Alliance, UNCA working to turn hopeful signs into realities
As states face continued budgetary stress, nonprofit human service providers are feeling the pressure. Despite bleak indicators in the past and present, the passing of health care reform legislation and positive activity in the area of child welfare rate setting are signs that a brighter future may lie ahead.
The joint public policy office of the Alliance for Children and Families and United Neighborhood Centers of America (UNCA) is working to turn these hopeful signs into realities to positively impact members’ bottom lines.
Increasing Medicaid Rates for Providers
When Congress enacted comprehensive health care reform earlier this year, it was an important step forward. The new law, which is supported by the Alliance and UNCA, makes important strides toward reducing the number of Americans without health insurance.
But health insurance is not the same as health care. For the new law’s provisions related to health insurance to translate into true health care, reimbursement rates need to be high enough for providers to perform needed treatment.
Congress partly addressed this by requiring the federal government to pay for most of the expansion of coverage under Medicaid. Yet, the opinion of the Alliance and UNCA is that more needs to be done.
Recognizing this, Congress funded a new committee, called the Medicaid and Children’s Health Insurance Program Payment Access Commission. The commission will review Medicaid policies that affect children’s access to covered health services and make recommendations to Congress.
Members of the commission have been named already, and the work is expected to begin soon. When it does, the Alliance and UNCA public policy office will work to make sure issues specific to the child welfare community are considered and addressed.
New Implications for Child Welfare Rates
Even more progress has been made for child welfare rates.
In December 2009, the 9th Circuit Court of Appeals ruled in California Alliance v. Allenby that federal law requires states to pay the full cost of care for children in foster care. A lower court later ruled that the state must increase rates for nonprofit group homes by 32 percent in order to comply.
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Even though the state is planning to appeal, this decision may have a significant impact on rates throughout the nation. While this most certainly includes the other states under the 9th Circuit Court’s jurisdiction—Alaska, Arizona, Hawaii, Idaho, Montana, Nevada, Oregon, and Washington—all 50 states may be impacted as other federal courts look to the California decision for guidance.
The Alliance and UNCA public policy office considers the case’s potential impact in a report released in March. The report analyzes the 9th Circuit Court’s decision; its national impact; and, most importantly, its potential implications for each state.
The public policy office released a second, related report in April that looks to a rate-setting commission used in Montana as a model for other states wishing to avoid legal challenges, as well as improve their foster care systems.
The second report explains how, in 2005, the Montana legislature established an advisory commission to review foster care rates and make recommendations to the legislative and executive branches. The commission’s members include representatives from the legislature, governor’s office, nonprofit human service organizations, and families providing foster care to youth.
The commission released its first report in 2008. While the state legislature did not act on those recommendations, individuals involved in the process say the commission has laid the groundwork for a more rational system that can be implemented when the state’s economy and budgetary outlook improve.
The Alliance and UNCA’s analysis of Montana’s potential to be a model for other states was immediately welcomed by Sen. Max Baucus, D-Mont., chairman of the Senate Finance Committee, which has jurisdiction over the U.S. Department of Health and Human Services.
“The Montana model for child welfare reimbursement creates positive results for our kids through open communication between policymakers, child welfare caregivers and everyday people who use the services,” Baucus said in a prepared statement. “Providing lawmakers with more and better information is essential to helping them improve child welfare services and the successful Montana model is one that may benefit children in other states as well.”
Congress is expected to address foster care financing next year as part of its reauthorization of the Temporary Assistance for Needy Families program. During that process, the Alliance and UNCA will advocate for national reforms that promote foster care rates that better serve the country’s children and families.
Until then, the public policy office will continue to review and assess the rate-setting processes in all 50 states. The ultimate goal of these efforts is to ensure that members’ bottom lines reflect a fair value for the services they provide through government contracts.
The public policy office’s reports about the 9th Circuit Court’s decision and Montana’s rate-setting commission can be accessed at the Alliance website. Also read the article from Issue 1 – 2010 of the Alliance for Children & Families Magazine, which looks at several suggestions for reforming the nonprofit human services financing model as it relates to government contracting.
Patrick Lester is senior vice president for public policy for the Alliance and UNCA. He has a master’s degree in public policy from Georgetown University. His past experience includes director of public policy for United Way of America, aide for President Bill Clinton’s Domestic Policy Council, senior policy analyst for the Maryland Association of Nonprofit Organizations, and legislative director for the Coalition of Human Needs. He can be reached at 202-429-0400, ext. 15, or by e-mail. |  |
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