On Oct. 15, the Social Security Administration announced that, for the second year in a row, it will not provide a cost-of-living adjustment for Social Security recipients. The decision has many in the House and Senate looking to pass a one-time $250 payment to Social Security recipients during the lame-duck congressional session that will convene after the November elections. The SSA denied the cost-of-living adjustment because inflation has not increased enough to warrant another adjustment. The $250 payment to eligible seniors is supported by the Obama administration and by a number of interest groups, but is expected to face tough opposition in the Senate; a similar bill there stalled in March, 13 votes short of overcoming the 60-vote procedural threshold to move forward with a vote. The SSA press announcement on the issue is available at http://www.ssa.gov/pressoffice/pr/2010cola-pr.htm.
A new report from the Kaiser Family Foundation shows that Medicaid spending and enrollment growth has far exceeded state projections. The study says that total Medicaid spending growth averaged 8.8 percent in fiscal year 2010, the highest rate of growth in eight years, and well above the projected 6.3 percent. Enrollment is expected to continue to grow in 2011, but at a much slower rate. State costs for Medicaid actually dropped for the first time in the program’ s history during FYs 2009 and 2010 due to the receipt of American Recovery and Reinvestment Act federal spending, but despite this decreased state spending, nearly every state implemented at least one new Medicaid policy to control future spending, according to the report. States’ increased efforts to manage Medicaid programs in the midst of budget shortfalls included increasing managed care programs and introducing health information technology as avenues to generate savings. ARRA helped to protect—and in some cases expand—eligibility for Medicaid, but ARRA funds are set to expire in June 2011, which will result in a dramatic increase in revenue needs for states to cover Medicaid enrollment. So far, however, the report indicates that states have been able to meet their Medicaid obligations and seem to remain optimistic about the implementation of health care reform and future efforts to improve their Medicaid programs. The report is available at http://www.kff.org/medicaid/8105.cfm.
On Oct. 19, the Office of Management and Budget released a memorandum on pilot projects for the Partnership Fund for Program Integrity Innovation. There is a four-step selection process for pilots. First, there is a submission of a pilot "idea," defined as innovative suggestions submitted by states, federal agencies, and other stakeholders. After the pilot idea is submitted, it is refined into a pilot "concept." Federal agencies will confer with interested state, local, and other stakeholders as pilot ideas are developed into pilot concepts. The next state is review by a Federal Steering Committee review and OMB approval. At this stage, a federal agency must commit to taking the lead on implementation of the pilot as well as provide a preliminary cost estimate and evaluation plan. Finally, the OMB transfers funds to the lead federal agency; that agency will in turn conduct a merit-based process to select specific states, localities, or other relevant entities to participate in the pilot. The full memorandum is posted at http://www.whitehouse.gov/omb/memoranda_default/.
On Oct. 14, U.S. District Judge Roger Vinson for the Northern District of Florida ruled to allow parts of a lawsuit against health care legislation to advance. The ruling was not on the merits of the case, but instead considered the possibility of the individual mandates as being unconstitutional. The suit has been brought by Florida and 19 other states, and was filed by mostly Republican state attorneys general shortly after the law’ s passage. They and other opponents of the health care law cited the ruling as a step toward repealing the law, which was signed by President Obama on March 23. The judge will continue the hearing on Dec. 16 to hear arguments on the merits of the case. The Obama administration expects the law to be upheld and eventually dismissed by courts. Most observers expect the U.S. Supreme Court to rule on the matter within the next two years, before many of the law’ s mandates take effect in 2014.
On Oct. 21, the Association of Maternal and Child Health Programs sponsored a forum titled, "Looking to the Future: Opportunities and Challenges in Health Reform for MCH." State and local agency members were among the many attendees who heard speakers discuss the Affordable Care Act. One session was on "the new law of the land" that state and local agencies are trying to implement at their levels. Martha King, group director of the Health Program with the National Conference of State Legislatures, and Kathleen Nolan, director of the Health Division of the National Governors Association, said many challenges have slowed down or halted the implementation efforts of state legislatures. Nolan said health care reform has proved difficult in light of fiscal problems facing most states, and many are having to make difficult decisions with the limited time and resources at their disposable, not all of which affect health care. Rick Fenton, acting director of APHSA’ s Health Services Department, was also among the speakers.
The speakers also cited anxiety about the gubernatorial transitions this fall, which could potentially result in more than 30 political changeovers. Moreover, Medicaid expansion has proved to be a difficult reality for some legislatures that have not had much previous experience dealing with it; some states find it challenging to consider long-term expansion by 2014 when they are already concerned about having sufficient infrastructure and staff to get through the next year alone. The speakers said the major priority for states right now is the development of health insurance exchanges, and the issue remains as to whether all states will do them; all but two states have applied for and will receive grants to develop them. Notwithstanding all these uncertainties, the speakers remained optimistic that states are on their way to acceptance and successful development, noting that the states have been innovators in reform, and many proposals within the legislation came from state examples. Already, 35 states have high-risk pools in place; most states have expanded Medicaid beyond minimum requirements; and Massachusetts and Utah have exchanges up and running. More details are posted at http://www.amchp.org/SiteCollectionDocuments/Health%20Reform%20and%20MCH%20Conference%20Program.pdf.
