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

   
   
Vol. 18, Issue 25: 7/5/2005   
Headlines

TANF, Child Care Programs Extended

Medicaid Revisions on the Horizon

Senator Smith Seeks Effective Long-Term Medicaid Reform

Senate Bill Seeks to Extend Access to Student Loans for Adoptive Children

Senate HELP Committee Holds Roundtable on Family Leave

DVD Highlights Court Reforms

Correction

Key Upcoming Dates for Congress



TANF, Child Care Programs Extended

Before leaving for its Independence Day break, Congress extended the Temporary Assistance for Needy Families (TANF) and Child Care programs for an additional three months. This is the 10th short-term extension of these programs since their authorizations expired in October 2002. Although many programs continue to operate after their authorizations have expired (for example, Head Start and the Higher Education Act), the TANF and Child Care block grants are mandatory funds not appropriated on an annual basis, so an extension is required.

A temporary delay in this extension resulted as the two key House Committees--Ways and Means and Commerce and Energy--debated which would absorb the cost of extending transitional Medicaid benefits for TANF recipients who leave cash assistance, and the cost of the abstinence education block grant. The Commerce and Energy Committee agreed to accept the cost of the extension of these two programs.

The fate of the two reauthorization bills (H.R. 240/S. 667) remains unclear, as neither the House nor the Senate have voted on final measures. The major difference between the House and Senate versions are the work requirements for TANF recipients and the level of child care funding. The House bill includes the White House recommendations for increased work requirements and nearly freezes the level of funding for child care. There is some thought Congress might include a reauthorization bill as part of a larger budget reconciliation bill later this year.


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Medicaid Revisions on the Horizon

With the Senate Finance Committee instructed to reduce spending levels by $10 billion, all expectations are that these savings will come from the 40-year-old Medicaid entitlement program, which provides health care coverage for 53 million low income people, of whom nearly 50% are younger than 19. Key Senate leaders have sought ways to examine stronger performance outcomes for the nearly $270 billion dollar program. Of this amount, more than $176 billion was allocated in FY 2004.

The Senate Finance Chair Charles Grassley (R-IA) opened a two-day hearing on July 28 by stating, "We are incapable of accurately demonstrating the amount of money lost through fraud, waste, and abuse of Medicaid." Ranking Minority Member Max Baucus (D-MT) pointed out some of the recent increases in Medicaid spending through increased enrollment, rising cost of health care, and health care inflation. Baucus encouraged the Administration to work closely with the states and strongly support state efforts for greater transparency and accountability in the program.

Testifying before the committee were a series of current and former Medicaid officials, who were joined by public advocacy groups representing greater fiscal management of the system. Tim Westmoreland, former Director of the Center for Medicare and Medicaid Services, testified that Medicaid is playing "catch-up work for the whole broken health care system" as it bears the responsibility for filling in the gaps left behind from $100 billion annually from the 7 million people who are dually eligible for Medicare, from $10 billion annually for those on the two-year waiting list to receive Medicare, from the private health insurance market; and as the primary insurer for people with chronic illness or disabilities.

Westmoreland was adamant in recommendations to the committee to "find all the waste, fraud, and abuse [the Senate] can...and then plow those savings back into Medicaid."

Senator Jeff Bingaman (D-NM) noted that the two-year eligibility waiting period for "dual eligiibles" costs Medicaid in excess of $10 billion annually. U.S. Justice Department officials testified to the difficulties in prosecuting medical malpractice by physicians who abuse the Medicaid system, due to lack of appropriate funding streams and an inability to gather concrete evidence. All state and administration officials testified that the 1998 amendments to the False Claims Act had tremendous effect on the ability to prosecute and to provide greater incentive and protection for whistleblowers.

A Government Accountability Office report released at the hearing documents ways that some states have increased federal reimbursements inappropriately, how states use increased federal reimbursements for school-based Medicaid services, and the practice by 34 states of using high-priced consultants to increase their federal reimbursements.

All testimony from the two-day hearing is available online at http://finance.senate.gov/sitepages/hearings.htm.

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Senator Smith Seeks Effective Long-Term Medicaid Reform

One of the biggest fights during the congressional budget resolution battle in April was a proposed $15 billion cut to Medicaid. Senate Finance Chair Charles Grassley (R-IA) pushed for these cuts as part of the greater budget reconciliation package that would drastically slash spending on entitlement programs.

Recognizing that cuts may be made without any long-term plan, Senator Gordon Smith (R-OR) led the charge that decreased the cut to $10 billion and to create a bipartisan Medicaid commission, to be headed by the National Institutes of Health, that would examine the optimal means to ensure coverage and save costs. With the U.S. Department of Health and Human Services not allowing Congressional members to be a part of the voting membership of the commission, Smith opted not to participate and sought to examine Medicaid as chair of the Senate Select Committee on Aging.

On June 28, Smith held the first of a series of hearings detailing the long-term solvency of the program by examining mandatory vs. optional funding strategies in Medicaid. Leading health policy advocates and state officials agreed there is "no such thing as an optional person," as services such as prescription drug coverage, prosthetic devices, durable medical equipment, dental and vision care, and long-term home- and community-based care are all critical services to those who receive them.

Seeking recommendations for reform, witnesses testified that Medicaid needs better, stronger management; a reevaluation of prescription drug costs away from the average wholesale price; and stronger efforts to eliminate the asset transfer model, whereby individuals who normally would not qualify for Medicaid services become eligible after transferring assets to their children.

