Federal Update: Progress? Or Same Old, Same Old?

HSFO Annual Meeting Sparks, NV July 2015

Overview

     

FY 2016 appropriations Reconciliation Reauthorizations Child Welfare Financing Debt Limit Other issues/deadlines

Where the money goes: pieces of the federal budget pie

Composition of Federal Outlays in FY 2014 ($ in billions, % of total)

Many grants have been flat…

HHS has largest number of grants

HHS distributes the most funding

Major health and human services grants

Mandatory vs. discretionary HHS grants to states

Mandatory vs. discretionary HHS funding to states

2015 Congressional “To Do” List

Done

CHIP Extension Health Extenders Reconciliation Human Trafficking

Must Do

Appropriations TANF Extension Child Nutrition Extension Debt Limit

May Do

Older Americans Act (OAA) Reauthorization Child Welfare Financing Reform TANF Reauthorization Child Nutrition Reauthorization

Budget Resolution Process

Appropriations Process

Divergent paths create problems

…and the future is uncertain

Comparison of Current Law/CBO Discretionary Baseline, FY 2016 Budget Resolution, and President's Budget

($ in billions)

Defense:

BCA/CBO Baseline* Budget Resolution President

Non-Defense:

BCA/CBO Baseline* Budget Resolution President

FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 FY 2022 FY 2023 FY 2024 FY 2025

$521 $521 $522 $492 $492 $506 $523 $523 $561 $493 $493 $526 $536 $536 $573 $504 $477 $535 $549 $549 $584 $516 $478 $545 $562 $562 $592 $530 $487 $554 $576 $576 $598 $543 $495 $559 $590 $590 $610 $555 $503 $570 $605 $623 $622 $569 $509 $582 $620 $636 $635 $583 $515 $595 $635 $649 $648 $598 $521 $608 $651 $662 $661 $613 $527 $620

*CBO baseline figures as reflected in House Budget Resolution

Differences of magnitude, not direction

Appropriations Subcommittee

Agriculture Commerce-Justice-Science Defense Energy-Water

302(b) Sub-allocations, FY 2016 ($ in billions) FY 2015

$20.6

50.1

490.2

34.2

FY 2016 House

$20.7

51.4

490.2

35.4

Senate

$20.5

51.1

489.1

35.4

Financial Services Homeland Security Interior-Environment Labor-Health and Human Services-Education Legislative Branch 21.8

39.7

30.4

156.8

4.3

20.3

39.3

30.2

153.1

4.3

20.6

40.2

30.0

153.2

4.3

Military Construction State-Foreign Operations Transportation-Housing and Urban Development

TOTAL

71.8

40.0

53.8

$1,013.7

76.1

40.5

55.3

77.6

39.0

55.6

$1,016.6 $1,016.6

Change from FY 2015 House

0.2% 2.5% 0.0% 3.5%

Senate

-0.4% 1.9% -0.2% 3.4% -7.1% -0.9% -0.8% -2.4% 0.0% -5.7% 1.3% -1.3% -2.3% 0.2% 5.9% 1.3% 2.7%

0.3%

8.0% -2.5% 3.4%

0.3%

The most progress in years

Appropriations Subcommittee

Agriculture Commerce-Justice-Science Defense Energy-Water Financial Services Homeland Security Interior-Environment Labor-HHS-Education Legislative Branch Military-Veterans State-Foreign Operations Transportation-HUD

Approval Status of FY 2016 Appropriations House Level

Full Committee House House House Full Committee Full Committee Full Committee Full Committee House House Full Committee House

Veto?

* X X X * * X * * X * X

Senate Level

Full Committee Full Committee Full Committee Full Committee Full Committee Full Committee Full Committee Full Committee Full Committee Full Committee Full Committee Full Committee

Veto?

* * X * * * * * * * * * Note: X = specifically threatened with veto *The Office of Management and Budget has stated that it would recommend that the president veto any legislation "that implements the current Republican budget framework."

