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

   
   
Vol. 18, Issue 32: 8/22/2005   
Headlines

Urban Institute Documents Medicaid Use by Foster Children

CWLA Endorses Child Welfare Reform Bill

Davis Introduces Child Welfare Bills with CWLA Support

Paul Wellstone Mental Health Equitable Treatment Act Reintroduced

Bipartisan, Bicameral Home Visiting Bill Now in House

House Extends Access to Student Loans for Adopted Children

Key Decisions On Reconciliation Likely Soon

Take Action On Reconciliation

Key Upcoming Dates for Congres



Urban Institute Documents Medicaid Use by Foster Children

The Urban Institute is expected to release a report, Medicaid Spending on Foster Children, on August 22 that highlights the importance of Medicaid to the child welfare system. Largely overlooked when analyzing child welfare financing, many fail to recognize that $3.8 billion in Medicaid spending went directly for services to the child welfare population in 2001. These Medicaid dollars are used where Title IV-E Foster Care and Adoption Assistance leaves off, namely in the area of mental health services for the children that have been removed from their home as a result of abuse or neglect.

Research reveals that up to 80% of children in the child welfare system experience some from of emotional or behavioral disorder that requires mental health services. Using fiscal year 2001 data from the Medicaid Statistical Information System, this new data shows that more than 869,000 youth in foster care received services through Medicaid beyond the shelter, food, and clothing supported through Title IV-E. The report also includes a state-by-state breakdown of Medicaid spending and the number of foster children enrolled in the health program.

Detailed in the report are the types of services used with the child welfare community that Medicaid reimburses: rehabilitative services (13.1%), inpatient psychiatric (11%), inpatient hospital (9.4%), clinical services (8.7%), medication (7.7%), and targeted case management (TCM, 7.1%). Also included are "other" services, at 16.7% of all Medicaid child welfare spending, which feature such options as eyeglasses, prosthetic devices, and other community-based waiver services.

Focusing TCM, nearly one-fifth of all children in foster care benefit from these direct specialized services, even though only 38 states report using TCM for the foster care population. The benefits of TCM are clear, as recipients have greater access to physicians, prescription drugs, dental care, and rehabilitative services than those children who do not receive TCM.

As of writing, the report is set for release from the Urban Institute on August 22. To access the complete report, visit the Urban Institute's website at www.urban.org.

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CWLA Endorses Child Welfare Reform Bill

On July 28, Representative Jim McDermott (D-WA), Ranking Democratic Member of the House Ways and Means Subcommittee on Human Resources, introduced the Leave No Abused or Neglected Child Behind Act, H.R. 3576. The legislation would expand Title IV-E maintenance funding to services, extend funding to kinship placements, untie or delink eligibility from the 1996 Aid to Families with Dependent Children (AFDC) program, and offer expanded opportunities to states to address the workforce issue. CWLA has endorsed the bill.

The legislation eliminates the current Title IV-E financial eligibility link to the 1996 AFDC income standards by reducing the Federal Medical Assistance Percentage (FMAP) matching rate for Title IV-E foster care assistance. At the same time, coverage would be expanded to all children in foster care--not just the approximately 50% of cases that are now income-eligible. States that would lose funding due to this change in formula would be "held harmless," meaning their federal funding for foster care and adoption assistance would not be reduced.

The bill would also expand Title IV-E eligibility to all special-needs adoptions, instead of limiting adoption subsidies based on the current 1996 AFDC eligibility. Additionally, states would have the option of using Title IV-E funding for kinship placements. Today, states can use Title IV-E funding for kinship placements only if they receive a time-limited waver of current IV-E law.

One of the more significant proposed changes in the bill is the creation of a Child and Family Services Program that would allow Title IV-E funding to be used to provide services to reduce out-of-home placements, reduce the length of stay in foster care, and improve the well-being of children in foster care, adoption, and kinship placements. To qualify to use Title IV-E funds in this way, states would have to submit plans with service and outcome goals and also provide information about how they would measure the success of these outcomes.