Congress has until September 23 to pass a reconciliation package. Complete testimony from the hearing is available online.



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Senate Bill Seeks to Extend Access to Student Loans for Adoptive Children

On June 22, Senators Norm Coleman (R-MN) and Mary Landrieu (D-LA) introduced S. 1287, Fostering Adoption to Further Student Achievement. This legislation would amend the Higher Education Act by defining independent student to include any child who is adopted from foster care at age 13 or older.

On introducing the bill, Coleman said it "addresses a major problem in our current adoption system: Right now, if a teenager is adopted, he or she can lose out on some or all college financial aid depending on his or her adopted parents' financial situation; but if the teen stays in the system and 'ages-out' to 18 without being adopted, he or she is probably eligible for all available loans and grants, given their personal financial situation. Kids should not have to make that kind of choice."

The bill would amend the definition for all student loans. Access to post-secondary education is a major challenge for youth who age out of foster care. In addition, some indications are that youth who have an opportunity to find permanent families through adoption could be discouraged from doing so because such a change in status could limit their access to financial assistance. The legislation applies only to those children adopted from foster care. The Higher Education Act is due to be reauthorized in this Congress, perhaps this year, although floor time for nonappropriations bills is running out.



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Senate HELP Committee Holds Roundtable on Family Leave

On June 23, the Senate Health, Education, Labor, and Pensions (HELP) Committee, chaired by Senator Michael Enzi (R-WY), held a roundtable hearing on the Family and Medical Leave Act (FMLA). Enacted in 1993, FMLA allows workers to take up to 12 weeks of unpaid, job-protected leave to care for newborns, newly adopted and foster children, and seriously ill family members, or to recover from their own illnesses. Although FMLA leave is unpaid, beneficiaries are able to retain crucial benefits, such as health insurance.

Although there seemed to be consensus that no changes should be made that would undermine the intentions of FMLA, changes are likely to be regulatory and under the control of the U.S. Department of Labor. Advocates worry that opponents of FMLA may try to roll back provisions so that it covers fewer circumstances and fewer employees. Since it was enacted, 50 million Americans have used family and medical leave; of those, 98% have returned to the same employer afterward. Jody Heymann of the Harvard Center for Society and Health testified that national employer surveys show that 95% of employers found FMLA to have a positive or neutral affect on growth and profit.

Employers expressed concern over the number of abuses taking place, the cost of FMLA, and the need for clear, specific regulatory language and practical enforcement mechanisms. Of particular concern to employers was intermittent leave, which allows employees to take off blocks of time spread over a longer period. Intermittent leave can be more difficult to plan for and more unpredictable, although Debra Ness, President of the Partnership for Women and Families, explained that it allows employees the flexibility to reserve their continuous leave time while undergoing medical treatment. Despite these concerns, however, there was agreement that, overall, the law is working as intended and that abusers are the exception. Enzi indicated more hearings would be held in the near future.


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DVD Highlights Court Reforms

On July 28, the Pew Commission on Children in Foster Care released the new Fostering the Future DVD, illustrating the effects of court-based delays on children and the commission's recommendations for improving courts' abilities to move children quickly out of foster care. At the release, Senators Mike DeWine (R-OH) and Jay Rockefeller (D-WV) announced their intention to introduce legislation in the near future based on the commission's recommendations.

The DVD uses firsthand accounts from children, parents, judges, and others to demonstrate the important role courts play in the lives of children in foster care and the obstacles they often face. Michigan Supreme Court Justice Maura Corrigan acknowledged that although family courts are responsible for making life-altering decisions on whether children will return home or enter foster care, "they are often the last in line in getting the tools and training they need to make decisions that are best for children."

The DVD gives specific examples of individuals' experiences with the legal system, depicting common problems, such as court delays, lack of information, and failure to collaborate among all parties involved. One child in foster care recounts her experience having had 16 placements in just six years, while a judge notes that in some courts, children's attorneys carry caseloads of up to 2,000. The DVD goes on to illustrate how the commission's recommendations may alleviate these challenges.

An audience member and former foster child who aged out of the system applauded the commission for its efforts to improve the courts. The commission hopes that Fostering the Future will be a helpful tool to child advocacy organizations in spreading awareness of the needs of children in foster care and lending practical solutions to improving family courts. The commission is planning a September summit on Justice for Children, where delegations of court justices and officials from all 50 states will gather to create individual state plans for implementing the Pew Commission's recommendations.

For more information on the Pew Commission's recommendations, and to preview and preorder Fostering the Future, visit www.pewfostercare.org.


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Correction

Last week, Children's Monitor reported that the House of Representatives had approved the appropriations for the Departments of Labor, Health and Human Services, and Education on June 23. In fact, the date was June 24. For more information about funding decisions for key children programs, go to www.cwla.org/advocacy/budget.htm.

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Key Upcoming Dates for Congress

July 2-10: July 4 Congressional Recess

July 12: Senate Labor-HHS-Education Appropriations Subcommittee marks up appropriations bill

July 14: Senate Appropriations Committee marks up Labor-HHS-Education appropriations bill

July 30-September 5: Summer Congressional recess

September 16: Deadline for assigned committees to adopt $35 billion in cuts to mandatory programs for budget reconciliation bill

September 23: Deadline for tax-writing committees to adopt tax cuts of $70 billion


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