The Senate has been struggling to move their opiods legislation, but the hope is it will finally move this week. When they do its passage is to set the stage for a mega-negotiation with the House. Back in the spring there had been a hope that there would be movement on another opiods abuse bill getting through Congress quickly. Some in the House had hoped to move their legislation by Memorial Day. When Congress broke for the August break the Senate had hoped to complete work on a combined Senate package which in turn would allow for negotiation with the many House bills. That timeline has also slipped. The Senate was reported as close to moving their bill before Labor Day, but were still negotiating. The House acted on a series of bills during the summer months including HR 6, the SUPPORT for Patients and Communities Act of 2018. That legislation is to become a vehicle for a much larger package of legislation that addresses opioids and will eventually be sent to the Senate for action.

For child welfare advocates, the House bill includes legislation drafted by Congressperson Karen Bass (D-CA) to clarify that states do not have the option to deny Medicaid health coverage to former foster youth who aged out of the foster care system in a different state. Under the ACA, youth who exit foster care to independence are guaranteed Medicaid coverage to the age of 26. Due to a technical problem the way the law was written, the protection is mandated only on states the young person was in when he or she aged out of care. The Bass legislation makes clear that the guarantee continues even if a young person moves to another state. This is especially important if a young person finds a relative in another state, goes on to college or leaves in a close state area areas, for example the tristate area such of the VA-DC-MD areas. There is a comparable Senate bill by Senator Robert Casey (D-PA). For details on the Bass bill go here.

In regard to substance abuse and child welfare, earlier this summer the Senate Finance Committee moved legislation that deals with a child welfare aspect of opiods that was included in the Helping to End Addiction and Lessen (HEAL) Act of 2018, a combination of bipartisan bills mainly dealing with the Medicare and Medicaid programs. Title III deals with child welfare.

The three child welfare-related Senate bills are: S. 2924, Supporting Family-Focused Residential Treatment Act, sponsored by Senator Tim Scott (R-NC) and Senator Robert Menendez (D-NJ), S. 2926, Improving Recovery and Reunifying Families Act sponsored by Senator Menendez and Senator Scott and S. 2923, Building Capacity for Family-Focused Residential Treatment Act, sponsored by Senator Charles Grassley (R-IA) and Senator Menendez.

The bills attempt to build on the Family First Act, the parts that deal with family-based treatment and treatment facilities. The Family First Act allows states to provide foster care maintenance payments for a child considered a candidate for foster care if the child is placed with his/her parent in a family-based treatment program. The maintenance payments of up to twelve months can be provided to offset the child care costs while in the facility without regard to the current foster care link to the 1996 AFDC (look-back) eligibility standards. In other words, regardless of income eligibility restrictions for children in foster care.

The first bill, S 2924 directs HHS to assist states in this part of Family First provisions by providing state instruction and guidance on how to use Medicaid and IV-E funding for these treatment/placements. The challenge right now is that despite the modifications made by Family First, there are a limited number of facilities and beds for these parent-child treatment facilities. Some of the challenges have to do with whether treatment centers accept children, have capacity, can handle sibling groups or handle older children.

S. 2926, also builds on a state waiver project that focused on reunification services involving recovery coachers and other intensive family-focused services. It provides $15 million for HHS projects to replicate and study the projects. Again, if further developed and proven, it could serve as a program that could be funded under the Family First Act.

S 2923 builds on the first bill except it provides $20 million in FY 2019 for funding projects to develop family-focused treatment facilities. Eligible programs include various applicants including the state and tribal governments.

At this point a final second wave of opiods legislation (after the late 2016 version) will not be complete until after the November election.