In the Families First COVID-19 emergency supplemental bill (COVID-19 bill # 2), Congress acted swiftly to provide a much-needed 6.2 percentage increase in the FMAP. The FMAP is the match level of funds the federal government provides to Medicaid. Usually the federal government provides a match from 50 percent to 80 percent depending on the state. That means they pay anywhere from half to 80 percent of all Medicaid spending. As the pandemic increases the duration and depth of health and economic challenges, CWLA is urging Congress to expand the FMAP to 14 percent as provided in the House-passed H.R. 6800. This FMAP increase must extend to Title IV-E child welfare programs, including foster care, subsidized guardianships, and adoption assistance.
On July 10, 2020, the bipartisan National Governors Association (NGA), The National Association of Counties (NACo), the National League of Cities, the International City/County Management Association, the National Conference of Legislatures, the Council of State Governments and the United States Conference of Mayors spearheaded a letter calling for Congress to expand the FMAP to at least 12 percent and to tie both the amount and duration to unemployment and economic recovery. The joint letter stated:
“According to the National Association of State Budget Officers (NASBO), in fiscal year 2019 Medicaid was the largest expenditure for states, accounting for nearly 29 percent of total spending from all funds. The COVID-19 pandemic is drastically shrinking state and local revenue with most states experiencing a budget shortfall ranging between 5 and 20 percent. Even states with a lower shortfall will be challenged to provide adequate healthcare services to their residents. This leaves state and local leaders with tough choices to balance their budgets while responding to a pandemic.”
Medicaid is unique in that it responds automatically to health and economic crises, expanding as needed to meet health care needs during a recession while the reverse occurs in better economic times. Medicaid funding is critical to addressing the behavioral health needs of children and families both in the formal child welfare system as well as families in need of preventive services.
Separate but tied to that match is the FMAP for Title IV-E, which covers foster care, adoption assistance, and subsidized guardianship programs. The additional funding is complex because not all children in these three categories are covered by federal Title IV-E funding, although all will have the same costs and rates regardless of federal eligibility. Nationally only 40 percent of the foster care population is covered by Title IV-E according to the FY 2021 budget projections. States pay the same categorical rates REGARDLESS of whether that child is covered by IV-E funds.
Some states have provided increases for foster parents per child during the pandemic. This is intended to address the increased need, such as new in-home schooling requirements and many other pandemic-related needs. If a child(ren) has learning disabilities, this could be even more challenging. There is also a need to retain foster families during this pandemic due to exposure and related issues regarding COVID-19. Other state adjustments may include, for example, providing a higher “medically complex” rate for a child that has tested positive.
An increase in the FMAP has been deployed in past recessions and is one of the most effective ways for Congress to help stabilize the economy. Such increases preserve health care during a public health emergency, aid local governments, and maintain other critical services threatened by this crisis.
To take action, please take 5 minutes to email your Senators and ask them to include an additional increase in the FMAP and continue to apply that increase to Title IV-E.