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Focusing on a variety of education, health and youth development issues of importance to children and families in Pennsylvania.

Pennsylvania Commits to Continued Medicaid Coverage for Former Foster Youth

As we’ve noted, Pennsylvania is one of 14 states that extends Medicaid health insurance coverage until age 26 to youth who have aged out of the foster care system in another state. Last fall, the Center for Medicaid and CHIP Services released a bulletin detailing the steps a state must take to continue to offer this coverage, which is allowed under Section 1115 of the Social Security Act. In January, the Department of Human Services held a public meeting in which it was announced that the state would continue to support Pennsylvania young adults who have aged of foster care, regardless of what state they’re from, by completing the necessary waiver application.

The 1115 waiver plan, due in May, will ensure that the 18 former foster youth from other states currently covered under the Medicaid state plan will continue their coverage, and ensure additional youth who move to PA will be eligible for coverage as well.

To protect the overarching Medicaid to 26 provision of the ACA, our partner, Juvenile Law Center, recently collected signatures from current and former foster youth affected by the provision. The signatures were added to a letter to Congress, asking members to ensure that this provision is protected as efforts to change health care law are undertaken in the coming months. In addition to the letter, on Wednesday, signers and other supporters of the ACA were encouraged to participate in a national “call in day”, calling their Representatives and Senators to explain how the law affects current and former foster youth, and why it’s important to save it.

Here in Pennsylvania, over 700 youth aged out of the foster care system in 2016, while over 20,000 did so nationally. These young adults are more likely than their peers to experience health issues requiring medical insurance coverage due to the experiences in and prior to foster care, such as exposure to trauma, abuse and neglect.

The state has already committed to providing this vital coverage to all former foster youth in Pennsylvania, regardless of where they spent time in care. The call in day and letter, which can be found here, argue that our federal government should do the same. 

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How the Governor's 2017-18 Budget Proposal Affects Kids

On Tuesday, Governor Wolf presented his 2017-2018 budget proposal, using a different approach to addressing the state’s growing fiscal deficit: rather than proposing a broad-based tax increase, his plan instead calls for notable changes to the operations of state government, including merging the Departments of Human Services, Health, Aging and Drug and Alcohol Programs into one entity, which would be called the Department of Health and Human Services.

The Governor’s proposal includes the following investments that affect children and youth in the Commonwealth:

  • $65 million in additional funding for the state’s Pre-K Counts program and an additional $10 million for the Head Start Supplemental Assistance Program.
  • An additional $9 million investment in evidence-based home visiting programs that would support 1,700 additional families.
  • A $35 million increase in state funds for child care - including $10 million that will make it possible for 1,800 kids currently on state waiting lists to enroll in a child care program.
  • A $100 million increase for Basic Education Funding to be driven out through the newly-enacted student-weighted formula that would increase the state’s fair share of providing basic education services to students.
  • An increase of $25 million for special education funding through the enacted Special Education Funding Formula.
  • An increase of more than $57 million designed to meet the goals of county child welfare needs based budgets.
  • Continued state funding for both the Medicaid and the Children’s Health Insurance Program (CHIP).

You can find PPC’s full coverage of the budget proposal including all line items related to children’s investments here.   

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What’s Next for Child Welfare in 2017

The coming year is expected to be busy for federal programs and policies that affect children which, in some cases, will subsequently effect state legislative work as well. As we wrote last week, attempts to repeal and replace the Affordable Care Act may negatively affect not only children and youth in foster care, but also biological, resource and adoptive families who receive supports through grants at risk of elimination.

Additional topics of interest for lawmakers, child welfare professionals and advocates alike include home visiting programs, child welfare finance reform, and educational stability provisions for foster youth. See below for what’s next in 2017 for these three priorities:

Home Visiting

The federal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program will be up for reauthorization in 2017. Here in Pennsylvania, four evidence-based home visiting models are currently funded through the MIECHV program: Early Head Start; Healthy Families America; Nurse-Family Partnership; and Parents as Teachers. In these services, nurses and other trained professionals visit families with infants and toddlers to provide parent education and support and promote their children’s health, well-being, learning and development. In March 2010, Congress authorized the creation of the MIECHV program to promote evidence-based home visiting programs that strengthen health and development outcomes for at-risk children and their families. Originally authorized for five years, Congress extended MIECHV funding for two additional years in 2015; absent Congressional action, MIECHV will expire in September 2017. PPC will not only continue to pursue federal reauthorization, but also advocate for an increased state appropriation to better support these services in the commonwealth in 2017 and beyond.

