MISSOURI LEGISLATIVE
UPDATE
SENATE PASSES FY ’09
BUDGET
Last week the
Missouri Senate took up and gave approval to the FY ’09
Missouri State Budget.
The final stage of the budget process, conference
committee, will begin this week as legislators from both
chambers debate the differences between the two houses.
Thursday’s
debate on House Bill 2011, the budget bill for the Departments
of Social Services remained relatively uneventful. Senator Chuck Graham
offered an amendment related to forensic sexual assault exams
but ultimately withdrew his amendment without a vote. Senator Jeff Smith,
offered an amendment to restore the Governor’s
recommendation to include dental and optical benefits as part of
the MO HealthNet program.
This amendment was defeated 11-22. It may come as a
surprise to many, that some of the “health care
champions” voted against this amendment, however, these
were members who serve on the Appropriations committee. Since that committee
works on consensus, it was expected that appropriations members
would vote in a block against any amendments. Sen. Yvonne Wilson and
Sen. Joan Bray broke with their committee and voted to support
this amendment.
In addition,
Partnership for Children has been working tirelessly to support
the Governor’s entire child care benefit package. As you may recall, the
Governor’s recommendation for this program totaled $8.5
million dollars. The House cut $2.4 million dollars in general
revenue for a total of $6.1 million dollars. The Senate
Appropriations Committee supported the House’s
position. Last
week, child care champion Senator Jolie Justus offered an
amendment to restore the Governor’s $2.4 million dollar
general revenue request.
This amendment was defeated 10-22; therefore, this line
item is closed and will not go to conference.
This week, as the
conference committee begins their work, Partnership for Children
will continue to lobby for $3.3 million general revenue dollars
to help reach out to eligible yet uninsured children through an
outreach strategy known as presumptive eligibility. This line item was
included in the House’s recommendation after an amendment
by Rep. Ryan Silvey was adopted in the House Budget
committee. In
addition, here is a list of items related to children and
families still left for
conference:
Foster
Care Rate Increase: House recommended a 4% increase
($1.3m total); Senate recommended 2% increase ($0.6
total)
Adoption
Subsidy/Guardianship Rate Increase: House recommended 2%
increase ($1.2m total); Senate recommended 3% increase ($1.7m
total)
Residential Treatment Rate
Increase:
House recommended a 6.64% increase or $5/day ($2.8m
total); Senate recommended a 2% increase ($1.3m
total)
Insure
Missouri: House recommended $0;
Senate recommended $395.1m total ($25m GR), however a bill must
pass in order for the program to be funded.
Youth
Smoking Prevention: House recommended $2m dollars; Senate
recommended $0
The budget must be
completed by 6 pm on May 9th.
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REPORT ON BILLS HEARD IN COMMITTEE
THIS WEEK:
HOME VISITING PROGRAM
EXPANSION
HB2423 (Holsman) adds home nursing
visits and follow-up care as needed until an infant's second
birthday for certain at-risk newborns to the list of covered
services under the MO HealthNet Program. Home visiting is a
long-standing, well-known prevention strategy used by states and
communities to improve the health and well-being of women,
children, and families, particularly those who are at risk.
Early investments in home visiting programs have been shown to
reduce costs due to foster care placements, hospitalizations and
emergency room visits, unintended pregnancies, and other more
costly interventions.
States’ primary reasons for launching home visiting
programs include improving parenting skills, enhancing child
development, and preventing child abuse and neglect. Other goals
include: improving
pregnancy and birth outcomes; enhancing the maternal life
course, such as employment and education; and improving child
health by promoting preventive health services such as
immunizations and well-baby
check-ups.
Currently, states fund their home
visiting programs through a number of different funding streams
including Medicaid, the State Children’s Health Insurance
Program, The Title V Maternal and Child Health Services Block
Grant, and TANF.
About a dozen of the nearly 30 states with home visiting
programs cover this service under their Medicaid program, either
through reimbursement rates, targeted case management dollars or
targeted case management administrative
funds.
Others who testified in support
included Nurses for Newborns, Former State Senator Patrick
Dougherty and current State Rep. Rachel Storch, both current
board members of Nurses for
Newborns.
INSURANCE COVERAGE MANDATE FOR
AUTISM
The House Committee on Health Care
Policy met last Tuesday to discuss two bills that would require
private insurance companies to cover the diagnosis and treatment
of children with autism spectrum disorder. The bills originated
from a recommendation from Missouri’s Blue Ribbon
Panel on Autism established by Senate President Pro-Tem Michael
Gibbons last year.
