In Attendance

Beth Cottam, Welfare to Work, Community Health Center, Five County Association of Governments
Steve Blackman, Utahns Against Hunger
Julie Williams, Housing Authority of Salt Lake City
Mary Beth Vogel, Social Research Institute, University of Utah
Emma Chacon, Director, Office of Recovery Services
Helen Thatcher, Manager, Service Delivery Support, Workforce Services
Shirley Weathers, Walsh & Weathers Research and Policy Studies
Bill Walsh, Walsh & Weathers Research and Policy Studies

Medicaid Position Paper - draft

Bill Walsh reviewed the UREAP Position Paper process: 1) UREAP staff (he and Shirley Weathers) research and compile recommendations for changes being proposed on a particular major reauthorization topic (in this case, Medicaid) by interested parties in Utah, other states, academicians, or national think tanks. This document is placed at the UREAP website. 2) The document's information is discussed at a UREAP meeting. 3) UREAP staff then reorganizes the recommendations by category and Dale Canning, SL CAP, puts this second document up at the website as an online questionnaire. Participants across the state are asked to use the questionnaire to convey their views. 4) The results are tabulated by staff and used, along with other input and comparison of recommendations to the UREAP principles, to draft a position paper on the topic. This is generally discussed briefly at a UREAP meeting and posted at the website along with requests for input by a deadline. 5) The position paper is finalized and used to convey UREAP's views on the topic to Utah's Congressional Delegation and others. UREAP operates by consensus. If there is an issue about which there is not agreement (e.g., an approach to Child Care quality as revealed below), staff will write language stressing the common ground importance of the issue, but the position paper will not include a recommendation.

Bill explained that the Medicaid draft document was at step 4 in the process. Based on responses to the online questionnaire, the draft position paper states that Medicaid and SCHIP should not be restructured as part of the welfare reform reauthorization process. Fine tuning is desirable, but not restructuring. The six recommendations dealing with Collaboration and Coordination were affirmed. The eight recommendations under Coverage were approved. Beth Cottam asked that one recommendation be  rewritten to reflect that low-paid child care workers deserve health care insurance and that demonstrations to accomplish this should be supported by states and the federal government. Others in attendance agreed. The recommendations concerning Americans with Disabilities Act, Funding and State Flexibility were all approved. The prescription drug recommendations were approved, with a supportive statement regarding the use of generic drugs added.

Child Care and Development Block Grant Reauthorization Position Paper - draft

Shirley noted that the Child Care Position Paper was also at step number 4 of the UREAP process and said that it would be good to finalize Child Care and Medicaid Position Papers by the end of January. Congress is not moving on these issues yet, but UREAP will get position papers in place for the day movement occurs. Shirley asked Helen Thatcher to clarify whether Utah spends SSBG dollars on child care. Helen said that child care provider checks include a very small percentage of SSBG dollars. The reason is that child care providers cannot utilize the Child Care Feeding Program unless a certain percentage of their clients receive SSBG money. This generated a discussion on eligibility and the recommendation that number 1 under the Coordination, Eligibility, Supply, and Continuum of Care section be rewritten to liberalize who can be served and to reduce the burden on providers and the state. Shirley agreed to rewrite that recommendation to reflect the consensus of the group that CCFP rules be broadened.

The Quality Issues section has new language in italics that emphasizes the importance of quality, but does not recommend a mandate or incentive, "carrot or stick," approach because UREAP participants could not agree on one over the other. This difference of opinion has been manifested in two UREAP meetings, came forth in poll results, and even finished in a 10-10 tie when a separate email was sent on the matter. The wording was approved, as was the Research and Data Collection section.

Shirley said that a second draft of the Child Care Position Paper would reflect the discussion at this meeting and would be put at the website with a request for comments by early February (the actual deadline for comment was subsequently set for February 13).

UREAP Items

Shirley announced availability of the CLASP 17-session audio conferences on welfare reform reauthorization. Utah Issues has invited all UREAP participants who are able to join in. Bill and Shirley are trying to work with Eastern Region DWS to develop opportunities there to participate.

Shirley distributed copies of a UREAP email message that was sent to Senators Hatch, Bennett, Harkin and Durbin on Food Stamps. The message reflects the UREAP Food Stamp Position Paper in its discussion of the issues that are under discussion in the Farm Bill the Senate may take up soon, possible amendments, and the House Bill that passed late last year.

Participants discussed two January meetings with Congressman Jim Matheson on welfare reform reauthorization. The common reaction was that he is interested and concerned and is very open to receiving input from Utahns. One meeting was chaired by the Department of Human Services, hosted by the Department of Workforce Services. UREAP participants were invited via the email list. The second meeting was sponsored by Utah Children and centered on child care and children's issues. Emily Merchant, his Washington, D.C. staff person was impressive and informed.

Bill said that they had emailed Senators Hatch and Bennett early in January to get an update on when welfare reform might come up in Congress, as well as to check on the possibility of UREAP meeting with the Senators. Quinn Warnick of Senator Bennett's D.C. staff guessed that it would be this summer. He said Senator Bennett's local staffers, Jan Bennett and Bryan Thiriot, had asked to meet with him and Shirley on January 23 to learn more about UREAP and share their information on reauthorization issues and the potential schedule.