Finance Reform

Federal child welfare finance reform was a national topic of conversation in 2016 with the roller coaster development of the Family First Prevention Services Act (FFPSA). Passed unanimously in the U.S. House in June, the bill subsequently died in the U.S. Senate, before undergoing two seeming resurrections through the 21st Century Cures Act and the Continuing Resolution (the provisions did not make it into the final iteration of either). The FFPSA makes needed and important reforms to many federal child welfare financing mechanisms to support prevention efforts and reduce congregate care placements for foster youth. It seems likely we will see a new version of the FFPSA in early 2017, but it remains to be known what form it may take as many of the cost-savings provisions were only possible if passed during this recent legislative session. PPC fully supports efforts targeted at reducing the use of congregate care and increasing family-based placements for youth in foster care, and will continue to support the bill’s re-introduction and passage in 2017.

Educational Stability

On December 10, 2016, provisions included in the federal Every Student Succeeds Act (ESSA) that affect students in foster care went into effect. As we noted previously, a portion of the law requires states to allow these students to remain enrolled in their same school when entering foster care or experiencing a placement change, unless remaining in the same school would be a risk to the child's safety or well-being. Local education agency transportation plans are due to the Pennsylvania Department of Education by January 31, 2017, which will outline exactly how school districts and child welfare agencies plan to coordinate to ensure students in foster care are not only provided school stability, but are also provided transportation to their original school as needed. Pennsylvania failed to codify any of the federal law into state statute, though amendments to Title 42 passed in the Senate this fall. PPC will continue to monitor the need for such legislation in 2017, and ensure the ESSA is being implemented to its full fidelity, ensuring foster youth receive the right of a safe and stable school placement.

Projecting activity between sessions is a challenge, particularly in years of a presidential transition. While we can’t predict what will happen in 2017, PPC remains committed to working to enact policies and programs that ensure all children are raised in loving families free from abuse and neglect.

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New Videos Help to Prepare Families for Post-Permanence

The Quality Improvement Center for Adoption and Guardianship Support and Preservation (QIC-AG) - a five-year project to test and implement interventions that achieve long-term, stable permanence in adoptive and guardianship homes – recently released two videos to create awareness of the need to support families not only in the pre-adoptive or guardianship stage, but continuing after permanency has been achieved.  

The first video describes a “continuum of service needs” which the project describes as a “way to visualize a family’s lifelong adoption or guardianship journey”.  In order to maintain family stability and promote healing for children who have experienced trauma, families’ must receive services along this continuum – preparation prior to the child’s placement, support during the child’s placement, and continuing support after the placement is finalized. The continuum framework includes eight intervals that represent various needs that might appear for the family adopting or providing legal guardianship to a child in foster care.

 

Both placement instability and experiencing trauma have been linked to a number of negative outcomes for youth, such as increased behavioral symptoms, lower academic achievement and poor developmental, social, and emotional functioning in adulthood. By recognizing the need to strengthen ongoing permanency services for these children and ensure these services do not end once permanency in achieved, the QIC-AG is taking a vital step forward in ensuring all children in foster care not only become part of a permanent family, but thrive throughout their lives.

The QIC-AG project is working across eight sites to implement eight different interventions with the ultimate goal to replicate and/or adapt the interventions to other states if proven effective. The second video describes the project sites more in-depth; together, the videos provide a powerful way to raise awareness among the public of the need to continue serving these families after permanency is achieved.

To watch both videos and share with your own networks, click here.

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How Repealing the ACA Affects Children and Youth in Foster Care

As we have previously noted, the Affordable Care Act (ACA) contains a key provision for youth aging out of foster care – under the law, states are required to provide Medicaid health insurance coverage for youth who were in foster care in their state, up until age 26. This policy mirrors the ability of youth not in foster care to stay on their parent’s health insurance until the same age. Pennsylvania even goes a step further and provides this coverage to young adults who aged out of foster care in another state.

Recent proposals by Congress and President-elect Trump to repeal the ACA and convert Medicaid into a block grant would strip this right from youth who are already at risk of experiencing various negative adult outcomes. Research shows that youth who age out of foster care are at greater risk of unemployment and homelessness than their peers who don’t experience foster care. Continued health coverage protects these same young adults from these risks.

