This Week in Washington

This Week in Washington is written by APHSA’s expert staff based on their day-to-day contact with key officials in the administration, in federal agencies, and in Congress about the latest developments in human service programs and policy. Don’t miss a single issue of our reports from the capital by subscribing today.

For the week ending December 4, 1998

Headlines

Medicare Commission Begins Reviewing Various Reform Proposals
DOL Announces Welfare-to-Work Performance Bonus Policy
Senate Organizes for 1999
HHS Grants Adoption 2002 Excellence Awards, Announces Internet Adoption Site
HCFA Releases Letters on Ryan White, Viagra to State Medicaid Directors
HHS Approves Kentucky CHIP
Fatherhood Development Grants Awarded

Medicare Commission Begins Reviewing Various Reform Proposals
On Wednesday, December 2, the National Bipartisan Commission on the Future of Medicare met to discuss the economic impact of various Medicare reform proposals that committee members have been reviewing over the past few months. Specifically, the 17 members discussed modernizing cost sharing (by combining Part A and Part B deductibles, extending hospital coverage to 365 days per year, establishing hospital co-insurance, and offering Medicare stop-loss protection), reforming MediGap plans, raising the eligibility age from 65 to 67, removing graduate medical education and indigent care costs from the program, introducing prescription drug coverage, and restructuring the Medicare program to closely model the Federal Employees Health Benefit Program (FEHBP). The FEHBP model, in which the government pays a defined contribution to a beneficiary's premium cost, is strongly supported by Republican members of the commission. Economic projections presented to the commission suggest that even if all of the cost-cutting proposals were implemented, the Medicare program would still experience a $30 billion shortfall in 2030. The commission, which requires an 11-vote majority to approve any proposals, must present its recommendations to President Clinton by March 1, 1999. A summary of all reform proposals and cost projections can be accessed at http://medicare.commission.gov.

DOL Announces Welfare-to-Work Performance Bonus Policy
The Employment and Training Administration of the U.S. Department of Labor (DOL) has published criteria outlining bonus awards to states that successfully operate the DOL Welfare-to-Work program. The notice was published in the November 23 Federal Register (pp. 64832-64833) and explains how DOL will distribute $100,000,000 in bonus funds during FY 2000. The bonus funds, authorized in the Balanced Budget Act of 1997, will be disbursed during FY 2000 and will be based on the performance of welfare-to-work states during FYs 98 and 99. Performance measures include a basic job entry rate; a rate for participants entering employment at least 30 hours per week; a job retention rate; and an earnings gain rate. Some of the criteria are similar to the TANF High Performance Bonus measures. Data for the measures will be drawn primarily from the welfare-to-work quarterly financial status report, which DOL anticipates will be based largely on unemployment insurance (UI) wage records. States choosing to use other data sources must justify the validity of those sources. Allocation of the $100 million bonus pool will be determined by a weighting formula (with the basic job entry rate being the largest single determinant) and by how far a state's performance ranks above the national average. No state may receive more than 25% of its formula allotment, and no state may receive more than $20 million. DOL will consider adjustments to state performance that may have been caused by varying economic circumstances; this issue will be covered in a forthcoming supplemental notice.

Senate Organizes for 1999
Working on a later timetable, Senators gathered this week in Washington to decide on their leadership for the 106th Congress. As expected, there were few changes and none of the controversy that surrounded the House elections a few weeks ago. Sen. Trent Lott (R-Miss.) was reelected as Senate Majority Leader with no opposition, Sen. Tom Daschle (D-S.D.) continues as Minority Leader for the Democrats. The number two position, Assistant Majority Leader, will continue to be filled by Sen. Don Nickles (R-Okla.). For the Democrats, the retirement of Sen. Wendell Ford (D-Ky.) left a vacancy for the minority party's number two position. Sen. Harry Reid (D-Nev.) now becomes the Minority Whip. Because the split between Republicans and Democrats remained the same in the new Congress (55-45) there will be no change in the committee ratios in the new Senate, but there is discussion of adding two seats to the Banking Committee. While committee assignments are not final until early next year, the Democrats announced their assignments based on current vacancies created by the election and members shifting spots. Agriculture will now include newly elected Sen. Blanche Lambert-Lincoln (D-Ark.), with Sen. Mary Landrieu (D-La.) giving up the assignment. The Appropriations Committee has two vacancies with Sen. Barbara Boxer (D-Calif.) giving up her assignment and Sen. Dale Bumpers (D-Ark.) retiring. Sen. Dianne Feinstein (D-Calif.) and Sen. Richard Durbin (D-Ill.) will fill these vacancies. On the Finance Committee, Sen. Chuck Robb (D-Va.) will fill the one vacancy created by the defeat of Sen. Carol Moseley-Braun (D-Ill.). There are no changes on the Labor and Human Resources and Budget Committees for the Democrats. Although the Republicans have not made their formal decisions, Sen. Fred Thompson (R-Tenn.) announced that he would be filling the Finance Committee vacancy created by the defeat of Sen. Alfonse D'Amato (R-N.Y.), and it was revealed that Sen. Jon Kyl (R-Ariz.) will fill the vacancy on the Appropriations Committee created by the defeat of Sen. Lauch Faircloth (R-N.C.).

