Tag Archives: Medicaid

Ryan Budget Adopted On Party Line Vote

On Thursday, April 10, by a vote of 219 to 205 the House approved a budget resolution (H. Con. Res. 96) crafted by House Budget Committee Chairman Paul Ryan (R-WI). All Democrats and 12 Republicans voted against its final passage.

Ryan claims the proposal would balance the budget within ten years. To get there it makes significant cuts to entitlements including block-granting Medicaid and the Supplemental Nutrition Assistance Program (SNAP/food stamps) and it makes additional cuts to the Pell education grants. H. Con. Res. 96 also converts Medicare to a “premium support” proposal (what is referred to as turning Medicare into a voucher program) and eliminates the Social Services Block Grant (SSBG). In total it proposes over $5 trillion in spending cuts over the next ten years, which according to the Center on Budget and Policy Priorities would make over 70 percent of those cuts to programs that assist low income families.

The block-granting of Medicaid would cut funding for the health care program by $732 billion. States would have flexibility in spending their Medicaid funds, but as the aging population grows with baby-boomer retirements, there will be enormous pressure to pit spending for long term care against spending for children, low income families, and the newly eligible adults covered through the Affordable Care Act (P.L. 111-148). The block grant would include an adjustment based on inflation and population growth over time, but previous block grants adopted with similar gradual increases did not retain them long. For example, SSBG and Temporary Assistance for Needy Families (TANF). The supplemental grants under the TANF block grant that were intended to assist 17 states due to future population growth and low funding was cut out by Congress in 2011.

The weakening of programs through block granting is ironically highlighted as H. Con. Res. 96 not only proposes to convert SNAP and Medicaid into block grants, but also proposes the elimination of the former entitlement-based funding source: SSBG. SSBG continues to be a target for elimination and its future is in doubt if the Senate changes party control after next year’s election. A proposal by Senator Orin Hatch (R-UT), the potential chair of the Finance Committee, which has over-site of the program, would funnel all of SSBG into child welfare, while his House counterparts would use all of it for deficit reduction. SSBG needs the attention of advocates NOW before it goes!

“Doc Fix” Includes Home Visiting & Demo’s On Therapeutic Foster Care

On Monday, March 31 the Senate followed up House action from the week before and approved the Medicare “doc-fix.” As a result they also gave approval to extend the Maternal, Infant and Early Childhood Home Visiting (MIECHV) program into 2015. The Senate vote on the measure (H.R. 4302) was 64 to 35 and it became P.L. 113-93 when the President signed it on Tuesday. It extends the home visiting program for half the fiscal year through the end of next March but provides a full year of $400 million in mandatory dollars. After passage, the House held a hearing on Home Visiting that is reported below.

The “doc fix” extension legislation also includes the bipartisan “Excellence in Mental Health Act,” which authorizes the creation of a 2-year pilot program to be awarded to 8 states that compete to create federally certified Community Behavioral Health Centers. The provision designates $900 million in the expansion of services to various populations in need of mental health services and establishes new standards for providers. One of those provider groups identified in the legislation are agencies licensed by the state to deliver therapeutic (or treatment) foster care (TFC). For the first time ever, TFC is defined under Medicaid (Social Security Act, Sec. 1905) as a reimbursable service provided by state licensed child placing agencies which are accredited by nationally recognized accrediting bodies.

The Foster Family-based Treatment Association (FFTA) has been working hard to strengthen the definition and the use of treatment foster care within Medicaid for several years. Traditional foster care and treatment foster care are distinct program models intended to serve different child populations. Children are referred to TFC programs to address serious levels of emotional, behavioral and medical problems. Treatment foster care is active and structured, and occurs in the foster family home. What people view as “traditional” foster care provides nurturing, safe, and custodial care for children who require placement outside of their family. The primary reason for placement in traditional foster care is the need for care and protection. The role of the foster parent is that of caregiver and nurturer. Treatment, if any, occurs outside of the foster home. Therapeutic care combines the treatment technologies typically associated with more restrictive settings and the nurturing, individualized family environment with foster parents who receive special training.