There’s always a “but”

• • • • OMB recommends a veto of any legislation "that implements the current Republican budget framework.“ CR all but certain.

A new budget deal to override the BCA?

– Changes to mandatory programs?

Focus on timing: a mid-December convergence?

How do major program areas fare?

Federal Agency Agriculture Education HHS HUD Energy/EPA Justice Homeland Security Labor Transportation

Total – Discretionary ($ in millions)

FY 2015 $6,902 36,547 26,714 42,269 2,599 1,255 1,482 6,066 55,568

179,614 Proposed FY 2016 vs.

FY 2015

President House 0% 6% 5% 8% 0% 1% 1% 10% 29%

13%

-2% -4% -2% 3% -22% 6% 0% -0% -0%

-1%

Senate -1% -2% -1% 2% -20% -3% -1% -4% -1%

-1%

A few programs may see increases

Program Head Start Child Care & Development Block Grant Family Violence/Battered Women’s Shelters Poison Control Centers Rural Outreach Grants Garrett Lee Smith State Grants Heart Disease and Stroke Diabetes Oral Health

($ in millions)

FY 2015 $8,598 2,435 135 19 59 35 130 140 16

Proposed FY 2016 vs.

FY 2015

President House 18% 2% 11% 0% 11% 0% 0% 0% 0% 0% 0% 7% 16% 0% 34% 31% 28% 27% Senate 1% 6% 0% 0% 8% 0% 0% 0% 0%

Some programs are at risk

Program Refugee Assistance State Health Insurance Program Developmental Disabilities – State Councils Developmental Disabilities – Protection and Advocacy Teen Pregnancy Prevention Rural/Community Access to Emergency Devises Maternal and Child Health Block Grant

($ in millions)

FY 2015 $1,560 52 72 39 108 5 637

Proposed FY 2016 vs.

FY 2015

President House 3% -8% 0% 0% 0% 0% 4% -100% 0% 0% 0% -81% 0% 0% Senate -10% -42% -5% -5% -81% -100% -3%

Some programs are at risk

Program Substance Abuse Block Grant Family Planning Section 317 Immunization Sexually Transmitted Infections REACH Community Prevention Grants Primary/Behavioral Health Integration Screening, Brief Intervention, Referral and Treatment Access to Recovery Projects for Assistance in Transition to Homelessness

($ in millions)

FY 2015

Proposed FY 2016 vs.

FY 2015

President House Senate $1,820 287 611 157 51 80 50 0% 5% -8% 0% -100% -25% -48% 0% -100% -4% 0% -2% -100% -14% -3% -10% 0% -20% -100% -100% 0% 47 38 -36% -100% 0% 0% -36% -100% 65 0% -15% -38%

Will any new initiatives be funded?

• Prescription Drug Abuse (SAMHSA, CDC) Program

($ in millions)

FY 2015 President

Proposed FY 2016 vs.

FY 2015

House Prescription Drug Overdose (CDC) Targeted Capacity Expansion (SAMHSA) Grants to Prevent Prescription Drug/Opioid Overdose (SAMHSA) $20 23 $68 36 $70 36 0 12 0 • Antibiotic Resistance Initiative (CDC) – – House ($120M), expand state laboratory capacity Senate ($30M), support collaborations Senate $32 29 6

How will appropriations affect ACA?

• Potential reductions to existing programs because of new ACA coverage • Allocation of Prevention and Public Health Fund • Proposed mandatory rescissions • Preventing use of discretionary funding for ACA

Reconciliation Process

All’s quiet on the reconciliation front

• • July 24 deadline (missed) Committees determine policies, but there is disagreement over approach • President must sign

Reconciliation Directives in FY 2016 Concurrent Budget Resolution ($ in millions) Committee