HHS Grants Adoption 2002 Excellence Awards, Announces Internet Adoption Site
On November 24, the Georgia Department of Human Resources and the Illinois Department of Children and Family Services were among eight recipients of the U.S. Department of Health and Human Service's (HHS) Adoption 2002 Excellence Awards. The awards were highlighted at a White House ceremony celebrating November as National Adoption Month. Georgia and Illinois received awards in the category of increased adoptions. Georgia adoptions have increased 66% since FY 95. Illinois adoptions increased from 2,229 in FY 97 to 4,293 in FY 98. To help states and communities meet the goal of doubling the number of adoptions by 2002 and shorten the time needed to find adoptive families, President Clinton directed HHS to develop a plan for expanding the use of the Internet and including photos of legally available children on the web. HHS Secretary Donna Shalala will report to the president within 60 days on a plan to work with the states and other leaders to carry out this effort.

HCFA Releases Letters on Ryan White, Viagra to State Medicaid Directors
On November 25, HCFA issued a letter to state Medicaid directors urging them to improve coordination between the Medicaid program and the programs of the Ryan White Comprehensive AIDS Resources Emergency Act (CARE). The letter specifically requests that state Medicaid agencies cooperate with Ryan White grantees to ensure that Medicaid pays for Medicaid-covered services for Medicaid-eligible persons with HIV in order to conserve funds appropriated for Ryan White programs. Also, HCFA requests that Medicaid directors appoint a contact person in their agencies to coordinate Ryan White issues. Another letter released on November 30 reiterates HCFA's position on Viagra. Specifically, the letter states that state Medicaid programs cover Viagra when medical necessity dictates such coverage for the drug's medically accepted indication. Both letters can be accessed on HCFA's web site at http://www.hcfa.gov.

HHS Approves Kentucky CHIP
On Monday, HHS announced the approval of Kentucky's Children's Health Insurance Program (CHIP). The state will use Title XXI funding to expand Medicaid eligibility to children ages 14 to 19 in families with incomes up to 100% of the federal poverty level (FPL) and to create a separate program for children, KCHIP. KCHIP will cover uninsured children through age 18 in families with incomes between 100% and 200% of FPL. KCHIP will build upon the Medicaid Partnership Model implemented under the state's 1115 Medicaid managed care waiver. KCHIP will use a managed care delivery service made up of private and public providers that will emphasize primary care. The state is also developing a process to include an employee contribution subsidy as part of CHIP. Although KCHIP is a separate insurance program, it will be closely coordinated with Medicaid, including use of a common eligibility application.

Fatherhood Development Grants Awarded
The National Center for Strategic Nonprofit Planning and Community Leadership (NPCL) awarded $600,000 in grants to nine cities to help fathers find jobs and better assist their children. NPCL believes the reason many fathers do not pay child support is because they are unemployed and cannot afford to make payments. NPCL's fatherhood programs provide counseling and outreach and are designed to help single, low-income fathers gain friends, obtain jobs, and provide positive influences on their children's lives.

This Week in Washington is published 50 times a year by the American Public Human Services Association. It is written by the Government Affairs staff of APHSA: Larry Goolsby, Kim Johnson, Justin Latus, Anna Lovejoy, Michelle Mickey, Erin Nagy, Lee Partridge, Elaine Ryan (editor), Matt Salo, John Sciamanna, and Heidi Shaner.

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