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

   
   
Vol. 18, Issue 41: 10/24/2005   
Headlines

Outpouring of Opposition Forces Congress to Delay Votes to Deepen Budget Cuts

House Tries to Include TANF in Budget Reconciliation

Senate to Consider FY 2006 Annual Spending Bill for HHS

House Passes Bill to Protect World Orphans Affected by HIV/AIDS

Casey Report Examines Medicaid Use for Children in Foster Care

Kaiser Family Foundation Releases "State of Medicaid" Report

Key Upcoming Dates for Congress



Outpouring of Opposition Forces Congress to Delay Votes to Deepen Budget Cuts

Through a targeted effort by CWLA members and others across the country, Congress was flooded with more than 60,000 calls last week opposing proposals to cut human service programs. Due to this outpouring, the House postponed a previously scheduled vote that would have forced Congress to reduce federal spending for entitlement programs by $50 billion rather the previously agreed-to amount of $35 billion.

Although Congress is not required to reduce federal supports for abused and neglected children through changes or cuts to Title IV-E Foster Care and Adoption Assistance or Medicaid to reach its budget reduction goals this year or to pay for hurricane relief efforts these programs are threatened unless Congress continues to hear from constituents that such cuts are unacceptable.

Senate action has also been stalled due to lack of consensus. Senate Finance Chair Charles Grassley (R-IA) has a draft proposal to cut Medicaid and Medicare by $12 billion, but he is still seeking the additional Republican support necessary for passage. Without revealing the details of his proposal, Grassley has said it would reduce federal spending without affecting program beneficiaries. The Senate Agriculture Committee also changed its plans to cut food stamps and instead passed legislation cutting federal spending by $3 billion in other agricultural programs without reducing federal spending for food stamps.

The House vote was to be on a new version of an FY 2006 budget resolution. The new version would not bind the Senate to act in the same way.

If Congress does pass this new budget resolution calling for $50 billion in cuts and directs the House Ways and Means Committee to find $9 billion in savings rather than the previous target of $1 billion, then the committee will likely target some of the cuts for programs that support children in the child welfare system. The committee would likely consider two White House proposals. One would repeal a U.S. Ninth Circuit judicial decision (Rosales v. Thompson) that has resulted in many more children becoming eligible for Title IV-E Foster Care assistance. This proposal would save the federal government nearly $400 million.

For more information on Rosales v.Thompson, visit www.cwla.org/advocacy/rosales.htm.

The other proposal would enact a new Title IV-E policy recommended by the U.S. Department of Health and Human Services earlier this year, that would restrict states' Title IV-E reimbursements for casework involving children who are candidates for foster care to those children who are moving into a licensed home. CWLA and others strongly oppose this proposed rule.

For more information on this proposal and CWLA's opposition to it, visit www.cwla.org/advocacy/kinshipIV-E.htm. If this policy change is implemented, the federal government would save $4.5 billion.

The House leadership does not expect to receive any votes from House Democrats, so it is attempting to pass the increased budget cuts by getting the necessary 218 votes from Republican members. There are 231 Republican members of the House. House Speaker Dennis Hastert (R-IL) said the vote on the budget resolution would happen some time after October 24.

The House leadership also plans to include an across-the-board cut of 2% for all programs. The 2% figure could possibly double in size if defense spending were exempt, as many expect. Despite the appetite for spending cuts, House leaders are talking of ways to expand tax cuts. Although plans for a package of $70 billion in cuts is still on track, Ways and Means Committee Chair Bill Thomas (R-CA) is also talking about a package of about $10 billion in additional tax cuts targeted for hurricane relief efforts.

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House Tries to Include TANF in Budget Reconciliation

Last week, the House Ways and Means Committee considered a TANF and Child Care reauthorization bill that is now expected to be put into the budget reconciliation package.

The TANF and child care reauthorization bills passed in the two previous congressional sessions and reported out of the House Subcommittee on Human Resources this year have included only a $1 billion increase in child care funding. That total represents a first-year increase (of the five-year reauthorization) of $200 million. That one-year total represents a 4% increase, with funding levels frozen for the next four years. That funding level fails to keep up with inflation or population growth, especially in light of recent across-the-board cuts in funding in 2004, 2005, and possibly this year.