Education-Workforce Energy-Commerce Ways and Means

TOTAL House Savings/10 years

$1,000 1,000 1,000

$3,000 Senate Committee

Finance Health, Education, Labor, Pensions

TOTAL Savings/10 years

$1,000 1,000

$2,000

Illustrative examples

Area

Foster Care Health Health Health Health Health Labor Labor Nutrition Nutrition Nutrition Nutrition Social Services TANF TANF

Examples Cited in House Budget Committee Report for FY 2016 Budget Resolution Illustrative Example

Increase state flexibility, including privatization Repeal ACA Prevention and Public Health Fund Repeal ACA Covert Medicare to premium support (2024) Convert Medicaid to "State Flexibility Fund" Combine Medicaid and Children's Health Insurance Program (CHIP) Further consolidate job training programs Prohibit individuals from collecting disability and unemployment insurance (UI) Eliminate Supplemental Nutrition Assistance Program (SNAP) outreach activities Convert SNAP to "State Flexibility Fund" (2021) Eliminate eligibility for SNAP via Low-Income Home Energy Assistance Program (LIHEAP) Eliminate SNAP eligibility via Temporary Assistance for Needy Families (TANF) Eliminate the Social Services Block Grant (SSBG) Block administration waivers for work requirements Allow pilot projects for work-based state reforms

Doc Fix Enacted

• • Doc fix enacted: – Extends CHIP funding with 23 percentage point E-FMAP increase (through FY 2017) – Extends related programs through FY 2017 – Permanently extends QI and TMA; other ACA-related programs extended through FY 2017 Delays DSH reductions until FY 2018

Doc Fix: select program extensions

Program

Maternal, Infant, and Early Childhood Home Visiting Health Profession Opportunity Grants Personal Responsibility Education Program Abstinence Education Community Health Centers (mandatory funding) National Health Service Corps Family-to-Family Health Information Centers

FY 2015

$400M 85M 75M 50M 3.5B

287M 5M

FY 2016

$400M 85M 75M 75M 3.6B

310M 5M Medicare Improvements for Patients and Providers Act (additional funding for outreach/assistance):

FY 2017

$400M 85M 75M 75M 3.6B

310M 5M Aging and Disability Resource Centers Area Agencies on Aging State Health Insurance Programs 5M 7.5M

7.5M

5M 7.5M

13M 5M 7.5M

13M

Human Trafficking Law Enacted

• • • Establishes Domestic Trafficking Victims Fund, effective FY 2016 – Financed by penalties and Community Health Center transfer – Funding not subject to appropriations process (HHS/DOJ determine distribution) New Victim-Centered Child Human Trafficking Deterrence Block Grant – – Competitive grants to state/local government Matching requirement New HHS Office on Trafficking in Persons

Domestic Trafficking Victims Fund

Program Name

Grants to State and Local Law Enforcement for Anti-Trafficking Programs Grants for Victim Services

Agency

DOJ DOJ

Annual Authorization

$10 million $11 million Victims Assistance for U.S. Citizens DOJ and HHS $19 million and Lawful Permanent Residents (LPR) Local Children’s Advocacy Centers DOJ $15 million Grant Program for Certain Persons Subject to Trafficking Victim-Centered Child Human DOJ and HHS $8 million DOJ and HHS $7 million Trafficking Deterrence Block Grant Program Internet Crimes Against Children Task Force DOJ $60 million

Funded in FY 2015

No

Eligibility

State and local law enforcement Yes No Yes No New Yes State and local governments, tribes, nonprofits States and local governments, tribes, nonprofits States and local governments, institutions of higher education, tribes, nonprofits State and local governments State and local governments State and local governments

Senate passes OAA reauthorization

• • • Authorizes funding through FY 2018 Modifies Title III (state grants) hold harmless provision – Current law = FY 2006 allotment – FY 2016-2018 = 99% of prior-year allotment – FY 2019 and beyond = FY 2018 allotment Expands lists of allowable activities for certain grants

