Federal Advocacy

H.R. 1041/S. 441 proposed by Rep. Ayanna Pressley (D‑MA) and Sen. Cory Booker (D‑NJ)

A national “baby bonds” program, as included in the American Opportunity Accounts Act, would authorize federally funded and managed savings accounts (American Opportunity Accounts) for children under the age of 18. The goal being to build a foundation for economic opportunity for all Americans, while breaking the generational cycles of poverty for underserved communities in the process, combatting the racial wealth gap.

The government would automatically deposit into managed savings accounts (American Opportunity Accounts) $1,000 for each child when they're born (annually adjusted for inflation). Funds would sit in the interest-bearing accounts and each year, a child could receive additional deposits from the government depending on family income. The investments would be excluded from asset limits for other government benefits. A child can access the funds at 18 for allowable uses such as educational expenses or buying a home.

For more information on how this bill would impact families across the country and in Massachusetts, check out our blog post.

Connecticut was the first state to establish a baby bonds program, followed by the District of Columbia and more recently
California. We urge Congress to pass a national baby bonds program informed by the lessons learned at the state and local level.

S.2849

Substantially improves college access, retention, and graduation rates for foster and homeless youth by helping them cover the costs of college and providing robust support and mental health services. It would invest $150 million a year in states, tribes, and territories to establish or expand statewide initiatives to assist foster and homeless youth in enrolling in and graduating from college. States that receive such grants must award subgrants to institutions of higher education to carry out these activities in partnership with child welfare agencies and organizations serving homeless youth.

Currently, less than 10 percent of foster youth graduate with an associate or bachelor’s degree.

(H.R. 7010)

This legislation builds on the advances in supports and service provision made by states that currently extend foster care beyond age 18 and will take significant steps toward ensuring that all young people in foster care have the option to remain in care through age 21, regardless of where they live.

• Extended care would go through age 21 to the young person's 22^nd birthday, rather than stopping at 21.
• It drops the mandate that states extend foster care and instead relies on an incentive, delinking young people ages 18-22 from the AFDC eligibility requirements and therefore providing more Federal coverage for this population.
• It requires ACF and DOL to put forth guidance on how young people in extended foster care can be connected to Workforce Innovation and Opportunity Act (WIOA) programs.

Our nation spends billions annually to address a host of health, educational, and social challenges that families who are at risk face, including poor birth outcomes, child abuse and neglect, childhood cognitive disabilities, and poor school readiness and academic achievement. These conditions, however, can be reduced or prevented at a fraction of the cost with voluntary evidence-based home visiting programs. Scientific research demonstrates that evidence-based home visiting improves prenatal care and birth outcomes, early child health and development, school readiness, and parenting practices; reduces child maltreatment; and helps families become more self-sufficient.

Congress must:
- Continue to increase funding so more counties and communities have access to quality home visiting programs
- Protect the Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program from current budget cuts through sequestration

January 7, 2025

Monitoring Medicaid

CLM monitors priorities and concerns for children and families, including in light of the next federal Administration's potential funding and policy changes. While impending changes to Medicaid are uncertain, historically, Republicans have proposed Medicaid cuts, such as by dropping eligibility, benefits, and provider payment rates, using improving program efficiency and program integrity as rationale to do so. So, Medicaid advocates are watching for federal activity that could threaten to:

• eliminate or severely underfund the Affordable Care Act (ACA) Medicaid expansion coverage for low-income adults;
• weaken long-standing program protections for enrollees;
• make it harder for states to draw down federal support, like effectively eliminating states ability to tax providers; and/or
• restructure and cut general federal funding for the program, such as:
  • reducing the federal matching rate; and/or
  • capping federal spending.

In Massachusetts, Medicaid and the Children’s Health Insurance Program (CHIP) are combined into one program called MassHealth. MassHealth members may be able to get doctors visits, prescription drugs, hospital stays, and many other important services. Behavioral health services are more impacted by Medicaid cuts than other children and family services in the Commonwealth.

We will continue to monitor the program and urge our Congressional delegates to maintain healthy Medicaid budgeting and programming to sustain the long-term health benefits to children and families.

Medicaid's Significance

Overview
Medicaid is a public insurance program that provides health coverage to low-income families and individuals, including children, parents, pregnant women, seniors, and people with disabilities. 32.97 million children, and 88.4 million people overall, were enrolled in Medicaid as of Sept. 2023. (HHS Source).