HB 2265, sponsored by Rep. Grisamore
(R-Lee’s Summit), and HB 2351, sponsored by Rep. Page
(D-St. Louis County), both include a maximum coverage cap of
$50,000 for treatment services but differ slightly in the age
ranges of children to be covered by the mandate; HB 2265
requires coverage for children up to age 16 while HB 2351
extends up to age 21.
Witnesses in support of the bill
testified that Autism is currently the only neurological
condition excluded from private insurance coverage, that
mandatory coverage is estimated to raise overall insurance
premiums by only .5 to 1%, and that early diagnosis and
intensive intervention can create significant savings down the
road by increasing the likelihood that autistic children grow up
to be independent, fully functional adults. Several insurance
companies in Missouri testified in
opposition to the bills.
Similar legislation in the Senate, SB
1122 sponsored by Senator Ridgeway (R-Clay County), was voted
out of the Senate Committee on Small Business, Insurance, &
Industrial Relations last Tuesday.
CRIMINALIZATION OF PRENATAL SUBSTANCE
ABUSE
Last Tuesday, PFC testified before the
House Committee on Crime Prevention and Public Safety in
opposition to HB 1795, sponsored by Rep. Darrell Pollack. This bill creates the
crime of endangering the welfare of an unborn child if a person
uses heroin, cocaine, LSD, or methamphetamine while she is
pregnant and knows or reasonably should have known that she was
pregnant. In
addition, any healthcare provider who has reason to believe that
a pregnant woman has used heroin, cocaine, LSD, or
methamphetamine may make a report to the appropriate law
enforcement agency.
Research indicates that women are far
less likely to obtain preventive and primary health care during
pregnancy when there is a threat of criminal prosecution. This has been documented
by studies. In
South
Carolina, following the state Supreme
Court case that criminalized any behavior that might endanger a
fetus, the infant mortality rate increased. Also, research indicates
that the threat of incarceration has been ineffective in
reducing the incidence of alcohol and drug use, and removing
children from the home may subject them to worse risks in the
foster care system.
Drug and alcohol abuse is a complex
and treatable illness.
We must find preventive ways to address the needs of
women with alcohol and other substance abuse problems by
investing our time and resources in targeted mental health and
substance abuse treatment services.
Several groups went on record in
opposition to this bill including the Missouri Coalition Against
Domestic and Sexual Violence. In addition, many nationally
respected health organizations such as the American Medical
Association, American
Academy of Pediatrics,
American College of Obstetricians
and Gynecologists, American Nurses Association, the American
Public Health Association, and the March of Dimes also oppose
this type of legislation.
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HOUSE PASSES
SALES TAX FOR VETERANS’
SERVICES
Last Thursday the
House passed a constitutional amendment (HJR 71) authorizing a
statewide one eighth of 1% sales tax to fund veterans’
homes, services, and programs. If approved by voters, the sales
tax would produce $103 million for veterans’ services in
FY ‘2011 but the veterans would also relinquish all
funding from state general revenue, about $37 million.
Currently, the MO Veterans Commission receives approximately
$6-$9 million each year from the Gaming Commission Fund, which
also funds several early childhood programs. If the ballot
initiative is approved, the Gaming Commission Fund would need to
be statutorily changed to remove the veterans as a beneficiary,
which would likely transfer much needed funds to quality early
childhood initiatives. For many years these two vulnerable
constituencies, children and veterans, have had to fight for
limited funding that does not address the true need for services
for both groups. A dedicated sales tax for veterans would
relieve this conflict, but appropriations from the Gaming
Commission alone cannot come close to fully funding needed
expansions for quality early care & education programs that
prepare our youngest Missourians for future educational
success.
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EARLY CHILDHOOD BOARD TO CONVENE
SCHOOL READINESS
PANEL
Missouri’s Coordinating Board for Early Childhood has
assembled a task force that will convene three times this summer
and fall to more fully examine and advance the issue of early
childhood education. Decades of research show that experiences
in the earliest years of life are critical for future
educational success in K-12 and college, yet Missouri’s publicly
funded Preschool Project only serves 4% of our four-yr-olds in
the state. As more Missouri
superintendents and school districts are looking to expand pre-k
access, concerns have arisen that Missouri
may be developing a patchwork system of early education that
does not promote equal quality and access across the
state.
Members of this
School Readiness Task Force will explore several issues,
including: what the State’s vision for pre-k should be;
which age and economic groups should be served; whether all
publicly funded programs should be required to meet similar
standards; and how oversight of programs should be structured.
Partnership for Children is hopeful that the task force will
produce recommendations this fall that will meet the approval of
our incoming governor at the beginning of his/her first
term.
