HHS Vacancies On Agenda for Spring

On April 11, President Obama nominated Sylvia Mathews Burwell to be the next Secretary of the U.S. Department of Health and Human Services  (HHS). Current health secretary Kathleen Sebelius will stay in the role while the Senate works the confirmation process for Burwell.  It is hoped that Burwell, the current Director of the Office of Management and Budget (OMB), will not require extensive Senate evaluation since she received 96 votes when the Senate approved her in that OMB role back in late April, 2013. Previously, Burwell served at the White House during the Clinton presidency and worked in the private sector for Walmart and the Gates Foundation in the time between the two Democratic Presidents’ terms. Concern over possible delays is in regards to the potential that some Senators may attempt to make a statement on the Affordable Care Act by delaying her nomination. She has to testify before two Senate committees, the Finance Committee and the Committee on Health, Education, Labor and Pensions (HELP), but only the Finance Committee will actually vote on her nomination.

In addition to the pending nomination for health secretary, currently, HHS also has a pending nomination for Assistant Secretary for the Administration for Children and Families (ACF) and a vacancy for Commissioner of the Administration on Children Youth and Families (ACYF). The latter position was left open when Bryan Samuels stepped down last year. The Senate Finance Committee must approve the ACF position. Maria Cancian was nominated on February 12 by President Obama for that office. The Administration for Children and Families has jurisdiction over eighteen offices that cover most of the services that are outside of health care and research including child welfare, welfare, child care, Head Start, refugee assistance, Native American services and community services. The last time the position was filled by a confirmed Assistant Secretary was in September of 2009 when President Obama appointed Carmen Nazario. Assistant Secretary Nazario served until the following summer when she had to leave the position due to family issues.

Important Progress in Child Welfare Policy in 2012

There was important progress in federal child welfare policy in 2012. An extension of the adoption tax credit was approved as part of the American Taxpayer Relief Act of 2012 (H.R. 8). Had Congress not acted the credit would have expired. The credit was extended permanently, without a sunset provision.  The bill retains the provision that allows the adoption tax credit to be “flat” for special needs, meaning special needs adoptions are excluded from needing to document qualified adoption expenses, and it includes a permanent cost of living adjustment so that it will be indexed for inflation. While it is good news that the adoption tax credit is permanent and it includes these other provisions, unfortunately the credit is not refundable.  Not including the refundability provision means that many families will not benefit.

The Administration of Children, Youth, and Families at the Department of Health and Human Services are reviewing applications for waivers to federal child welfare policy in nine states. The waivers are part of the Child and Family Services Improvement and Innovation Act (P.L. 112-34). The goal of the waivers is to facilitate innovation and experimentation in child welfare programs through the demonstrations and to improve outcomes for children. ACYF is encouraging states to consider whether funding flexibility and improvements in the service strategies for children both at risk of foster care placement and those already placed outside the home could lead to better outcomes for children. Priorities for the applications are to produce positive well-being outcomes for children, youth and their families, enhance the social and emotional well-being of children and youth, and yield more than modest improvements in the lives of children and families. As many as thirty state waivers are possible over three years and many states are considering whether or not to apply.

The Port Gamble S’Klallam Tribe became the first Native American community in the nation to operate its own Title IV-E foster care, kinship guardianship assistance, and adoption assistance program.  Passage of the 2008 Fostering Connections to Success and Increasing Adoptions Act (P.L. 110-351) made it possible for tribal governments and consortia to apply to directly operate IV-E programs without receiving funding through state administration or agreements.  Many other tribes are developing plans or considering how they too can operate Title IV-E programs.

While these measures and other prevention focused improvements are important there is much more to be done to address critical challenges faced by vulnerable children and families. Our 2012 Legislative Agenda includes many specific recommendations. This year we issued additional recommendations for reform based on our survey of direct care workers and supervisors. CWLA continues to be at the forefront of advocating for major child welfare financing reform and remain committed to comprehensive child welfare reform. We will urge the new 113th Congress to pick up where the 112th left off.

 

Forum on Psychotropic Medications for Children in Foster Care

Today in Washington a forum was held on psychotropic medications for children in foster care. Dr. David Rubin of the Policy Lab and the Children’s Hospital of Philadelphia is leading a major research project on this issue. He reviewed their latest findings and highlighted data from all fifty states regarding use of psychotropic medications by children in foster care over a five year span.

Providing the state perspective was James A. Rogers, M.D., Medical Director, Texas Department of Family and Protective Services, which is a CWLA member agency. Dr. Rogers presented on what steps have been taken in Texas, which has historically high rates of psychotropic medication use. He also highlighted some of the improvements that have been made and explained the new protocols and monitoring that are being developed inTexas.

Clare Anderson, Deputy Commissioner at the Administration for Children, Youth and Families (ACYF) and Kate Stepleton also from ACYF spoke about the coordination initiative underway between federal agencies on these issues, the technical assistance webinar series they are conducting, and a planned summit that will involve all the states and will take place in late August.  

Nadia Sexton, Senior Fellow at the Office of the Commissioner, ACYF, and on detail to the Centers for Medicaid and Medicare Services, Division of Benefits and Coverage, focused her remarks on the role of Medicaid. In particular she described efforts to align federal resources, strengthen the partnership of shared knowledge, and efforts to work with states to ensure children receive the right treatments through Medicaid’s EDSDT benefits.  

David DeVoursney, Policy Analyst, Office of Policy Planning and Innovation, Substance Abuse and Mental Health Services Administration highlighted the major challenge of workforce shortages. He noted that 94 million Americans live in areas where there is a shortage of mental health professionals. He described the work of the National Child Traumatic Stress Network and its initiative in this and related areas.