Benefits
There are many benefits of Medicaid, such as that it:

• provides health insurance coverage to the most vulnerable people and improves access to care.
• supports financial stability among low-income families;
• improves health outcomes;
• reduced evictions; and 
• provides additional long-term improved outcomes for children, because children with Medicaid:
  • experience fewer emergency room visits and hospitalizations,
  • do better in school and miss fewer school days due to illness or injury,
  • are more likely to finish high school, attend college, and graduate from college., and
  • earn more money as adults.

Eligibility
In order to receive federal funding, states must cover certain “mandatory” populations, including:

• children through age 18 in families with income below 138 percent of the federal poverty line ($29,974 for a family of three in 2020);
• people who are pregnant and have income below 138 percent of the poverty line;
• certain parents or caretakers with very low income; and
• most seniors and people with disabilities who receive cash assistance through the Supplemental Security Income (SSI) program.

Covered Services
Covered services include hospital care (both inpatient and outpatient), physicians’ services, nursing home care, home health care, and certain additional services for children. States have the authority to cover other services and populations and have used that authority extensively. Moreover, many states seek and receive waivers of federal statutory limitations that allow them to provide benefits and cover groups that would otherwise be excluded.

Cost
Medicaid is funded jointly by the federal government and the states with the federal government covering about 65 percent of the total, depending on the year. For 2023, the Federal Government will spend an estimated $607 billion on Medicaid, which is the 65% of the total estimated spending ($934 billion). Benefits for children account for only $70 billion (15.8%).

Comparison to Medicare
Medicaid is sometimes confused with Medicare, the federally administered, federally funded health insurance program for people over 65 and some people with disabilities. There is some overlap with nearly 10 million low-income seniors and people with disabilities, known as “dual eligibles”, enrolled in both Medicare and Medicaid.

Resources

• Policy Basics: Introduction to Medicaid (Center on Policy and Budget, 2020)
• Webinar: How Medicaid Works & What’s at Stake in 2025 (Center for Children & Families (CCF) of the Georgetown University McCourt School of Public Policy, 2024)
  • Presentation Slides
• Medicaid Threats in the Upcoming Congress (Center on Policy and Budget, 2024)

H.R. 5629 /S. 2906

Commits the federal government to cutting child poverty in half within five years.

Requires the Department of Health and Human Services (HHS) and the Census Bureau to take actions with respect to poverty measures and data related to child poverty, e.g., annually report an anchored supplemental poverty measure for individuals under the age of 18 and must otherwise collaborate with the bureau to, for example, correct income data to account for underreporting. Further, HHS must publish resources on its website related to child poverty, and the Census Bureau must release certain economic and survey data at the same time it releases a specific report related to income, poverty, and health insurance coverage in the United States. And, the National Academy of Sciences must report annually on child poverty and study other issues, such as policies to reduce intergenerational poverty.

Also, currently, the Census Bureau uses the official poverty measure (based on cash resources) and the supplemental poverty measure (based on both cash and certain noncash resources, such as nutrition assistance program benefits) to measure poverty. Anchoring the supplemental poverty measure fixes the poverty threshold at a given point in time and then adjusts it for inflation.

Title-IV B of the Social Security Act

In December 2024, the U.S. Senate passed the Supporting America’s Children and Families Act (HR 9076), preventing the expiration of Title IV-B of the Social Security Act and updating the program for the first time since 2008 by incorporating improvements. The House passed the bill in September. This bill reauthorizes Title IV-B of the Social Security Act for five years, boosts annual funding for the program, and initiates several policy shifts to modernize the program.

CLM, along with approx. 270 other organizations, advocated for the passage of this comprehensive bill. We thank Congress for reauthorizing Title IV-B of the Social Security Act with key improvements to enhance the wellbeing of children and families.

The legislation folded together 16 different legislative efforts, which are highlighted comprehensively as follows:

• Family Preservation & Poverty Prevention
  • Increases funding for the Promoting Safe and Stable Families (PSSF) program by $75M per year beginning in 2026.
  • Permits IV-B funds to be spent on concrete support such as housing, transportation or nutrition assistance.
  • Clarifies in federal law that poverty is not neglect, by underscoring the role of family preservation services for families experiencing a crisis related to a lack of resources and ensuring children are not separated from parents solely due to poverty-related neglect. 
  • Expands by $10M per year the Regional Partnership Grants to address the intersection of parental substance use and child welfare involvement.  
  • Expands by $10M per year the Court Improvement Program for state and tribal courts to manage nearly 600,000 children’s cases in court each year.  
  • Provides $5M for evaluation of services approved by the Family First Prevention Services Clearinghouse.
    
• Lived Experience
  • Adds caregivers and individuals with experience in the child welfare system into who states must consult with during periodic child welfare plan updating.
  • Adds peer-to-peer mentoring led by lived experience experts to the list of accepted family preservation services.
    