A day after the “doc fix” extension became law, the House Ways and Means Subcommittee on Human Resources held a hearing on MIECHV. The Chair of the Subcommittee, Congressman Dave Reichert (R-WA) opened the hearing with a statement that said in part, “Our purpose today is to review what we know about the effects of this program, so we can begin thinking about next steps…we need to review whether the actual outcomes of this program are living up to its promise in terms of producing better outcomes for children and families. We also need to think about whether the program’s mix of supporting proven and promising approaches continues to makes sense. And we should consider whether this program should continue to have 100 percent federal funding, especially since some of the positive outcomes we hope to see will benefit our state partners.”

Witnesses included Crystal Towne, Nurse-Family Partnership; Sherene Sucilla, Former Nurse Family Partnership (NFP) program participant; Darcy Lowell, Child First; Jon Baron, Coalition for Evidence-Based Policy; and Rebecca Kilburn, RAND Corporation.

Crystal Towne described the NFP model explaining that it has served over 190,000 families and currently has over 28,000 first-time families enrolled in 43 states. She said that for every 100,000 families served research demonstrates that,

  • 14,000 fewer children will be hospitalized for injuries in their first two years of life;
  • 300 fewer infants will die in their first year of life;
  • 11,000 fewer children will develop language delays by age two;
  • 23,000 fewer children will suffer child abuse and neglect in their first 15 years of life; and
  • 22,000 fewer children will be arrested and enter the criminal justice system through their first 15 years of life.

Jon Barton offered a strong endorsement for reauthorization summarizing:

  • “MIECHV represents an important, bipartisan departure from the usual approach to social spending: it uses scientific evidence of effectiveness as a main factor in determining which activities to fund.
  • This evidence-based design is important because there is great variation in the effectiveness of different home visiting program activities (“models”). Rigorous studies have identified several models that produce major improvements in the lives of children and mothers – such as 20-50% reductions in child maltreatment – as well as a larger number of models that produce no meaningful effects.
  • MIECHV’s evidence-based design has succeeded, in part, in focusing funds on the subset of effective models; and, with a few modest revisions, it could do even better.”

To read all the testimony, go the Human Resources website. Organizations can still submit testimony for the record to the subcommittee by April 16. Directions for public submissions for the record can be found here.

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.

Budget Committee Plan Replaces Sequester of Defense Funding with Human Service Cuts

Late last week Representative Paul Ryan (R-WI), Chair of the House Budget Committee, introduced the Sequester Replacement Act , H.R. 4966, which replaces the cuts to defense programs through sequestration which is called for in the Budget Control Act , P.L. 112-25, with more drastic cuts to human service programs. These cuts include eliminating the Social Services Block Grant, saving $17 billion over ten years, and cuts of $33 billion in SNAP over ten years. Also included in the bill are Medicaid changes including the elimination of the maintenance of effort (MOE) requirements on states and the repeal of the bonus payments to states for increasing their Medicaid enrollment.

Eliminating SSBG would cause severe harm to child welfare. SSBG represents 12% of federal funds states spend to provide child abuse prevention, adoption, foster care, child protection, independent and transitional living and residential services for children and youth. The cuts to SNAP (formerly the food stamp program) would result in millions of low-income people being forced out of the program. As previously reported, repealing the maintenance of effort requirements in Medicaid opens the door for states to institute caps on enrollment and even decrease enrollment by creating more strenuous eligibility standards. Furthermore, repealing bonus payments to states only works as a disincentive to states that want to increase enrollment for eligible children and families.

These and other cuts were recommended by a number of House committees including Ways and Means, Energy and Commerce, and Agriculture. The Budget Committee has scheduled a markup of the legislation for Monday, May 7th, at 2pm EST.