The bill would authorize $100 million a year in matching funds for five years for states to improve the quality of their child welfare workforce. States could use these matching grants to improve wages, increase the number of child welfare workers, reduce turnover and vacancy rates in child welfare agencies, increase education and training of child welfare workers, attract and retain qualified candidates, and coordinate services with other agencies. An applying state would have to submit a plan on advancing and improving its child welfare workforce. The bill would also amend Title IV-E training funds so they could be used for private agencies contracted by the state. This has not been allowed under current law. The workforce part of the bill is similar to legislation introduced by Representative Pete Stark (D-CA), one of the cosponsors of this bill.

Finally, the bill would allow tribal nations direct access to Title IV-E funds. Under current law, tribes can only access these funds through a state agreement. Frequently, this lack of access results in tribal children being denied access to such funding. A more detailed analysis of this bill will be posted on CWLA's website soon.

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Davis Introduces Child Welfare Bills with CWLA Support

In the closing days of the summer session of Congress, Representative Danny Davis (D-IL) introduced four bills that address child welfare issues on a number of fronts.

The Guardianship Assistance Promotion and Kinship Act, H.R. 3380, would expand the use of Title IV-E funding to kinship and guardianship placements. Similar to Senate bill S. 985, it would also provide some limited state grants to create a "navigator" system for all kin families who may be in need of basic information or support groups as they take care of their grandchildren and other relatives. The bill would also expand the use of Chafee Independent Living funds and educational vouchers to children who exit foster care to guardianships or adoption after age 14. The current age is 16.

The Stronger Families Act, H.R. 3379, seeks to expand the current adoption incentive bonus to other permanent placements. Modeled after recommendations by last year's Pew Commission on Children in Foster Care, states could earn incentive payments as they increase their guardianship placements and reunification rates, as well as adoptions. Under the bill, placement would have to meet specific timetables to guard against rewarding placements that turn out not to be permanent.

The Accountability in Foster Care Act, H.R. 3470, calls for the creation of an advisory panel under the U.S. Department of Health and Human Services to revise and monitor changes to the Adoption Foster Care Analysis Reporting System (AFCARS). In addition to making recommendations to revise AFCARS, the bill would require implementation of the National Youth in Transition Database, and integrating this database with the AFCARS system. The National Youth in Transition Database was authorized in 2000 but has not been implemented. This database is designed to collect a wealth of information on foster youth as they transition out of foster care.

Finally, Davis introduced the Strengthening the Chafee Foster Care Independence Program Act, H.R. 3471. This bill would assist youth aging out of care by providing them information about and access to services that could help them make the difficult transition to adulthood. Under this bill, states would have the option of using Chafee funds for independent-living services and educational vouchers for children who exit foster care to adoption or guardianship after age 14.

CWLA has endorsed this package of bills. If they become part of a child welfare reform effort, CWLA will work with the sponsors, key members of Congress, and key committees to make sure the legislation accomplishes its goals. The Davis bills, along with legislation introduced by Representative McDermott, represent a growing interest in child welfare legislation in the 109th Congress. Such interest may increase the opportunities for a more expansive review of the child welfare system and a more comprehensive reform. Much of this may depend on whether changes to child welfare are enacted as part of the September budget reconciliation legislation.

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Paul Wellstone Mental Health Equitable Treatment Act Reintroduced

The Paul Wellstone Mental Health Equitable Treatment Act has been reintroduced as H.R. 1402 by Representatives Patrick Kennedy (D-1-RI) and Jim Ramstad (R-3-MN). With one difference, this bill is identical to the parity bill from 2003, which gained 249 cosponsors in the House.

