(Editor’s note) With Congress in recess, This Week in Washington will go on summer hiatus until Friday, September 9. APHSA is your eyes and ears in Washington for news and analysis of all that happens that affects the health and human services field. In order to make This Week in Washington your main source for this information, we will return in September with a new look and expanded coverage featuring items previously covered in our NAPCWA Newsletter, Health Services News and other specialized publications. Also, beginning in September, we will be making this publication free to all APHSA members as a member benefit.
Lawmakers broke for their August recess this week after a bitter partisan fight that finally resulted in raising the debt limit and avoiding a U.S. default on its financial obligations. In that measure (the Budget Control Act of 2011, S. 365, P.L. 112-25), Congress established a new and temporary procedure to lower the nation’s debt by about $2.5 trillion over the next 10 years. The legislation established a new congressional committee called the Joint Select Committee on Deficit Reduction, which is charged with finding about $1.5 trillion in debt reduction between 2012 and 2021. The $1.5 trillion figure is a "goal" of the Joint Select Committee, meaning that its members could report a measure that falls short of that number. The Joint Select Committee will include 12 lawmakers, with Senate Majority Leader Harry Reid (D-NV), Senate Minority Leader Mitch McConnell (R-KY), House Speaker John Boehner (R-OH), and House Minority Leader Nancy Pelosi (D-CA) each appointing three members. For the committee to report a bill, a majority of the entire committee must vote for it. Republican leaders declared almost immediately that they will not appoint anyone to the joint committee who will vote for increasing taxes. This may set up a virtual replay later this year of the spending cuts vs. new tax revenues fight that almost caused the government to default this week.
Every congressional committee has until Oct. 14, 2011, to make recommendations to the Joint Select Committee for statutory changes to reduce the deficit. The Joint Select Committee will then have until Nov. 23 to adopt, reject, or amend the recommendations sent to it by the other committees. The Joint Select Committee must report its recommendations by Dec. 9, with a Dec. 23 deadline for final congressional approval.
Several human service programs are due for reauthorization at the end of September, including Temporary Assistance for Needy Families, the Social Services Block Grant, and the Child Care and Development Block Grant. It seems increasingly likely that Congress will deal with these programs as part of the bill drafted by the Joint Select Committee. Should Congress fail to pass legislation that reduces the deficit by the targeted amounts, a process called sequestration occurs after Congress adjourns for that session. Sequestration makes across-the-board cuts in appropriation bills sufficient to lower expenditures to meet the overall budget targets contained in that year’s budget resolution. Under the provisions of the debt reduction bill, TANF, the Supplemental Nutrition Assistance Program, and the Women, Infants and Children program are exempt from sequestration. However, they are not exempt from cuts or amendments in the recommendations made by the Joint Select Committee. Given the hectic schedule confronting Congress this fall, a full reauthorization of the TANF programs seems less and less likely. The House had expressed a desire to produce and vote on a separate reauthorization bill this year. However, hearings on the workforce engagement provisions of TANF originally scheduled for Aug. 4 were cancelled when Congress adjourned for the August recess.
Once Congress returns from recess in early September, another budget threat will loom. Lawmakers must pass 12 appropriations bills to fund large segments of the federal government by Sept. 30, but with partisan tensions still high, the same scenario that threatened to close the government down last April may recur. This week’s debt ceiling measure essentially established a new fiscal year 2012 budget resolution for Congress to follow in drafting appropriations bills. The new budget resolution is a close approximation of the House-passed budget proposed by House Budget Committee Chairman Paul Ryan (R-WI). Since the Senate Budget Committee was never able to report its version of a budget resolution, the House used the Ryan budget as a guideline in drafting appropriation bills. (Normally the House and Senate would have held a conference committee to hammer out any differences between their respective proposals, thus producing one budget resolution and allowing both appropriations committees to use the same set of numbers and assumptions in drafting appropriation measures.) None of the 12 bills has passed the full Congress, so members will have about three weeks to act before a continuing resolution or other funding measure will be required to extend federal funding into the new fiscal year. With other legislative challenges also waiting, including for example some solution to disagreements over the long-delayed trade bills with South Korea, Colombia, and Panama, the path to a budget agreement is very unclear.
Sen. Charles Grassley (R-IA) has introduced a bill titled the "Partners for Stable Families and Foster Youth Affected by Methamphetamine or Other Substance Abuse Act," S. 1234. This bill would amend the Promoting Safe and Stable Families program to reauthorize through 2016 grants that aid children affected by methamphetamine or other substance abuse. The measure would allocate $40 million for each year from 2012 through 2016. In addition, the legislation would give the secretary of Health and Human Services the option to extend the grants of current recipients for two more years. S. 1234 would also reserve funds for new grantees. APHSA has urged Congress to support reauthorization of PSSF and supports renewal of the methamphetamine or other substance abuse grants. The text of S. 1234 can be found at http://www.thomas.loc.gov.
This week, the Administration for Children and Families (ACF) submitted its report to Congress detailing the TANF data it collected from reports submitted by states that were mandated in the Claims Resolution Act of 2010. The reports submitted by states break out information on the total engagement of work eligible individuals (WEIs) in the TANF caseload, including both clients who counted toward a state’s work participation rate and those clients who did not. The reports also required states to identify TANF spending information in greater detail, specifically to explain how funds were being used that were classified as "other" spending and spending "authorized under prior law." Both these are categories of TANF spending that are regularly reported in the ACF-196 reporting form submitted by states.
