Tag Archive: Special Session

  1. Special Session 2020: Policymakers Must Prioritize Child and Family Health

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    The Virginia General Assembly wrapped up its regular session this past March by passing a historic two-year budget that invested in Virginia’s children and families. COVID-19 hit Virginia at the exact same time—disrupting lives and upending our economy. New and urgent budgetary demands presented an unforeseen and unprecedented budget shortfall, forcing Governor Northam to make the tough decision to “Unallott” or freeze more than $2 billion in new spending, much of which was set to take effect this summer. When policymakers returned in August for a Special Session, Governor Northam released an updated budget proposal based on revised budget projections. Sadly, the budget outlook is grim and the Governor’s proposed budget strikes much of the new funding approved in March.

    While the Governor’s new budget makes important investments to avoid evictions, it does not prioritize spending for important healthcare priorities that are critical to families during this time, including: Ensuring more moms have continuous health coverage for one year postpartum and removing barriers to healthcare for legal immigrants.

    To meet the growing needs of children and families, the legislature must explore all revenue options including rainy day funds, new sources of state revenue and exhausting all federal funding opportunities. As the Legislature makes tough funding decisions during special session, policymakers should restore funding for the following health equity priorities:

     

    Restore funding to eliminate Virginia’s “40-Quarter Rule” for legal immigrants

    Federal law requires legal immigrants or Lawful Permanent Residents (LPRs) to establish five years of U.S. residency in order to access Medicaid coverage. Virginia also adds an additional obstacle for immigrants to qualify for Medicaid coverage: 40-quarter work requirement. This rule requires legal immigrants in Virginia, who meet income eligibility guidelines for Medicaid coverage, to prove 10 years of work history before qualifying for coverage. Virginia is only one of six states that still has this additional barrier for immigrants to qualify for coverage. This rule is particularly harsh on legally residing immigrant children and pregnant women who qualify for Medicaid for a period of time but lose it because they may not have 10 years of work history established.

    Before the pandemic hit, Policymakers made progress towards creating a more equitable Virginia by funding policy priorities that eliminated barriers faced by low-income and communities of color. Now is the time for lawmakers to prove that they care about the health of all Virginians and end the 40-quarters rule for LPRs. The good news is that policymakers have already indicated support for this policy change by allocating $4.5 million (over the biennium) in the General Assembly-approved budget passed in March. While the economic outlook is much different now, lawmakers must continue to prioritize the health of Virginians and restore funding to critical health care budget items that reduce existing health disparities.

    Check out this story from our partners at the Commonwealth Institute 

    A big thanks to Delegate Carroll Foy, Delegate Samirah and Delegate Sickles for patroning budget amendments that restore funds to eliminate this burdensome “40-quarter rule”.

     

    Restore funding to extend postpartum coverage for FAMIS MOMS

    The postpartum period is an important, but often neglected element of maternity care. New mothers may be dealing with a host of medical conditions, such as complications from childbirth, pain, depression or anxiety–all while caring for a newborn. While Medicaid pays for nearly half of all births and must cover pregnant women through 60 days postpartum, after that period, states can and have made very different choices regarding whether eligibility for Medicaid coverage is continued.

    In Virginia, FAMIS MOMS covers pregnant women through 60 days postpartum whose income exceeds the Medicaid threshold (138% FPL) but under 205% of the federal poverty level. That’s $53,710 a year for a family of four. Data from the Virginia Maternal Mortality Review Team show the majority of pregnancy-associated deaths occur more than 43 days after pregnancy. Virginia’s current Medicaid–FAMIS MOMS plan only provides health coverage for the first 60 days after delivery, which is insufficient given that the majority of pregnancy-related deaths occur more than 43 days postpartum.

    The previously approved budget included $3.2 million (over the biennium)  to extend health coverage for FAMIS MOMS from 60 days to 12 months postpartum. This policy change would allow 1,200 women per year,  an additional 10 months of health insurance coverage that would enable them to seek care for serious health conditions that may otherwise go untreated due a break or loss of health insurance coverage. Access to care is critical now and funding should be restored to support this policy priority.

    The good news is that the House of Delegates allowed its members to submit amendments to the proposed budget last week. We are incredibly thankful to Delegate Willett and Delegate Sickles for submitting budget amendments that extends postpartum Medicaid coverage for up to 12 months.

  2. 2020 Special Session Priorities

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    The last five months have been disruptive for children and families in Virginia. Children and parents are facing challenges, hardship and trauma that will impact them for a lifetime. Financial, parent, and child emotional distresses contribute to a chain reaction, which serves as evidence that, for many children, the pandemic is causing, what is often referred to as toxic stress or trauma. This involves the chronic activation of the stress response system in ways that are known to affect brain, biological, and socioemotional development.

