Welfare Watch, an email newsletter of the
Georgia Association of Homes
and Services for Children
as a public service.
http://www.gahsc.org
Normer Adams, Editor
___________________________________
Welfare Watch - June 30, 2010 - Federal Legislation Drives Most Policy
In Georgia, most policy related to children and family services is driven by mandates from the Federal government. We see this through laws which typically tie federal funding to funded programs. Child welfare programs, such as Temporary Assistance to Needy Families (TANF), foster care, child protective services, behavioral and physical health care receive their funding sources from the federal government, which contributes over 50% of the funds that Georgia uses to run these programs. Georgia has to depend on these funds to accomplish the objectives that it wants for its children and families.
When these objectives for children and families are in sync, "all is good with the world," and wonderful things can happen. When they are out of sync, often good programs are abandoned and less effective methods of care are chosen. This is no more true than with the programs that are paid with Medicaid funding. Medicaid is the primary health insurance program for foster children and the poor. Without it, millions of children would not get their health care needs met in Georgia.
In 2007, Georgia was mandated by the Center for Medicare and Medicaid Services (CMS) to dismantle its residential therapeutic services. This was done with all deliberate speed. Therapeutic services were to be provided by "therapeutic providers" and residential services were to be provided by "residential providers." Therapeutic residential services by definition and practice, became very fragmented and non-integrated. For example, therapeutic foster care, once the work horse of therapeutic behavioral health care services for foster children, became known as "specialty foster care." Therapeutic services had to be provided by outside vendors often unfamiliar with the milieu of the residential agency. Therapeutic providers weren't always readily available in the communities where the foster children were. The outcomes for children were often not good.
A bipartisan effort in Congress was created to address these concerns in Georgia and other States. Legislation was developed to protect essential services that state Medicaid programs once used to care for Georgia's and the nations most vulnerable populations. Legislation called the Medicaid Services Restoration Act (HR 4787) was introduced to clarify Medicaid policy and financing issues that impact greatly this special health care need population.
This act specifically authorizes a new service category that will finance therapeutic foster care (TFC) for more than 500 children in Georgia that need this intensive intervention. Therapeutic foster care is evidence based in that many studies have been completed showing its long term effectiveness in caring for severely emotionally and behaviorally disturbed children and children with other disabilities.
This legislation will undo much of the damage that was done with the "unbundling" of residential services from Medicaid. The "Rehab Option" under Medicaid can be used for services that are not rehabilitative in scope. Targeted Case management is clarified by codifying the Olmstead transitional case management standard and allowing states to use a bundled rate payment system.
This legislation will allow children with disabilities to live in the community, with the supports that they need in a cost effective manner. Federal policy can be changed but sometimes it takes legislation like this to make it happen.
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Welfare Watch, an email newsletter of the
Georgia
Association of Homes
and Services for Children
as a public service.
http://www.gahsc.org
Normer Adams, Editor
___________________________________