In Attendance

Helen Thatcher, Department of Workforce Services
Robin Arnold-Williams, Department of Human Services
Lois Kelson, Community Action Services, Provo
Judi Hilman, Utah Issues
Sheila Walsh-McDonald, Salt Lake Community Action Program
Julie Williams, Salt Lake City Housing Authority
Sarah Brenna, Department of Workforce Services
Steve Blackman, Utahns Against Hunger
Tonya Poulter, Davis County Community Action
Bill Tibbits, Crossroads Urban Center
Kayleen Simmons, People Helping People
Jacky Stokes, Health Care Financing, Department of Health
Pat Nielson, Salt Lake League of Women Voters
Shirley Weathers, Walsh & Weathers Research and Policy Studies
Bill Walsh, Walsh & Weathers Research and Policy Studies

Food Stamps

Shirley Weathers explained the differences between the Nutrition Titles of the various Farm Bills before Congress. One passed by the House, and those sponsored by Senators Harkin and Lugar. UREAP sent letters to Utah Senators in support of the Lugar Bill. Robin Arnold-Williams reported that the Harkin Bill was on the way to the Senate Floor and Senator Lugar planned to offer amendments on the Floor. The Lugar Bill has the most funding for Food Stamps over the next ten years, Both the Harkin and Lugar bills allow simplification of eligibility rules, extend Transitional Benefits from 3 to 6 months, restore some benefits to legal immigrants, including allowing their children to be eligible, establish Quality Control bonuses for good client service and supporting working families. The competing requests for funding are problematic in Congress. Sarah Brenna said she would forward DWS comments on Food Stamps to UREAP. The Senate and House Bills will go to Conference committee.

UREAP Items

Shirley said the website survey response on Child Care was helpful, but the debate between mandatory standards versus incentives on quality and safety was not settled. Reasons to mandate that states meet federally established standards center on child safety, quality and well being. The funding being discussed is strictly for subsidized child care, not the entire child care system, and too many mandates keep providers from taking subsidized children. APHSA and NGA oppose mandates because states prefer devising their own solutions. Sheila Walsh-McDonald suggested sending an e-mail to the UREAP list with the simple question of voting for mandates or incentives. Shirley said UREAP will notify the e-mail list and request a vote, then finish the Child Care Position Paper.

A discussion about the 2002 meeting schedule determined that the current practice of meeting on the 4th Tuesday of the month, 2:30 - 4:30 p.m., at Horizonte, will continue. There will be no meetings in December 2001 or February 2002 . The next UREAP meeting will be January 22, 2002 and March through September monthly meetings will be on the fourth Tuesdays. The dates will be posted on the website.

An updated membership list was distributed. UREAP presently has 25 members.

UREAP TANF Comment to HHS

Shirley presented a twelve page draft comment on TANF. The final is due November 30 to Health and Human Services. This comment is based on the UREAP TANF Position Paper, highlights Utah's long experience in welfare reform, and notes studies from Utah's academic community. Shirley pointed out UREAP's position on life time limits: i.e., we do not believe they are necessary and oppose them: however, if they remain in force, we have numerous additional recommendations. Congress imposed a 60 month life time limit and Utah's Legislature imposed a 36 month limit. Concern was expressed about how time limits will work in a slowed economy or a recession as is occurring now. Meeting participants supported this document. Bill and Shirley will finalize and submit it.

Robin and Helen Thatcher were asked to report on the HHS Listening Tour held in Dallas to solicit TANF Reauthorization comments. Rep. Jack Seitz also attended from Utah. Six areas were addressed: time limits, funding, flexibility, coordination with other programs, work-first, and child care. Robin said "stop the clock" concepts were discussed and that consistent messages are emerging, much like the recommendations being developed in the UREAP process. The changing economy is of concern. Helen said the line workers and clients who testified did very well. She said HHS Assistant Secretary Wade Horn is very concerned about child welfare in this process, and how to measure it. The National Conference of State Legislators (NCSL) has just formed a Welfare Reform Task Force and a Utah legislator will be named to sit on it. He/she will be yet another Utah voice with influence in this Reauthorization process.

Medicaid

Bill introduced Jacky Stokes, Policy and Training Manager in Health Care Financing, representing the Department of Health. Jacky described the "April 7 Group" which is addressing the problem of people losing Medicaid inappropriately during welfare reform. "April 7" refers to a date of a memo from the federal Health Care Financing Agency directing states to look into Medicaid eligibility practices since 1996 and correct mistakes with ex parte reviews. Additional computer support is expected to be available early next year so that when closing a medical case, the worker will be instructed to look for other Medicaid programs the client may be eligible for. Analysis shows some cases in the past have been closed in error. Cases closed for certain reasons (closure codes) will be reinstated for four months and reviewed to determine if they are eligible for Medicaid services. A search process for clients has been constructed. For example, children who were closed from SSI programs due to welfare reform, but who were eligible for other services, will be reopened if they can be found. Utah is attempting to learn from past practices, take corrective action, and make Medicaid eligibility more functional as welfare reform proceeds.

The group then discussed the compilation of "Medicaid/Health Care" proposals dated 11/15/01 and posted at the web site. The 15 APHSA recommendations were well received. The Center on Budget and Policy Priorities recommendations were also supported. All of the proposal presented will be incorporated into UREAP's Medicaid Online Survey, the results of which will be incorporated into a UREAP Medicaid Position Paper. It was pointed out that Utah was still able to provide twenty-four months of Transitional Medical Assistance as in the past under a waiver, but administrative finessing of regulations is required in order to serve some families in that situation.

A discussion ensued about subsidizing workers' insurance premiums in the private market. Utah Children's Report on the Self Sufficiency Budget indicated that 85% of uninsured workers had insurance "available" but could not afford to pay the premiums. State initiatives in this area should be supported.

Bill summarized the proposal of the National Governors Association (NGA) to restructure Medicaid, allowing greater state flexibility to design and deliver benefits, and the analysis by the Kaiser Commission on Medicaid and the Uninsured. Kaiser raises concerns about possible downsides of such an approach. The mandatory versus incentives approach is again at issue in Medicaid.

Judi Hilman explained Utah's efforts to expand health coverage through Social Security Act processes that utilize federal funding. A1931 Expansion coupled with a 1115 Waiver and a CHIP Waiver would cover approximately 40,000 adults up to 200% of poverty with a limited, prevention-oriented benefit package, available within what is to be called the Primary Care Network (PCN). The PCN would not include hospitalization nor specialty care, rather rely on hospital charity care, as has been the agreement with Utah Medical Assistance Program (UMAP) patients. Judi and Sheila were concerned about the lack of comprehensiveness of the package, as are health advocates in other states. HHS is expected to approve this plan by the end of the year. Part of the plan includes employer funding contributions to be built into PCN. Advocates are worried that this first step will shift resources and benefits, but without the political follow-up and funding to protect Medicaid populations and services.

Adjourn

The meeting adjourned at 4:30. The next meeting will be January 22, 2002, 2:30 - 4:30 p.m., at Horizonte. The main discussion will be about child support.