Senator Dempsey Files the Health Transformation Act of 2008

On Friday, Senator Tom Dempsey (R-St. Charles) filed SB1283.  This legislation has come at a time of much speculation after the Department of Social Services decided last week to pull the emergency rule to implement phase I of Insure Missouri.  At first glance, the components of this bill are very similar to recommendations from the Center on Health Transformation, an organization founded by Newt Gingrich.   It is important to note that while this legislation does establish the Insure Missouri Plan, it is unclear whether the program is the same as the Department’s plan.  Here is a summary of some of the major components of the bill: 

• Establishes a Missouri Health Cabinet and Health Policy Council; 
• Provides tax credits to small employers who do not provide health coverage for their  employees for the contributions they make to their employee’s health savings accounts;
• Requires school districts to comply with physical education requirements;
• Develops the Missouri Healthy Workplace Recognition Program for the purpose of granting official state recognition to employers with more than fifty employees for excellence in promoting health, wellness, and prevention;
• Requires the Department of Health and Senior Services to award a grant to implement an internet web-based primary care access pilot project designed as a collaboration between private and public sectors to connect, where appropriate, a patient with a primary care medical home, and schedule patients into available community-based appointments as an alternative to non-emergency use of the hospital emergency room.
• Expresses the state's recognition of the delivery of health care via telehealth as a safe, practical and necessary practice in the state.
• Creates the tobacco use prevention, and cessation fund.
• Establishes the Insure Missouri Plan;
• Denies reimbursement  to health care providers for the treatment of preventable errors, injuries and infections that occur under the providers' care;
• Requires coverage of prescribed medically necessary therapy services, including physical, occupational, and speech therapy under the Mo HealthNet program; and
• Requires the Missouri consolidated health care plans to include, as part of its covered benefits, all of the preventive benefits recommended by the federal U.S. Preventive Services Task Force.

Last week, the House Budget Committee heard reports from the various appropriations sub-committees with recommendations for cuts or additions to the Governor’s FY ’09 Budget. The Appropriations Committee for Health, Mental Health, & Social Services had originally recommended completely eliminating the Governor’s proposal for a transitional child care assistance program between 127% and 150% of federal poverty. However, it is now evident that federal funds can still be used to offer transitional assistance up to 139% FPL, which will allow a parent to earn up to $1 more an hour without losing all of her  child care subsidy benefits.

It also seems likely that children of veterans will receive some earmarked funds for mental health services in a new budget item of $650,000 for veteran’s family services. There was considerable discussion of the committee’s recommendation to allow FQHCs and Rural Health Clinics to utilize presumptive eligibility for children. Children found temporarily eligible could immediately receive all covered health services.  The family would then have 30 days to complete the Medicaid/MC+ application in order to continue the coverage. Of the 127,000 uninsured children in Missouri, an estimated 84,000 are eligible for state coverage but not enrolled. There has not been any funding request attached to this children’s health recommendation yet.

HB 2264, increasing the affordability of child care, was introduced by Rep. Grisamore (R-Lee’s Summit) last Wednesday with over a dozen bi-partisan co-sponsors. The bill establishes a goal of raising eligibility for child care assistance to 185% of federal poverty and raising child care provider reimbursement rates to the market rate by 2012. This would allow a family of 3 making up to $32,500 to receive assistance with child care costs ranging from $7,000 to $22,000 a year for two young children in Missouri. By reimbursing providers at the going market rate for child care in the region, HB 2264 will ensure that more providers can afford to serve subsidized children and that parents can afford to access high quality care.

HB 1946, sponsored by Rep. Franz (R-Howell County) was heard in the Special Committee on Family Services last Wednesday. HB 1946 reverses an income means-test requirement for the adoption subsidy program that was passed by the legislature in 2005 and subsequently ruled unconstitutional by the Missouri courts. Missouri’s Adoption Subsidy Program provides a monthly stipend to parents to help with the added costs of adopting a special needs and/or foster child that may need continuous services aiding in the recovery from abuse or neglect. The program helps ensure that more children transition out of the foster care system and into permanency. If the State Legislature does not pass HB 1946 this year, Missouri stands to lose $91 million in federal funding because our adoption subsidy program is out of compliance with the Federal Title IV-E program.

HB 1611, sponsored by Rep. Dixon (R-Springfield), establishes a children’s bill of courtroom rights to ensure that the special needs of child witnesses are addressed when testifying in court. The bill includes a child’s right to have a comfort item or a support person present during his/her testimony and requires that questioning of a child is neither intimidating nor frightening. During the hearing on HB 1611 in the Special Committee on Family Services last Wednesday, the bill sponsor and other witnesses highlighted the special needs of children who have been victims of abuse and who are required to testify against their abuser in court. A former foster youth and three witnesses from Greene County—a prosecuting attorney, a Child Advocacy Center, and the Junior League—testified in support of the bill.

Senate Appropriations:  Monday, March 3^rd at 11:30 am in SCR 2– will hear the Department of Social Services budget.

House Budget: Monday, March 3^rd at noon; Tuesday, March 4^th at 8 am in HR 3 – will hear HB 2002, the FY 09 budget for the Department of Elementary & Secondary Education.

SB 1127 (Rupp): Establishes the office of Autism services. Tuesday, March 4^th at 8:15 am in SCR 1 – Seniors, Families & Public Health Committee.

SB 1159 (Gibbons): Modifies provisions relating to forensic examinations of sexual offense victims. Monday, March 3^rd at 6 pm in the Senate Lounge – Judiciary Committee.

HB 1615 (Bruns): Changes the laws regarding protections for vulnerable adults and children. Tuesday, March 4^th at noon in HR 6 – Crime Prevention & Public Safety Committee.