It's possible that even that funding level could be reduced if the reauthorization bills were included in the reconciliation package. The House TANF bill also threatens to be more restrictive than previous versions, as it would limit how states measure recipients' enrollment in vocational education programs as they apply to meeting the law's work requirements.

The Senate has resisted including a TANF/Child Care reauthorization into budget reconciliation. Senator Olympia Snowe (R-ME) has taken the lead in this area, indicating that any TANF bill must include significantly higher funding for child care. Many advocates fear that even if the Senate does not include TANF and Child Care in its reconciliation package, the House will then insist on its inclusion in a House-Senate reconciliation conference negotiation. Including such measures as TANF and child welfare reforms in a reconciliation means that discussion on these issues would be competing for limited debate time on the floor; in some instances, significant policy discussions and debates could be become casualties of the reconciliation/budget-cutting process.

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Senate to Consider FY 2006 Annual Spending Bill for HHS

This week, the Senate may debate and vote on the FY 2006 annual appropriations for programs administered by the U.S. Departments of Labor, Health and Human Services, and Education. The bill, Senate Substitute for H.R. 3010 (Committee Report 109-103), offers few, if any, increases in children's programs. The Senate bill, similar to its House counterpart, imposes a virtual freeze----with some programs receiving slight increases and others being cut. The Senate bill reduces funding for the Promoting Safe and Stable Families (PSSF) prevention and support program by more than $8 million. Total funding for this program would decrease from $403 million to $395 million.

Since its reauthorization in 2001, with a commitment by the Administration to fund the program at $500 million a year, funding for PSSF has never exceeded $404 million, with funding peaking in 2004. Since then, funding has decreased. The Senate bill would freeze child care funding at current levels. If an additional across-the-board cut were imposed, it would mark the fourth year in a row discretionary child care funding has been cut. The Senate bill would increase funding for Head Start by $31 million increase. Due to the effects of inflation, this funding level would mean reduced Head Start enrollments.

For more information about these budget decisions, go to www.cwla.org/advocacy/budgetdetails06.htm.

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House Passes Bill to Protect World Orphans Affected by HIV/AIDS

Representative Barbara Lee (D-CA) led the House passage last week of legislation that seeks to protect orphans and other vulnerable children living in developing countries. The Assistance for Orphans and Other Vulnerable Children Act of 2005 (HR 1409) would establish a special adviser for orphans and vulnerable children within the U.S. Agency for International Development (USAID).

USAID was formed under President Kennedy's initiative for a global response to third-world countries and has served as the lead in developing long-range economic and social development assistance efforts. If enacted, HR. 1409 would place an advisor within USAID who would coordinate U.S. assistance to orphans and vulnerable children, including aid to programs that provide basic care and services, treatment for HIV-positive children, psychosocial support, and education, as well as programs that provide food at schools and work to abolish school fees and promote inheritance rights for children. The bill had 130 cosponsors and support from HIV/AIDS organizations. "If this bill becomes law, it will signal a remarkable new commitment to the world's 2.2 million HIV-infected children," said Mark Isaac, Vice President of the Elizabeth Glaser Pediatric AIDS Foundation.

Senate Foreign Intelligence Chair Richard Lugar (R-IN) has introduced a similar language in legislation, S. 350, which has bipartisan support.

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Casey Report Examines Medicaid Use for Children in Foster Care

As Congress considers substantial cuts to Medicaid, Casey Family Services has released a new analysis of the effect of these cuts on children in foster care. Noting that children in the foster care system are frequently at risk for severe medical, developmental, and mental health problems, the report, Protecting Children in Foster Care: Why Proposed Medicaid Cuts Harm Our Nation's Most Vulnerable Youth, shows the critical role that Medicaid-funded services provide for foster youth in addressing these needs.

A recent Casey Family Programs and Harvard Medical School study revealed that more than 50% of young adults who were formerly in the foster care system exhibited at least one major mental health problem. Of thse, 25% will suffer from post-traumatic stress disorder--a rate that is more than double of that of returning war veterans.