TANF reauthorization long overdue

• Last long-term reauthorization in FY 2005 – Multiple short-term extensions, latest expires after 9/30/15 • Includes TANF; Healthy Marriage/Responsible Fatherhood; mandatory/matching portions of Child Care and Development Fund (CCDF) • New programmatic requirements • Excluded funding for TANF supplemental grants • Reduced funding for TANF contingency fund – TANF contingency fund authorized through 9/30/16

Highlights of House Discussion Draft

• • • Maintains current funding levels for block grant and CCDF (FYs 2016-2020) – Does not restore supplemental grants; eliminates contingency fund, redirects for targeted grants Modifies work participation requirements – – Eliminates caseload reduction credit, two-parent rate Eliminates distinction between core and non-core activities, allows partial credit, extends limit on vocational education training – Modifies penalties Revives high-performance bonuses, new requirements

Child welfare financing receiving attention

• • • Senate Finance Committee released discussion draft Expand federal reimbursement under IV-E to include time-limited supports/services – Eligibility includes children who are in foster care, at imminent risk, and family members – Outcome-based reimbursement (starting in FY 2020, not to exceed +/- 10 percentage points) Modifies Promoting Safe and Stable Families – Additional mandatory funding – Eliminates current spending requirements

Meanwhile, in other news

Percent Change in Clawback Multiplier, December 2015-December 2016 Greater than 11.76%

Vermont Idaho Texas Arkansas Oregon Oklahoma Colorado Utah Ohio Montana Louisiana Rhode Island Missouri Tennessee Wisconsin Michigan Kentucky 18.25% 13.47% 12.96% 12.91% 12.86% 12.85% 12.67% 12.66% 12.62% 12.47% 12.32% 12.21% 12.09% 12.05% 12.03% 11.92% 11.80% California Virginia Washington Wyoming New Jersey

11.76%

Alaska Connecticut District of Colombia Maryland Massachusetts Minnesota New Hampshire New York North Dakota Pennsylvania 11.76% 11.76% 11.76% 11.76% 11.76% 11.76% 11.76% 11.76% 11.76% 11.76% 11.76% 11.76% 11.76% 11.76% 11.76%

Between 10% and 11.76%

Illinois North Carolina Maine Indiana South Carolina New Mexico Kansas West Virginia Hawaii Delaware Nebraska Georgia Alabama Nevada Mississippi Arizona 11.74% 11.50% 11.43% 11.39% 11.37% 11.27% 11.25% 11.06% 11.06% 10.84% 10.82% 10.69% 10.50% 10.42% 10.33% 10.25% Florida

Less than 10%

9.80% Iowa South Dakota 9.55% 8.55%

Deadlines with funding on the line

October 1, 2015

• Enact FY 2016 budget or CR • TANF, CCDF, Healthy Marriage/Fatherhood • Some child nutrition programs

October 1, 2016

• TANF Contingency Fund • Promoting Safe and Stable Families • Money Follows the Person

October 1, 2017

• CHIP • Healthy Profession Opportunity Grants • Abstinence Education, Personal Responsibility Education Program • Community Health Centers (mandatory) • DSH cuts effective

Deadlines with little consequence

Expired

• CSBG • Aging and disability • Head Start • Substance abuse/mental health • LIHEAP • Ryan White

October 1, 2015 October 1, 2016

• Child abuse prevention and treatment programs • Universal Newborn Hearing Screening • Child Welfare Services

Will the debt limit wreak havoc

• • • • Current estimate for hitting limit is end of 2015.

Will budget deal/CR/HTF be added to the mix?

Will reductions to mandatory programs be on the table?

These events always pose a risk to the economy, state tax revenues.

Take-aways

• • • • • • Appropriations: CR for sure, budget deal possible, conflict certain Reconciliation: Delayed, and president must sign Reauthorizations: OAA possible, TANF and Child Nutrition unlikely Child Welfare: Momentum, but unlikely Debt limit: Poses the greatest risk for mayhem Keep your eyes on mid-December

Questions?

• • Check for updates at www.ffis.org

Trinity Tomsic, [email protected]

, 202-624-8577