    As leaders of Virginia, we know that you intend to keep the best interests of children in mind and that you wish to address the adverse experiences of this pandemic. To address these needs in both the short and long-term, you must prioritize the needs of children and their parents with your proposals for the state budget.

    Keep Children and Families Economically Secure and Food Secure

    A nationally representative survey, the Rapid EC project has found that 1 in 5 families with young children reported having a hard time paying for their basic expenses (food, housing & utilities) right now. And the Census Household Pulse survey shows that  families of color in Virginia are twice as likely to report insufficient access to food in the last seven days (22% of Black households and 23% of Hispanic households) than the average household.

    OUR POLICY ASKS:

    • Exhaust every resource from TANF, CARES or additional federal funds to keep families financially secure. The safety nets for families exist for crises like these to afford housing security and stability for families. Cash assistance for families will be necessary to weather additional economic downturns and to pay for unexpected expenses for child care and food in the wake of school closures.
    • Extend the moratorium on evictions. The Governor should sign an Executive Order or the General Assembly should act to halt evictions. Evictions will cause additional disruptions for families and could put children at-risk of entering the foster care system.
    • Ensure postpartum mothers can access health insurance. Extend eligibility for FAMIS Moms from 60 days to 12 full months postpartum.
    • Remove barriers to healthcare for lawfully residing immigrants by eliminating the “40-quarters rule”. 

    Keep Children and Families Emotionally Secure and Supported

    On the most recent Census Household Pulse survey 70% of parents or caregivers reported feeling nervous, anxious or on-edge more than several days in the week. The nationally representative sample of families with young children, the Rapid EC project, reported increasing anxiety   stress levels for all parents as a result of the pandemic. In mid-June anxiety levels had started to decline except for three groups of parents—economically disadvantaged parents, Black parents and families with three or more children. The compound effects of the pandemic and systemic racism on Black families should be acknowledged and addressed by Virginia leaders.

    OUR POLICY ASKS:

    • Extend telehealth and broadband capacity to continue mental health and parent coaching visits. A bright spot of the pandemic has been how quickly mental health and health care providers, as well as home visitors and those offering OT/PT and developmental services, were able to shift their supports on line. Additional funding to support broadband access as well as the home visiting and Part C support services can continue these needed services.
    • Help children access mental health care through connections to primary care by continuing the Virginia Mental Health Access Program (VMAP). Unfreeze $8.4 million to expand access to mental health services for children.
    • Meet capacity and care needs at the Commonwealth Center for Children and Adolescents (CCCA). Ongoing mental health needs will likely cause a surge in admissions in the following months. CCCA has incurred COVID-19 related expenses that remain unmet. To maintain a safe and therapeutic environment, unfreeze $1.5 million to fund additional clinical staff at CCCA.
    • Continue implementation of behavioral health system reforms: STEP-VA, Medicaid services redesign, increasing Medicaid provider rates and bringing more providers to the system through loan repayment programs.

     Support the Early Education and Care Industry

     A July survey by NAEYC found that 38% of child care providers in Virginia would close in the next six months without additional  financial support. During the 2020 Session legislators authorized $85 million to increase access to early education. To respond to current needs, those funds should prioritized and shifted to use as grants for the private child care industry to further expand a strong mixed-delivery system for early education.

    OUR POLICY ASKS:

    • Additional grants are needed to stabilize the child care industry and target community need. With schools closing or moving virtually, the child care industry has stepped up to provide safe care for families who need it. That does not come without additional costs. Child care providers should be awarded grants or contracts to serve children in low-income working families. State leadership for stabilization grants should come from the Department of Education as the new home for the unified early childhood sector.

    Support Early Childhood Educators and Caregivers

    The Center for the Study of the Child Care Workforce reports in their 2018 survey that 51 percent of the child care workforce in Virginia received public benefits. The average hourly wage for an educator in a child care facility was $9.82 in 2018. This low-wage workforce is predominately women and disproportionately women of color.

    OUR POLICY ASKS:

    • Additional funding and protections will be necessary for the early childhood workforce. These caregivers should be afforded the same access to protective equipment and testing as other frontline workers. As these caregivers put themselves and their families at risk for very low wages, additional funding should be maximized to offer hazard pay or incentives.

    Return to School and Child Care Safely

    The pandemic has created numerous challenges to implement safe, caring and nurturing learning environments for children. State leaders must, at a minimum, help ensure that children in school divisions and localities across Virginia have their basic health and mental health needs met.