The difference in the new legislation is that it no longer specifically excludes substance abuse services from parity protection. This was changed as a result of new data showing that parity in the Federal Employee Health Benefit Program has had minimal cost. Members of Congress and their staffs are among the 8.5 million federal employees, retirees, and dependents who have had parity for both mental health and substance abuse disorders since January 2001. The Wellstone Mental Health Equitable Treatment Act was modeled on that federal employee benefit.

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Bipartisan, Bicameral Home Visiting Bill Now in House

Representative Danny Davis (D-IL) also used the closing days of July to weigh in on prevention services. On July 29, he introduced, along with Representatives Tom Osborne (R-NE) and Todd Platts (R-PA), the Education Begins at Home Act, H.R. 3628. This bipartisan legislation is modeled after legislation by Senator Christopher Bond (R-MO) introduced earlier this year, S. 503. Both bills would establish funding for home visiting programs, providing $400 million over three years in state grants to fund or expand access to quality home visitation programs.

Many have hailed these programs as effective ways to improve the well-being of children and prevent future problems of abuse or neglect. Programs vary in approach, with some using nurses to make visits to young or new parents, and programs may also target different families. A number of these programs currently exist--Parents as Teachers (PAT), the Home Instruction for Parents of Preschool Youngsters (HIPPY), and several others.

The legislation seeks to strengthen the Early Head Start program through linkage between various early childhood education and visitation programs, and to assist in staff training. The bill introduced by Bond does specifically refer to the PAT program, although it does not restrict funding to that program. The House bill does not specify any one home visiting program. CWLA endorsed the Bond bill when he first introduced in the 108th Congress, and has also endorsed the House bill.

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House Extends Access to Student Loans for Adopted Children

The reauthorization of the Higher Education Act (H.R. 609), approved July 22 by the House Education and the Workforce Committee, includes an amendment offered by Representatives Charles Boustany (R-LA) and William Jefferson (D-LA) to extend access to federal financial aid eligibility for older children who are adopted from foster care. The amendment promotes teenage adoptions by changing federal financial aid eligibility rules for older children who are adopted out of foster care.

Specifically, the amendment would expand the current definition of independent student to include foster children who are adopted out of the system after their 13th birthday. When the adopted children apply for federal financial aid, they would not be penalized because eligibility would be determined by the adopted student's ability to pay, not the ability of his or her parents to do so.

Currently, if a teenager is adopted from foster care, he or she could lose out on some or all college financial aid depending on his or her adopted parents' financial situation. If a child remains in foster care, however, he or she is eligible for financial assistance.

The Senate has yet to take any action on the reauthorization of the Higher Education Act.

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Key Decisions On Reconciliation Likely Soon

Congress passed an FY 2006 budget resolution earlier this year that requires Congress to prepare reconciliation legislation by September 16, 2005. The FY 2006 budget resolution specifically calls on Congress to reduce federal spending on entitlement programs by $35 billion over five years. For details on specific changes and cuts that could directly effect child welfare funding and services, see the Children's Monitor of August 8 and August 15 at www.cwla.org/advocacy/monitoronline.asp.

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Take Action On Reconciliation

August is a good time to contact members of Congress to let them know that budget reconciliation decisions should not reduce federal supports for abused and neglected children. Many members of Congress conduct town meetings during this time. Information about local congressional activity can be found by contacting your Senators' or Representative's local district offices, or from the member of Congress' website. These are great opportunities to make your views known.

All members of Congress will have an opportunity to vote on the final budget reconciliation legislation. Members of the Senate Finance Committee and the House Ways and Means Committee are especially key, since those committee members are assembling recommendations that will affect child welfare. Members of the Senate Finance Committee are listed at http://finance.senate.gov/sitepages/committee.htm, and members of the House Ways and Means Committee at http://waysandmeans.house.gov. In the House, the Energy and Commerce committee will make decisions on Medicaid changes and cuts. Members of Energy and Commerce Committee are listed at http://energycommerce.house.gov

You can also contact www.cwla.org/advocacy for more information.

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Key Upcoming Dates for Congres

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

October 1: Start of federal fiscal year


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