The Centers for Medicare & Medicaid Services on Sept. 8 issued a CMCS Informational Bulletin (http://www.cms.gov/CMCSBulletins/CMCSB/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=ascending&itemID=CMS1239214&intNumPerPage=10) reminding states about the process and a template for requesting a FY 2010 bonus payment for CHIPRA (the Children’ s Health Insurance Program Reauthorization Act of 2009, P.L. 111-3). The agency provided information on a "Bonus Payment" calculator template for states to use in determining an estimate of the potential amounts of their FY 2010 bonus payments, with a file that is populated with most of the data needed to calculate the FY 2010 bonus amount. Each state would only need to enter the number of monthly average unduplicated "Qualified Children" for FY 2010 in Medicaid. A more detailed description of the bonus payment calculation is contained in the State Health Official Letter SHO #09-015 issued in December 2009 and other materials the agency has recently provided. Appendix II on page 9 of the December 2009 letter has additional details and can be accessed at http://www.insurekidsnow.gov/images/sho_letter.pdf.
On Oct. 19, the U.S. Department of Health and Human Services announced new Consumer Assistance Grants program awards of nearly $30 million that the department says will help states and territories put patients in charge of their health care. These grants are designed to support states’ efforts to establish or strengthen consumer assistance programs that provide direct services to consumers with questions or concerns regarding their health insurance. The grants will allow states, in some cases partnering with local nonprofits, to help strengthen and enhance efforts to protect consumers from adverse insurance industry practices. Altogether, 35 states, four territories, and the District of Columbia applied for and will receive grant awards. The grants will build on other programs and initiatives recently announced by the department to help consumers make decisions about their care, including www.HealthCare.gov, where consumers already can find information about health insurance options, benefits, and rights under the Affordable Care Act. State consumer assistance programs also will help consumers act on their new right to appeal if their insurance plan denies them coverage. More details are at http://www.healthcare.gov/news/factsheets/CAPGrants.html.
On Oct. 19, the Office of Child Care held a day-long symposium to celebrate the 20th anniversary of the enactment of the Child Care and Development Block Grant Act and to discuss the future of the program. The event recognized longtime leaders in the field of early care and education as well as members of Congress who have been strong supporters of the CCDBG. The celebration reviewed the accomplishments over the last 20 years that have supported access to high-quality child care and school readiness for children of low-income working families. Speakers and panelists described the various ways that CCDBG legislation has helped working families in achieving economic self-sufficiency. Some of the speakers included Health and Human Services Secretary Kathleen Sebelius; Deputy Assistant Secretary Joan Lombardi; Shannon Rudisill, director of the Office of Child Care; Roberto Rodriguez, White House special assistant on education; and Deborah Phillips, professor of psychology at Georgetown University. Participants included senior officials from the Administration and Congress, CCDBG administrators, researchers, advocates, parents, and providers. Additional information is available at http://www.ccb-cmc.org/CCDBG.
APHSA and its affiliate the National Association of Public Child Welfare Administrators have submitted responses to the Children’ s Bureau July 23, 2010, Federal Register notices requesting comments on changes in the Adoption and Foster Care Analysis and Reporting Systems and Statewide Automated Child Welfare Information System. To ensure that the responses aligned with the state challenges, solutions, and priorities, NAPCWA established work groups for the two automated systems. The responses are posted at http://www.napcwa.org/Home/home_news.asp.
This Week Will Publish Again on Nov. 5
With Congress still on recess for the fall election campaign, This Week in Washington will not publish next week but will resume publication on Nov. 5.
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 Frank Solomon. Writers: Rashida Brown (child welfare), Ilana Cohen (health), Jordon De La Cruz (legislative affairs intern), Robert Ek (TANF, child support), Sue Hall (SNAP), Courteney Holden (child and family services), Kristen Knuth (communications intern), Bertha Levin (child and family services), Poornima Nayak (health), Ngozi Onunaku (child care), Bob Proctor (legislative affairs intern), Nanette Relave (health), and Emily Wengrovius (legislative affairs).
Prior to the congressional adjournment, Rep. Pete Stark (D-Calif.) introduced the Foster Children Self-Support Act, H.R. 6192. This bill is designed to ensure that foster children’s Social Security and Supplemental Security Income benefits are used to address their specific needs and are not used as a revenue source. State or local government agencies serving as a representative payee of such youths are prohibited from using more than 50 percent of the young person’s SSI or Social Security benefits for foster care maintenance payments. H.R. 6192 adds new state plan requirements under Title IV-E that would mandate the screening of foster youth for potential eligibility for SSI and Social Security benefits within 60 days of being in care. This would also be included as a procedure for the six-month case review. Moreover, if the foster child is determined eligible, the state must assist the child in applying for, and if necessary appealing, any decisions made with respect to the child’s benefits.
The bill’s new state plan requirements would also include developing a child-specific plan on how the remaining funds will be used for current and future needs, such as educational or employment purposes. Set-aside funds would be conserved and inaccessible to the child and placed into an account until the child turns 18 years old or is no longer in the custody of the state. These funds could be used for purchasing a vehicle, operating a business, paying for medical expenses, and similar purposes. The bill authorizes the Department of Health and Human Services to provide states with technical assistance on carrying out these provisions. The bill also appropriates $4.5 million for the first year for states to meet these requirements and such sums as necessary thereafter. The text of H.R. 6192 is available at www.thomas.gov.