Further, while a block grant may sound like a simpler way to fund the Medicaid program, this action risks destabilizing state budgets. A capped federal payment for these services doesn’t take into account the flexibility required should we face another recession, or the increase in health care needs of an aging baby boomer generation. States may find themselves cutting costs that hurt children and youth the most – such as prevention and other nonprofit children and family services – or freezing state staff hiring when these positions are vital to the health and well-being of children in state care, when faced with budget cuts in order to meet any unexpected increased need.

Child welfare agencies have long relied on Medicaid coverage for youth in foster care, and some states, including Pennsylvania, have expanded the program to cover low-income adults. Birth parents who receive substance abuse, mental health and other medical services as they work to provide a safe and stable home for their children are one group who is now served through this program.

Repealing the ACA without a sustainable replacement plan in place would double the number of uninsured children, and remove a vital service to one of our nations’ most vulnerable populations.

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Repeal of the ACA Would Double the Number of Uninsured Kids

One of the great success stories of the past two decades has been the increase in the number of American children who have health care coverage. We just celebrated the fact that our nation achieved the historic milestone of 95 percent of children with health care coverage.

Now Congress is considering a hasty, ill-conceived plan that would take our country on a U-turn. The number of uninsured children would double nationwide if Congressional leaders succeed in rushing forward with their risky plan to repeal the Affordable Care Act (ACA) without simultaneously replacing it. 

According to a new analysis from the Urban Institute, here in Pennsylvania, an estimated 956,000 would lose coverage - including many children, families, disabled individuals and people with pre-existing conditions such as cancer, diabetes and heart disease. 

Keeping our children healthy is key to many of the state’s goals. Asthma, diabetes, even tooth decay can keep children home from school, leaving them to fall behind academically.  Sick children can keep parents home from work, affecting their productivity. Healthy communities are prosperous communities, vital to our state's economic success.

A repeal of the ACA would also create chaos in Pennsylvania's health care system and wreak havoc on our state budget. Over a 10-year period, Pennsylvania would lose $36 billion in federal funding to meet the health needs of its residents.  Our governor and legislature already have their work cut out for them and the health care needs of Pennsylvania children and families won’t disappear when they lose their coverage.

Yet Congressional leaders tell us and our state legislators not to worry. They ask us to trust them in developing a replacement when they have been unable to agree on any such plan in the past six years. 

The stakes are too high for us to hope this time will be different. A repeal would simply pass the buck and leave Pennsylvania with a huge hole in its budget and our health care safety-net.

Voting to repeal the ACA without a replacement plan attached is not responsible governing; it’s a risky step that threatens the health of children and families.

Our elected leaders in Washington, D.C. should show responsibility and forethought by not rushing forward to repeal the ACA before they have done the hard work to negotiate and approve a replacement plan simultaneously. They owe all Pennsylvanians that much. 

To see the Urban Institute's full analysis, click here.

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National Foster Care Population Continues to Rise Says Federal Report

Last week, the Administration for Children and Families (ACF), within the Department of Health and Human Services, released new data from the Adoption and Foster Care Analysis and Reporting System (AFCARS) for fiscal year 2015. This data reflects a one-day snapshot total of youth in foster care in the United States from September 30, 2015, in addition to demographic information, type of placement and case plan goal, and entry and discharge information for children who entered and exited foster care throughout the fiscal year. 

Per the report, there were 437,910 children and youth in foster care in 2015, a 3.4 percent increase from 2014 and the third year in a row in which numbers increased from the previous year. These recent increases follow a fourteen-year period of decline. Additionally, 71 percent of states reported an increase in the numbers of children entering foster care in the past year, with the five largest reports coming from Florida, Indiana, Georgia, Arizona, and Minnesota.

ACF stated in a press release that the reason for the increase may be contributed to increased parental substance use, as removal due to parental substance use increased 13 percent from 2012 to 2015. The press release called for increased collaboration across service providers and community leaders to address this need, and noted the Children’s Bureau’s regional partnership grants program as one such program that seeks to improve the safety, permanency and well-being of children who have been removed from their homes because of parental substance abuse.

To review the data in its entirety, you can find the report here.