HB 1360 (Flook): Changes the laws regarding the Interstate Family Support Act. Tuesday, March 4^th at noon in HR 1 – Judiciary Committee.

KANSAS LEGISLATIVE UPDATE

Thanks to our partners at Kansas Action for Children for providing this update. 

Bill Expands Parents as Teachers Without Funding

A flurry of activity this week resulted in a new bill that would give school districts the ability to use state funds to provide Parents as Teachers to older children.  Amended in committee by Senate Education Chair, Jean Schodorf (R-Wichita), SB 527 would expand the age of eligibility to the age of school attendance.  This expansion would be particularly important for 3-year-olds because they have very limited access to other state-funded early childhood services.   Carried on the floor by the bill’s original sponsor, Sen. Chris Steineger (D-Kansas City), the bill passed 36-3 with relatively little debate.  It will now go to the House of Representatives and will be referred to the Education Committee.

The bill, however, does not actually increase access to Parents As Teachers because it contains no funding.  The program already has a waiting list of over 4,500 families and more than 70 school districts do not have a program.   Not included in the Governor’s proposed budget, it is estimated that $2.6 million is needed to eliminate the waiting list for services.  The next step for the budget is the House Education Budget Committee deliberations on Wednesday, March 5. 

Early Childhood Governance Bills Move Forward

The Senate Education Committee deliberated and approved SB 407 on Feb. 26. This bill would move administration of Early Head Start and Pre-Kindergarten pilots to the Department of Education. It passed the Senate 37-2 with no debate. It will now go to the House of Representatives where it faces an uncertain future. The Committee quickly passed over SB 408, the more controversial bill that would move administration of the infant-toddler special education program (Tiny-K). It is unclear if they will take up the accompanying SCR 1614. Under federal law, the Governor has the sole authority to designate the lead agency for Tiny-K.

More than 100 advocates gathered at the Statehouse on Feb. 26 to meet with legislators and urge support for early childhood programs and the proposed early childhood block grant. Business leaders Barry Downing of Wichita and Bill Nelson of Kansas City appeared before a packed House Appropriations Committee. Downing, Nelson and school administrator Dr. Larry Dixon were featured speakers at a luncheon for advocates and legislators that addressed the importance of investing in early learning opportunities. Click here to read more about Early Learning Day from the Kansas Health Institute News Service.

After several days of hearings, the House Federal and State Affairs Subcommittee on Child Care decided Feb. 27 to table HB 2003, HB 2053, and HB 2851. The Subcommittee expressed an interest in giving the Kansas Department of Health & Environment time to move forward with discussed improvements. The agency will report back to the committee in four weeks.

The Senate SRS Budget Subcommittee will hold hearings next week on the SRS budget. This budget contains funding for the Children's Cabinet, the new Early Childhood Block Grant and other key early childhood programs. Kansas Action for Children will testify on Thursday, March 6, in support of early education funding and the Child Care Assistance Program.

Join us Wednesday, March 12, for Health Advocacy Day in Topeka. Co-hosted by the Kansas Faith Alliance for Health Reform, Kansas Health Consumer Coalition and Kansas Action for Children, this event is an opportunity to learn more about advocacy and how you can be part of the health reform discussion among policymakers. For more information, click here to download the agenda. To attend, please RSVP to rsvp@kac.org by March 5. 

On Feb. 27, the House Insurance and Financial Institutions Committee passed out HB 2904, which ties insurance proceeds to child support enforcement by allowing computer matching of insurance claims and child support arrears. It is unclear at this point whether the bill will pass the full House.

FEDERAL

Administrative Regulations Put Vulnerable Children at Risk

On March 3, a harmful CMS rule is scheduled to take effect if Congress does not act immediately. Issued on December 4, 2007, the Medicaid Program: Optional State Plan Case Management Services rule (CMS- 2237-IFC) would significantly alter states use of federal Medicaid dollars for targeted case management services (TCM) leaving many vulnerable children at risk. TCM links many foster care children with vital services from health care to education to housing. If this new regulation takes effect as scheduled, Missouri will be severely limited in their ability to care for thousands of vulnerable children and youth in foster care – leaving many of these children at greater risk. Partnership for Children recently signed on to a letter calling on Congress to pass S. 2578/H.R. 5173, introduced by Sen. Norm Coleman and Rep. Keith Ellison, which would effectively delay the implementation of the rule until March 2009. If implemented, these rules will jeopardize the effective treatment of a wide variety of medical, behavioral, and psychological needs of children.   The Center on Budget and Policy Priorities has published two issue briefs highlighting these changes.  For more information, click on the following publications: 

Orris, Allison and Judith Solomon.  “Adminstration’s Medicaid Regulations Will Weaken Coverage, Harm States, and Strain Health Care System,”  Center on Budget and Policy Priorities, February 22, 2008.  Available online: http://www.cbpp.org/2-13-08health.htm.

Solomon, Judith.  “New Medicaid Rules Would Limit Care for Children in Foster Care and People with Disabilities in Ways Congress Did Not Intend.”  Center on Budget and Policy Priorities, Revised February 8, 2007.  Available online: http://www.cbpp.org/12-21-07health.htm

Representative Jim McDermott (D-WA) recently introduced the Invest in KIDS Act, H.R. 5466. McDermott is Chair of the House Subcommittee on Income Security and Family Support, the key subcommittee to the child welfare community.

The new bill encompasses the following key principles for a major child welfare reform proposal: federal support for all children in care, more flexibility in the use of funds to provide key services, support for kinship families, expanded access to federal funds by tribal communities, expanded support for youth, and funding to address the workforce shortage in child welfare.