Tag Archives: ACA

Coalition Discusses ACF-Medicaid Budget Proposal

The National Foster Care Coalition (NFCC) spent most of its recent quarterly meeting on health care for children and youth in foster care, an important focus of CWLA’s upcoming Advocacy Summit. The discussion follows the President’s budget proposal to bring the state child welfare and Medicaid agencies together with Administration for Children and Families (ACF) competitive funding and incentive funds under Medicaid to better address the needs of children in child welfare. The proposal has the potential to address such challenges as the over use of some prescription medications as well as providing better services to children overall. Joo Yeung Chang, Associate Commissioner for the Children’s Bureau (CB), discussed the Administration proposal following two related issues.

Robert Hall of the American Academy of Pediatrics (AAP) shared his organization’s on-going effort to promote the use of medical homes. The medical home concept is to make sure that populations, such as children in foster care, have one central coordinated health care provider instead of moving from provider to provider over time. Inconsistent providers can result in uncoordinated and conflicting therapies, treatments and services. The medical home is described by the AAP as “an approach to providing primary care services …[and] team-based whole person, comprehensive, ongoing, and coordinated patient-centered care.”

A second part of the agenda was on the new state requirements under the Affordable Care Act (ACA, P.L. 111-148) to provide Medicaid coverage to young people up to age 26 if they exited foster care at age 18 (or later). Timothy Bell of FosterClub discussed the challenge they are having in their efforts to help these youth formerly in foster care to obtain this health coverage. States are supposed to provide Medicaid coverage to all young people to age 26 if they were in foster care, regardless of whether the state has taken up or rejected the expansion of Medicaid under the ACA. However, states can deny coverage to youth if they were in foster care in another state. States are a mixed bag in terms of implementing the coverage and seeking out these young people. Some states may have more barriers to qualifying, including requirements for eligibility determination, acknowledgement of providing coverage, and existing data and information on past cases of placement in foster care. First Focus has provided a brief on the topic of Medicaid to 26 for youth in Foster Care.

Commissioner Chang discussed the Administration’s proposal and the CB’s openness to greater feedback and input on the structure of the incentive fund under ACF. Fifty million dollars a year would flow from ACF in competitive grants while the matching Medicaid funding of $100 million would provide states incentives to hit certain targets or goals. The capacity building through ACF would include:

  • Enhancing the child welfare workforce;
  • Providing reliable screening and assessment tools;
  • Coordination between child welfare and Medicaid, especially Early and Periodic, Screening, Diagnosis, and Treatment (EPSDT);
  • Training for foster parents, adoptive parents, guardians, and judges;
  • Implementing an evaluation and
  • Providing data.

Home Visiting Close to Passage For Year Extension

On Thursday, March 27, the House gave approval to a bill that will likely extend the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program into 2015. It came about when the House of Representatives passed another “patch” to the Medicare law that modifies the formula determining how doctors are reimbursed. The “doc-fix,” as it is called, has become an annual congressional ritual since it was included in a 1997 budget act. The coalition of home visiting programs and supporters had been working aggressively over the past several weeks to get any kind of home visiting extension attached to the Medicare bill under the belief it might be one of the only or the only “vehicle bill” that will be passed this year.

The MIECHV program, first included as part of the Affordable Care Act (ACA, P.L. 111-148), was authorized for five years with current funding set at $400 million a year in mandatory funds. The program sets new standards for the allocation of human service funding in that it requires states to spend 75 percent of its funding on evidenced-based and research-based models. The remaining 25 percent can be used for more experimental models but they too must undergo serious evaluation.

Although Congress has taken to passing the Medicare “doc-fix” (SGR, Sustainable Growth Rate) bill annually, this year’s effort took a few different turns and time was running out on the month and on how long Congress had to fix this year’s formula. While Finance Committee Chair, Senator Ron Wyden (D-OR) was crafting a permanent fix that would stretch out beyond ten years, Senate Majority Leader Harry Reid (D-NV) and House Speaker John Boehner (R-OH) were crafting a deal that would extend the patch through this year. That House-Senate deal included funding for the home visiting program. The deal had been reached on Wednesday but overnight the doctors groups started to sound the alarm about the shortness of the deal. At that point it looked like the House leadership might lose the needed two-thirds approval for the vote that had been taken up bypassing the rules committee. However, some behind the scenes discussions resulted in an agreement for a voice vote with neither side asking for a roll call, allowing members to not be on the formal voting record. Once the House moved the bill the Senate was scheduled to act, but that has been delayed until today.

In the Senate, a vote on Wyden’s ten year, permanent fix, is likely but not likely to pass because of opposition to using as savings the end of the war costs. When that vote fails, the Senate is expected to move the House bill. The deal allows the home visiting program to continue for one more year, requiring advocates to quickly refocus on the next round.