the administration, which has been aggressively funding initiatives that would increase enrollment in the CHIP program.

Over the last decade, CHIP and Medicaid have driven the uninsured rate of children down to the lowest level on record. Any cuts, rescissions, or waivers could drastically alter the landscape of children's coverage.

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GAO Examines Health Coverage Status for Parents and Children

While Medicaid and CHIP have been important sources of health insurance for low income individuals, particularly children, federal policies providing health insurance through these programs have focused largely on children, but not necessarily their parents. However, the enactment of the ACA includes provisions to expand health insurance coverage to an estimated 32 million individuals, many of whom are parents. New insurance options for parents raise a question about whether providing health insurance to parents benefits their children. The Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) asked the Government Accountability Office (GAO) to assess among other things: the extent a parent's health insurance status is associated with a child's health insurance status and how selected states' parent coverage under Medicaid and CHIP may change given upcoming expansions.

The GAO found that children were more likely to have insurance if their parents had insurance and were more likely to be uninsured if their parents were uninsured. Specifically, GAO found a strong association between a parent's health insurance status, defined as privately insured, publicly insured, or uninsured, and a child's health insurance status (with the vast majority of children in the sample having the same health insurance status as their parents). The most common insurance combination—about 69% of the sample—was privately insured parents with privately insured children, while 10% of the sample consisted of publicly insured parents with publicly insured children. Uninsured parents with uninsured children made up about 5% of the sample.

The GAO report also included an intensive literature review which contained data suggesting that children in states that offered CHIP-funded insurance to parents were approximately 10% more likely to enroll in CHIP. Another article found that the availability of family insurance in a state's CHIP program was associated with a 7-percentage point increase in the likelihood that eligible children would enroll in the program. A third article found that states that had expanded Medicaid coverage to parents beyond federal minimum requirements had higher Medicaid participation among children.

As Medicaid coverage continues to expand under the ACA, it will be important to see if children's coverage continues to increase as parental coverage is expanded more broadly. The GAO findings provide reason to believe that providing health insurance to parents may have an unintended benefit for their children.

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SNAP Reports Increase in Food Assistance

One out of every seven Americans, half of them children, received food assistance each month in 2010. This means the year had 40.3 million participants, more than ever in the Supplemental Nutrition Assistant Program (SNAP) history. USDA's recent release of average monthly participation in 2010 revealed participation is up 67% from 2007 when there was a consistent average of around 26 million participants throughout the middle years of the decade.

The sharp increase coincides with the recession, revealing a strong countercyclical response to the increasing vulnerability of people who are newly eligible and accessing the program. The American Recovery and Reinvestment Act included a temporary increase in SNAP benefits through the end of September 2013. For a family of four, that benefit equals an additional $80 in food assistance each month.

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Key Upcoming Dates for Congress

- February 14: President releases proposed budget for fiscal year 2012.
- February 18: CWLA members-only webinar on the budget.
- March 4: Continuing resolution on FY 2011 expires.
- March 29: CWLA Advocacy Day during the National Conference.


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