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National Adoption Month 2016: We Never Outgrow the Need for Family

Each November, the nation comes together to celebrate National Adoption Month, an initiative of the Children’s Bureau within the U.S. Department of Health and Human Services, Child Welfare Information Gateway and Adopt U.S. Kids. The goal of National Adoption Month is to increase national awareness and bring attention to the need for permanent families for children and youth in the U.S. foster care system. On September 30, 2015, over 111,000 children were waiting to be adopted across the nation, according to the Adoption and Foster Care Analysis and Reporting System (AFCARS).

This year, the initiative focuses on older youth adoptions, with a theme that reflects these youths' desire to be involved in conversations and decisions regarding their future: We Never Outgrow the Need for Family- Just Ask Us. To help potential adoptive parents explore the decision to adopt an older youth, engage in conversations with older youth about adoption, and build lifelong relationships with the youth in their care, the National Adoption Month website features several resources, such as tip sheets, fact sheets, videos and podcasts.

Of all Pennsylvania children and youth served in foster care in 2015, 3,962 had a permanency goal of adoption; 525 of these youth were older than 12. Since we know youth who age out of the foster care system without achieving permanency risk experiencing several poor outcomes in adulthood, securing lifelong, caring adult connections is a vital part of ensuring their future well-being.

To learn more about becoming a permanent resource for an older youth in foster care in Pennsylvania, visit adoptpakids.org. And remember, you don’t have to be perfect to be a perfect parent.

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Gov. Signs Bill Bringing PA into Compliance with Federal Child Protection Law

Act 115 was signed into law by Governor Tom Wolf today, bringing the state of Pennsylvania into compliance with the most recent changes to the federal Child Abuse Prevention and Treatment Act (CAPTA).

CAPTA, originally enacted in 1974 and most recently re-authorized in 2010, is the nation’s key federal legislation regarding child abuse and neglect. In addition to providing definitions for abuse and neglect, CAPTA provides funding for state child protective services systems. The federal law is authorized through 2016 and is up for re-authorization in the next legislative session.

Introduced by Senator Pat Vance (R), and passed unanimously in both chambers, Act 115 makes necessary changes in state law regarding parents who have committed child sexual abuse, the definition of child abuse, and the treatment of child victims of human trafficking.

Per the new law, grounds for involuntary termination of parental rights will now include instances where a parent has been found by a court to have committed sexual abuse against a child, as well as where a parent is required to register with a sex offender registry. Human trafficking is now included in the definition of child abuse, and further, the law now includes law enforcement officers who are investigating cases of human trafficking as a party to whom information from child abuse reports may be provided. 

Enacting these changes ensures that Pennsylvania is best positioned in its efforts to not only protect children from abuse and neglect, but also to provide justice to victims.

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Pennsylvania Making Great Strides in Covering Uninsured Children

The number of Pennsylvania children who are uninsured declined sharply last year as reforms began to take effect, according to a report released today. The report by Pennsylvania Partnerships for Children and Georgetown University’s Center for Children and Families found that between 2014 and 2015, the uninsured rate for Pennsylvania children declined from 5.2 percent to 4.1 percent. Before expanding Medicaid, Pennsylvania had seen only a marginal decrease in uninsured children the previous year – going from 5.4 percent in 2013 to 5.2 percent in 2014.

The 2015 data in this report does not fully capture the effects of the expansion of Medicaid because it was not in effect for the entire year. Enrollment ramped up in the first six months of 2015, and Pennsylvania will not have a full picture of the expansion’s impact until next year.

Even with the accelerated decline in uninsured children, the report shows that Pennsylvania has continued room for improvement. Only six states have more uninsured children than Pennsylvania, which means that more than 100,000 kids in the commonwealth lack basic health coverage. Pennsylvania also dropped in overall rankings of percentage of uninsured children – from 17th best in 2013 to 24th best in 2015.

Pennsylvania also has the highest rate of uninsured children of all of its neighboring states except for Ohio. The report includes data from West Virginia (2.8 percent uninsured), Maryland (3.9 percent uninsured), New Jersey (3.7 percent uninsured), New York (2.5 percent uninsured) and Ohio (4.4 percent uninsured).

Quality health coverage is essential because every child can succeed when given the chance. When it comes to setting up a child for reaching his or her potential, few things matter more than good health. When children’s health needs are met, they are better able to learn in school and parents miss fewer days of work.

Families who would like help enrolling their children should call 1-800-692-7462 or visit www.compass.state.pa.us.

 

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