• Kinship
  • Strengthens support systems for the 2.5 million grandparents and relatives providing kinship care for children who would otherwise enter foster care.
    
• Workforce
  • Reduces administrative burdens by requiring HHS reduce paperwork and data reporting for state agencies and caseworkers by at least 15%.
  • Ensures caseworkers have access to training and support to improve retention and recruitment.
    
• Transition Age Youth
  • Improve outcomes for youth transitioning from foster care by including individuals with lived experience (formerly in foster care) in state service planning and ensuring youth have access to mental health services.
    
• Post-Adoption
  • Support post-adoption services by requiring HHS to review post-adoption supports provided under Title IV-B and identify opportunities for strengthening them.
    
• Residential Care
  • Adds a residential care provision requiring that the Department of Health and Human Services develop: (1) guidance around how states should collect data on well-being and alleged maltreatment in residential care and (2) best practices on improving oversight of such programs. (This compliments the Stop Institutional Child Abuse Act championed by celebrity Paris Hilton).
    
• Tribal Support
  • Allocates more IV-B funding for tribes, reduces barriers to tribal participation in IV-B, and supports oversight of implementation of the Indian Child Welfare Act.  

Significance of Title IV-B

Title IV-B of the Social Security Act is a critical child welfare law comprised of substantial formula federal grants supporting states' child welfare systems. These grants provide flexible funding for states to invest in maltreatment prevention, child protection, family preservation, child welfare workforce training, reunification services, and support for kinship, foster, and adoptive caregivers.

Title IV-B is made up of two programs: the Stephanie Tubbs Jones Child Welfare Services program and the MaryLee Allen Promoting Safe and Stable Families program. The funds from both parts can be used in a similar fashion, and most years total up to between $500 million and $600 million. 

Subpart 1 - Stephanie Tubbs Jones Child Welfare Services Program: promote State flexibility in the development and expansion of a coordinated child and family services program that utilizes community-based agencies and ensures all children are raised in safe, loving families to do the following:
- protect/promote the welfare of all children,
- prevent neglect, abuse, or exploitation, support at-risk families, such as through services which allow children, where
appropriate, to remain safely with their families or return to their families in a timely manner, |
- promote the safety, permanence, and well-being of children in foster care and adoptive families; and
- provide training, professional development and support to ensure a well-qualified child welfare workforce.

Subpart 2 - MaryLee Allen Promoting Safe and Stable Families Program: establish, expand, and operate coordinated programs of community-based family support services, family preservation services, family reunification services, and adoption promotion and support services to prevent child maltreatment, assure children’s safety, preserve intact families when possible, address problems so that reunification can occur in a safe an stable manner (in accordance with the Adoption and Safe Families Act of 1997), and provide support services to adoptive families.

This a prior session bill that has not yet been reintroduced in the current 118th Congress. Former Bill Numbers: H.R. 3488/S.1848

The John Lewis Every Child Deserves a Family Act (ECDFA) would prohibit any child welfare agency receiving federal financial assistance from discriminating against any potential foster or adoptive family on the basis of religion, sex, sexual orientation, gender identity, or marital status. In addition, ECDFA would prevent discrimination against any foster youth because of their sexual orientation or gender identity.

Read more about the aims of this legislation

With issues such as rising costs of living, Congress needs to ensure that young people in foster care have access to adequate support and services as they transition to adulthood and independence.

Congress must:
- Increase funding for the John H. Chafee Foster Care Program for Successful Transition to Adulthood and fully fund Education
and Training Vouchers

The Chafee Program for Successful Transition to Adulthood provides funds to states to assist them in offering supportive
services for youth who experience foster care at age 14 or older, including former foster youth up to a certain age. The program
seeks to address poor education, employment, and other outcomes experienced by many such foster youth as they transition to
adulthood. This includes the Educational and Training Vouchers Program (ETV) for Youth Aging out of Foster Care.

- Extend foster care to at least age 21 nationally
- Provide greater and simpler access to student loans and on-campus services
- Support youth who experience foster care in obtaining driver’s licenses through the Foster Youth and Driving Act (S.699 /
H.R.1446)
- Provide greater targeted housing assistance

Congress must:
- Ensure that youth placed in Quality Residential Treatment Programs retain Medicaid eligibility through the Ensuring Medicaid Continuity Act
- Strengthen the FFPSA Clearinghouse and increase the number of eligible programs by providing research funds in the Title IV-B of the Social Security Act Reauthorization

The Family First Prevention Services Act (FFPSA) was signed into law in 2018, expanding entitlement funding, focused on preventing children and their families from becoming involved in the child welfare system by providing evidence-based services to children who are considered “candidates for foster care." It amended Title IV-E (Foster Care) and Title IV-B of the Social Security Act (Child and Family Services) to child welfare programs and policy. Highlights include as follows:

• Prevent children from entering foster care through new optional prevention services and programs
• Restrict placement options for children being placed in care to mainly family foster homes with limited use of congregate care settings
• Improve the electronic interstate processing system
• Establish model licensing standards for family foster homes
• Supports recruitment and retention of high-quality foster families
• Extend John H. Chafee Foster Care Independence Programs to age 23
• Reauthorization of the Adoption Incentives program
• Provides 50% match funding for kinship navigator programs
• Allows room and board payments for children in care placed with their parent in family-based substance use residential treatment

Massachusetts mostly uses Family First to fund programming through Family Support and Stabilization, where applicable.

The Expanded Child Tax Credit (CTC), passed as part of the American Rescue Plan Act to provide relief for families during the COVID-19 pandemic, has been hailed as the most successful anti-child poverty policy option available. The credit expansion lifted more than 3.5 million children out of poverty and research shows that most families spent their monthly CTC payments on necessities such as food, clothing, and housing. The expansion of the CTC had no negative effect on employment.

Congress must:
- Expand the Child Tax Credit by:

• making it fully refundable
• reinstating monthly payments
• increasing the total value for families, particularly those with low income

Child care and early childhood education are critical to the future well-being of all children and to building
a stronger foundation for all families. Too many families are unable to access child care, either because it’s too expensive
or because there aren’t enough quality providers where they live. Too many child care and early education professionals
earn poverty-level wages and struggle to make ends meet. This reality is untenable, and Congress must expand the child care
and early learning infrastructure and invest in our future.

Congress must:
- Increase appropriations for the Child Care and Development Block Grant
- Fund workforce development initiatives
- Address child care deserts by providing funding for providers in rural areas

Important legislation includes the following:

• Child Care for Every Community Act (S.388 /H.R.953; sponsored by Sen. Warren and co-sponsors include Sen. Markey) (Fact Sheet) - expand access to affordable child care to every American family, offer high-quality early education to every child, and create good jobs for our early educators. 
• Child Care for Working Families Act (S.1360 / H.R.2976; cosponsors include Sen. Markey) - to ensure families can afford the child care they need, expand access to more high-quality options, stabilize the child care sector, and help ensure child care workers taking care of our nation’s kids are paid livable wages. The legislation will also dramatically expand access to pre-K, and support full-day, full-year Head Start programs and increased wages for Head Start workers.

The Child Abuse Prevention and Treatment Act (CAPTA) provides funding to states for state child protective services, including investigation, protection and any treatment services. It requires states to meet certain provisions such as mandated reporting. Title II of CAPTA is referred to as the Community-Based Child Abuse Prevention program, or CB-CAP. It supports community-based efforts to develop, operate, expand, and coordinate programs and activities to prevent child abuse and neglect.

Congress must:
- Reauthorize CAPTA with a higher authorized funding level and with additional attention to child fatalities, children born exposed
to substances, and enhanced legal representation for children and families
- Reject all efforts to narrow and politicize the broad federal definition of child maltreatment
- Reauthorize the Adoption Opportunities Act with greater research on adoption disruption and dissolution and more support for
post-adoption services

The Family First Prevention Services Act of 2018 (FFPSA) created a federal category of residential settings called qualified residential treatment programs (QRTPs) that provide short-term care for children in foster care with assessed emotional or behavioral needs in a residential setting. The health care needs of children in foster care are covered by Medicaid. Today, however, QRTPs may not receive Medicaid financing because of the Institutions for Mental Disease (IMD) exclusion, a law that prohibits Medicaid payments to an institution with more than 16 beds that primarily provides care for people with mental health conditions.

The Ensuring Medicaid Continuity for Children in Foster Care Act of 2023 (H.R.4056) would provide a narrow exemption from the IMD exclusion to ensure children in foster care receiving care in QRTPs can continue to receive care provided in these settings without losing their federal Medicaid coverage. The bill would lift the Exclusion in a manner consistent with guardrails from the Families First Prevention Services Act, which include screenings to place children appropriately in and out of care and requirements to discharge children from facilities expeditiously so that they can return to their families as quickly as possible.

Numerous local, state, and national organizations have joined in advocating for this reform to ensure Congress understands the issue and the need to support access to trauma-responsive, youth-driven, family-focused QRTPs nationwide (see IMD Federal Policy Brief from the National Association of Medicaid Directors). Please join us in asking Senators Warren and Markey to support H.R. 4056 to ensure services for children in QRTPs are fully funded by Medicaid.