The new report details the role of Medicaid-funded programs and services in addressing the needs of foster youth. Medicaid currently addresses the needs of children in the child welfare system by providing services that include Early and Periodic Screening and Diagnostic Treatment (EPSDT), targeted case management, and rehabilitative services. States also have a Medicaid option to cover youth aging out of foster care. Under proposals currently before Congress, these services would be stripped, cut, or redefined in a way that would not allow further use by children in the child welfare system.

The broad coverage rules applicable for Medicaid allow child welfare agencies to ensure that children who are victims of abuse or neglect receive the proper care and services. Other child welfare programs, including Title IV-E Foster Care and Adoption Assistance, are limited to specified outlined services and do not allow for the integrated service delivery plan that Medicaid currently funds. Medicaid-funded services allow for the support of a comprehensive screening, diagnosis, and case management services.

Proposals by the National Governors' Association and the National Conference of State Legislatures would reduce some of the required treatments under EPSDT. HHS Secretary Michael Leavitt and the White House–backed Medicaid Commission have also produced measures that would strip in excess of $10 billion and risk services to the child welfare community.

The full Casey Family Programs report is available at www.casey.org.

CWLA strongly opposes any cuts in Medicaid that would adversely affect the child welfare system. To learn more about how these proposals would affect the child welfare community, and to get involved, visit the "No Caps on Kids!" campaign, at www.cwla.org/advocacy/nocapsonkids.htm.

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Kaiser Family Foundation Releases "State of Medicaid" Report

The Kaiser Family Foundation's Commission on Medicaid and the Uninsured (KCMU) released its fifth annual "State of Medicaid" survey of Medicaid spending on October 19. The survey, conducted in July and August of this year, notes spending trends for all 50 states and the District of Columbia. The survey reveals that annual Medicaid spending growth is at its lowest rate since 1999, droping from 12.7% in 2002 to 7.5% in 2005. Medicaid growth is projected to continue decreasing, to 5.5% for FY 2006.

Key to state Medicaid financing is the Federal Medical Assistance Percentages (FMAP),which designates at what level the federal government will reimburse state spending. Currently, FMAP rates range from 50% to 80% and serve as a critical source of funding for states with decreasing revenues. The Kaiser survey points out that 29 states saw a decrease in their FMAP rates in FY 2005, and 12 remained stable.

The Kaiser report finds that even as the growth rate is decreasing, Medicaid expenditures are still expanding faster than incoming state revenues. This has resulted in a uncertain future for Medicaid, as declining FMAP rates, increased state waiver programs that decrease eligibility, and the impending budget reconciliation process pose a danger to the future stability of Medicaid-funded programs.

At the briefing to release the report, Alan Weil, Executive Director and President of the National Academy State Health Policy, noted that any major substantive changes, like the measures currently before Congress, would have an adverse affect on Medicaid beneficiaries outside of "normal" recipients. Weil specifically noted this adverse effect would include the foster care and juvenile justice populations.

In its October 6 issue, the New England Journal of Medicine published an article by KCMU Executive Director Diane Rowland about the current congressional proposals to cut Medicaid funding. In the article, "Medicaid--Implications for the Health Safety Net," Rowland says,

These short-term strategies will not achieve substantial savings for states or facilitate Medicaid's ability to meet the health care needs of the low-income population and adequately pay their providers; nor will such approaches help to address the aging population's increasing need for long-term care. A better and more humane alternative for containing costs is to pursue long-term strategies for investing in Medicaid to promote better management of chronic illness, disease prevention, and coordination with Medicare.

The full report, Medicaid Budgets, Spending and Policy Initiatives in State Fiscal Years 2005 and 2006, is available on the Kaiser Commission on Medicaid and the Uninsured website at www.kff.org/kcmu.

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Key Upcoming Dates for Congress

October 19 for Senate (Approximate),
a week later for House: Deadline for assigned committees to adopt $35 billion in cuts to mandatory programs for budget reconciliation bill

October 26 for Senate (Approximate),
November for House: Deadline for tax-writing committees to adopt tax cuts of $70 billion

November 1: Presidential Commission on Tax Reform releases recommendations

November 18: FY 2006 Continuing Resolution Ends


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