The report cites an estimated 1.2 million WEIs in the TANF program nationwide. Of this pool, more than 300,000 were counting toward states meeting work participation rates (just over 23 percent), with an estimated 668,000 WEIs with zero hours of participation (just over 52 percent). Of those WEIs engaged in zero hours of participation, the reasons for nonparticipation in work activities varied. Nearly 20 percent were noncompliant cases and in the sanction process. Other reasons included families disregarded because they are caring for a child under age 1; those exempt due to illness or disability; families exempt due to other state policies; those exempt as a single parent with a child under age 1 but still not disregarded from the work rate; and those assigned an activity but where the activity has not yet begun, among other reasons. However, the report does indicate that 15 percent of those with zero hours of participation were individuals that the state or local agency failed to engage.
State reporting on TANF spending indicated what states have invested in the child welfare system. States spent an estimated $282 million that was categorized as "other" and another $106 million classified as spending authorized under prior law. Roughly 25 percent of the spending reported under "other" was used for child welfare payments and services. The second highest category of "other" spending was TANF program expenses, reflecting 19.5 percent of total other spending. Under the expenditures authorized under prior law, child welfare represented 91 percent of the total.
The report highlights that the findings presented in this early report should be used for suggestive purposes only. Given the short window for reporting and the fact that this is only a one-month snapshot, states had limited capabilities to collect information, with potential effects on the quality of the data. ACF’s assessment of the difficulties faced by states in gathering data for this newly mandated report reflects what APHSA learned from states when the reporting process was being planned. In many states it was not possible to automate the sample evaluation for the purpose of the March data report, which resulted in staff having to comb through the case files themselves to find applicable activities for the new March reports. The federal report also reflects APHSA’s findings on the issue of "zero hours" of engagement. For some time, Congress has noted the high "zero hours" levels of engagement in the annual work participation reports. The information in the March reports now provides a more nuanced picture of this population, one that shows more fluid movement on and off the TANF caseload for a wide range of reasons. APHSA notes that the report also underscores the need for its policy change proposals such as partial work credit, modification of reporting definitions, and others as published last year in the National Association of State TANF Administrators’ TANF reauthorization recommendations. These recommendations are posted on the APHSA web site at http://www.aphsa.org/Home/Doc/APHSA-NASTATANFRecommendations.pdf.
A more complete picture will be possible once ACF completes work on the state reports for April, May, and June, due out later this month.
On Aug. 1, the Department of Health and Human Services announced new guidelines that will require new health insurance plans to cover certain women’s preventive services without charging a co-payment, co-insurance, or a deductible. The Affordable Care Act amends the Public Health Service Act and the Employee Retirement Income Security Act to require that health insurance plans cover recommended preventive services without any cost-sharing, including women’s preventive care and screening provided for in guidelines supported by the Health Resources and Services Administration. The new guidelines, developed by the Institute of Medicine and supported by HRSA, include the following types of preventive services: well-woman visits; screening for gestational diabetes; human papillomavirus DNA testing for women 30 years and older; sexually transmitted infection counseling; HIV screening and counseling; FDA-approved contraception methods and contraceptive counseling; breastfeeding support, supplies, and counseling; and domestic violence screening and counseling. New health plans will need to include these services without cost sharing for insurance policies with plan years beginning on or after Aug. 1, 2012. More information on the women’s preventive services guidelines is posted at http://www.hrsa.gov/womensguidelines/.
Also, on Aug. 3, the Departments of the Treasury, Labor, and HHS issued a notice in the Federal Register with amendments to the interim final regulations implementing the rules for group health plans and health insurance coverage under ACA provisions regarding preventive health services. Regarding the women’s preventive services, the departments are amending the interim final rules to provide HRSA additional discretion to exempt certain religious employers from the guidelines where contraceptive services are concerned. The Federal Register notice is available at http://www.gpo.gov/fdsys/pkg/FR-2011-08-03/html/2011-19684.htm, and comments are due on or before Sept. 30, 2011.
On July 27, the Administration for Children and Families’ Office of Child Care (OCC) released a notice in the Federal Register requesting comments on proposed changes to the Child Care Quarterly Case Record Report (ACF-801). This report requires states and territories to submit monthly case-level data on children and families receiving services under the Child Care and Development Fund. The proposed revisions to the ACF-801 form would allow the OCC to gain more information from states and territories on provider quality for every child receiving child care subsidy. The revisions would also require states and territories to submit additional information on their quality rating improvement systems. The OCC requests comments from the public and government agencies within 60 days of the release of this publication. APHSA and its affiliate the National Association of State Child Care Administrators will hold an all-state call this month on these revisions and submit a comment letter to ACF. More information is available on the OCC web site at http://www.acf.hhs.gov/programs/occ/.
This Week in Washington is published by the American Public Human Services Association each week Congress is in session and on other dates. Editors: Larry Goolsby and Amy Plotnick. Writers: Rashida Brown (child care and child welfare), Christina Crayton (children and family services), Robert Ek (TANF and child support), Megan Lape (health), Bertha Levin (children and family services), Anita Light (children and family services), Nanette Relave (health), Rose Sloan (Policy and Programs Department intern), Ron Smith (legislative affairs), and Gary Terpstra (SNAP).
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