Bill announced that the UREAP Legislative Update had been updated to January 9, 2002 and had been put up at the UREAP website. He passed around a hard copy.

Child Support discussion

Bill led the group in a discussion of child support using the 1/15/02 Child Support Proposals for UREAP Participant Consideration that had been posted at the website. In recent years, the trend in child support collections has been to pass the funds to families rather than to keep funds for administration and recovery of services delivered. Utah made this switch several years ago, funding the Office of Recovery Services (ORS) out of the State General Fund; however, the state portion of funds collected for families receiving public assistance is still returned to the General Fund to recover the state and federal portions of services delivered.

The group considered the recommendations staff had compiled. Some comments are as follows: 1) APHSA's recommendations were viewed favorably. Emma Chacon stressed that charging Child Support Enforcement agencies with medical support activities would, indeed be administratively burdensome and divert attention and resources from collecting child support for families. 2) CLASP recommendations that get into the area of fatherhood and assignment of support rules were acknowledged. The sense was that the next phase of welfare reform should include these types of supports where families can be strengthened.  3) Irwin Garfinkel's recommendations were considered interesting and positive. Emma Chacon described Utah's "income shares model" of setting collections, but admitted that it is burdensome to reset the amounts if one parent lost employment. She clarified that Garfinkel is calling for national guidelines that are based on a percentage of income. With unmarried, but cohabitating parents, policies should be changed to treat them as families and intervene with supports so that these families are strengthened, not driven apart. 4) The Center on Budget and Policy Priorities' (CBPP) recommendations were reviewed positively. Funds intercepted by the federal tax intercept are presently returned to the state and federal governments and should be given to the families. 5) Recommendations from the Medical Child Support Working Group (MCSWG) were noted. The MCSWG was formed in the Clinton Administration to get health insurance to uninsured children in the child support system. Bill noted that UREAP may simply want to consider taking a conceptual position that either child support enforcement activities should be expanded to include obtaining medical support for more children or not, rather than considering each of the 17 recommendations put forth by the Working Group having specific congressional focus . 6) Seven bills relating to child support that have been introduced in Congress were briefly discussed. There are mandates and incentives, but there is common ground in most all the bills and that is what will likely eventually pass.

Emma responded to recommendations discussed. She knows the national and state history of child support and has seen many of these recommendations come and go. She said PRWORA was supposed to simplify child support collections, but actually made collections more complicated. Only thirteen states still use child support collections for people on welfare to fund their state child support services. The federal share of collections is used as Incentive Money for states to make improvements in their systems, but states do not know from year to year how much they will receive. States support the idea that funds should go to the families--a concept known as "Families First." Collection issues for families on public assistance need to be decided for all concerned. Emma noted that, unlike TANF, federal rules for state child support agencies are completely prescriptive. There is no flexibility, even with the 66% federal match. Funding the state share of child support services is a state funding issue. In Utah, $5.6 million of collections goes into the General Fund, so those funds would have to be replaced if the Families First concept were to be enacted. Of the $133 million collected in Utah, $101 million went directly to families last year.

Beth Cottam described their Welfare To Work Grant in southwestern Utah. She has found that, in working with non-custodial parents, they are willing to sign voluntary paternity forms and Personal Responsibility Contracts, but that ORS has not been willing to suspend collections, even in the short term, while the parent is trying to get ahead to be able to play a role It is very frustrating. Emma responded that she would look into the situation. She said that national guidelines are needed and the many programs that need special consideration should be consolidated and standardized. Shirley pointed out that this situation is addressed in recommendations developed by the CBPP and CLASP and suggested that the wisdom in this can be emphasized by UREAP.

Emma responded to the MCSWG recommendations indicating that, while she agreed with some of them, she had problems with many. Utah stopped collecting for Medicaid birth costs six to nine months ago because they found that it was discouraging  mothers from getting prenatal care and fathers from voluntary paternity acknowledgment. In terms of the overall concept espoused by the MCSWG, she said child suppor enforcement entities are simply not in a position of acquiring the kind of health insurance coverage expertise that would be needed to intervene in these matters. It is beyond their mission, but also beyond their capability. She said ORS shouldn't have to make important health care decisions for children, especially if the children or a parent or insurance company are in another state. That is a role that should be performed by another assistance system. UREAP participants tended to agree with the ORS position.

Helen Thatcher said that all these support programs are intertwined and that tweaking one can have unintended consequences for another. She gave the example of employers that do collect child support, but stongly object to additional mandates laid on them, even for a good cause. She suggested that if a social goal can be achieved by employer cooperation, a corresponding item of relief should be offered simultaneously. UREAP participants agreed with this idea.

Emma suggested that UREAP recommend that SCHIP interface more with child support agencies so that children can get health care insurance from the private or public sectors, and SCHIP could collect third part reimbursements and stretch their funding. She suggested that a mandate be passed so data matches can be made between ORS and insurance companies, like it is presently done with financial institutions, so that recoveries can be made from private insurance to reimburse Medicaid and SCHIP for funds expended.

The meeting was adjourned at 4:30. There will be no UREAP meeting in February. The next meeting will be March 26, same time and place, with Child Welfare as the main topic.