On July 5th, the Centers for Medicare & Medicaid Services (CMS) issued a final rule implementing provisions of the Affordable Care Act (ACA) including Medicaid and Children’s Health Insurance Program (CHIP) eligibility, benefits, and enrollment rules. While the final rule does not cover all of the topics in the proposed rule issued in February, it does focus on the changes that are most needed to implement the changes made by ACA starting in 2014. Additionally, it addresses key provisions deemed critical to former foster youth and children and youth currently in care.
The final rule clarifies that former foster children are already a population that is eligible to be determined presumptively eligible (the rule does not extend to current foster youth as they are already Medicaid eligible and don’t need to be determined presumptively eligible). The rule also clarifies that individuals under age 21 will continue to receive Early, Periodic, Screening, Diagnosis, and Treatment (EPSDT) services either through the Alternative Benefit Plan (ABP) or as additional coverage that supplements the ABP. The final rule makes clear that CMS does not have statutory authority to require states to provide EPSDT services beyond age 21, but acknowledges that states have the flexibility to design and offer voluntary enrollment in an ABP targeted to former foster care children that provides a more comprehensive array of health coverage than is provided through the regular state plan.
Despite recommendations that former foster youth be exempt from premiums and cost sharing, the final rule explains that while there are populations upon which states may not wish to impose cost sharing, there was no clear basis to support a federally-mandated exemption. The rule does state that agencies may not impose premiums or cost sharing on children receiving child welfare services under title IV-B as well as children in foster care and individuals receiving benefits under title IV-E, regardless of age.
One key issue not addressed in this rule that remains of concern to child welfare advocates has to do with state of residency of former foster youth. The ACA requires that in order for an individual to be eligible under this category, the individual would have to have been in foster care under the responsibility of “the state” and be enrolled in Medicaid under “the state plan” or an 1115 demonstration. Under the proposed rule, CMS interprets the requirement as meaning that the individual was in foster care and enrolled in Medicaid in the same state in which coverage under this eligibility group is sought. CMS does propose giving states the option to cover individuals under this group who were in foster care and Medicaid in any state at the age of 18 or at the point of aging out. However the proposed rule does not require states to cover former foster youth who were in care and enrolled in Medicaid in any state at the time the individual reached age 18 (19, 20, or 21), as advocates had hoped.
Today the House of Representatives narrowly approved a scaled-back farm bill. The bill was drastically different from its predecessor which would have would have cut $20 billion from SNAP (the Supplemental Nutrition Assistance Program). The former bill was rejected in the House last week by a 195 to 234 vote. This week’s bill however removed the nutrition title (which includes SNAP– the nation’s largest nutrition program for poor and working families). After last week’s vote, there was speculation that any new farm bill would likely not include the nutrition title.
Although the nutrition title has been taken off the table for the time being, SNAP could still become a barrier to the negotiation efforts to produce a compromise package if the Senate offers their version of proposed cuts (which includes cuts to SNAP). Agriculture Chairwoman Debbie Stabenow (D-MI) has said she is prepared to go to conference on a farm bill with the House once it is sent to the Senate (although in current form, the bills are vastly different).
Today the Senate Appropriations Committee approved the FY 2014 Labor, Health and Human Services, Education and the Legislative Branch (L-HHS-Education) bill by a vote of 16-14. The bill provides $165.6 billion in discretionary budget authority to make investments to reduce healthcare costs and improve the quality of health care delivery, improve early childhood care and education, and improve school safety and access to mental health services, among other things.
In her opening statement, Chairwoman Barbara Mikulski (D-MD) highlighted some key investments that the L-HHS-Education bill makes in early childhood education. The bill would increase funding for Head Start, Early Head Start, and Child Care Development Block Grants. The L-HHS-Education bill also funds universal Pre-K, which supports the President’s initiative to ensure that every four-year old can attend preschool. Finally, the bill fully funds the President’s request for implementing the Affordable Care Act.
The bill will now head to the Senate floor for consideration by the full Senate. The House has yet to mark up its Labor-HHS bill, so there is no way to provide a direct comparison at this time.
Today the Senate Budget Committee held a hearing on the impact of budget decisions on children. Chairwoman Patty Murray (D-WA) opened the hearing by saying there’s one group in particular whose voices are not often heard when it comes to the federal budget process – and that is our nation’s children. They may not be walking the halls of Congress, or calling up their Senators, or strategizing with lobbyists about how to protect funding for their programs. But they deserve a seat at the table. She stated that we cannot and should not solve our debt and deficit problems on the backs of our children. This is wrong for our kids and is not good economic policy.
Witnesses included Bruce Lesley, President of First Focus. He said since a peak in 2010 total federal spending on children has fallen by $35 billion, a 16 percent drop. Total spending for children has now fallen for three years in a row. First Focus compared the Senate budget to the House budget and found the Senate budget clearly places a much higher value on children and protecting investments critical to them.
Margaret Nimmo Crow is Acting Executive Director of Voices for Virginia’s Children. Her comments focused on the impact of decreasing budget revenues on children at the state level. In Virginia the number of children living in poverty has increased every year since 2005. She testified that in Virginia Head Start will cut 647 children this fall, as well as 112 jobs. In Prince George County, VA, 41 instructional, administrative and support personnel have been lost since 2009 while they have gained 150 new students.
Taking a much different perspective Dr. David Muhlhausen, Research Fellow at the Heritage Foundation, criticized federal funding for Head Start and other support programs. His research shows little evidence that they are providing positive results. His testimony offered a challenge to the Committee to make sure federal funds are spent in ways that can demonstrate positive results.
Shavon Collier is a Head Start parent who testified along with her daughter, Sakhia Whitehead, who is a Head Start alum. Their testimony was a positive account of their experiences with Head Start. Ms. Collier described how the program provided her children a strong academic foundation and an ability to focus. Ms. Whitehead testified how Head Start helped her prepare for kindergarten and to be on the Honor Roll in elementary school.