    OUR POLICY ASKS:

    • To meet the unique needs of health and safety practices in educational settings the state should create a task force to provide uniform guidance for health and safety in all educational settings. And to ensure guidance is relevant to meeting the needs of children, their caregivers and educators and working parents. This task force should look at safety guidance from DSS and VDOE, consistent guidance and approaches offered by local health department, and identifying additional resources needed to implement health and safety standards, such additional school nurse positions or other community health workers.
    • As local school divisions ramp up their social and emotional supports for children and families we hope that you will restore new education funding frozen in the budget and make additional funding available specifically for student mental health needs such as teaching training, additional support staff, purchasing services in the community, or implementing new mental health support approaches or technology.

    More Supports for the Foster Care System

    The pandemic has resulted in fewer calls to Child Protective Services while families are feeling more stressed and children are more likely to experience trauma and hardship. We would like to see calls to CPS continue to stay low, as long as children’s safety and security needs are being met.

    OUR POLICY ASKS:

    • The General Assembly authorized additional prevention services funds for communities and local social services agencies to stabilize families before coming in to the foster care system. The final budget should include $15 million to provide a range of evidence based and trauma-informed services to children at risk of entering foster care.
    • Reinvest $12 million to fund community-based prevention and intervention programs – with dollars specifically allocated to funds programs targeted at communities of color.
    • Local social services staff are also frontline workers helping families to navigate these challenging times. To ensure they are supported the state should unfreeze $11 million to raise staff minimum salaries.

     

  3. Prioritizing Children’s Mental Health During Special Session

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    COVID-19 isn’t just affecting our physical health and daily life—it’s also wrecking havoc on the mental health of our children and families. Whether it’s a lack of access to mental health treatment, loneliness and depression from isolation, fear of contracting COVID, stress and anxiety from racism, or despair from job loss—our country is in pain and our emotional well-being has been compromised.

     

    Mental health experts are becoming increasingly concerned about an emerging mental health crisis that our current system isn’t prepared to handle. While Virginia has made significant strides towards creating a more equitable behavioral health system, disparities in access and quality exist. Now, more than ever, policymakers must recommit to building a comprehensive continuum of behavioral health services for our children and families.

     

    On August 18, policymakers will gather once again to make tough decisions about the state budget and which funding priorities they will “reallot” or “unfreeze.” Policymakers have an opportunity to mitigate the negative impact this pandemic has on our children’s mental health by reinvesting in the following behavioral health priorities:

     

    Make permanent or otherwise extend telehealth flexibilities granted during the pandemic. A bright spot during the public health crisis has been the widespread use of telehealth services across the Commonwealth. As compared to primary care services, behavioral health service utilization remained relatively stable during the pandemic due to new telehealth allowances. To ensure equitable access to telehealth services moving forward, broadband capacity issues and telehealth flexibilities must be addressed. Telehealth flexibilities should:

    • Telehealth reimbursement parity
    • Allow for home and school to be considered an “originating site”
    • Permit phone-based care
    • Increase minutes available on Medicaid phones

     

    Re-allot funding that invests in behavioral health systems and supports that improve equitable access to quality services. These services include:

    • Medicaid Redesign: $13.6 million. Efforts to transform our behavioral health system includes implementation of evidence-based services that have demonstrated impact and value to children and adults and provides alternatives to and step-down from psychiatric admissions. In response to feedback from stakeholders, Virginia’s Medicaid office has now added a racial equity workgroup, a critical first step to addressing racial inequities in our behavioral health system.

     

    • Continue implementation of STEP-VA: $54 million. STEP-VA services improve access, increase quality, build consistency, and strengthen accountability across Virginia’s public mental health system.

     

    • Virginia Mental Health Access Program (VMAP): $8.4 million. Often times, concerns about a child’s mental health are first discussed with the families’ pediatrician. VMAP supports the integration of behavioral and physical health and builds the capacity of pediatricians to identify, diagnose, and treat mental health concerns through consultation, training, and referral support. The pandemic has and will continue to have an impact on the behavioral health of children in Virginia and Pediatricians need support to effectively address this need.

     

    Re-allot funding to support behavioral health workforce development and retention efforts. The behavioral health workforce shortage crisis is well documented. Our community services boards (CSBs) lack sufficient workforce capacity to address challenges in workforce recruitment and retention. CSBs often have difficulty hiring and retaining licensed clinical staff because salaries are often not competitive and reimbursement levels are low. As we build out a better mental health system, intentional efforts to support and develop an equitable workforce is paramount. These efforts include:

    • Fund the Behavioral Health Loan Repayment Program: $3.4 million
    • Increased Medicaid mental health provider rates to 110% of Medicare: $4.9 million
    • Fund additional clinical staff at the Commonwealth Center for Children and Adolescents (CCCA): $1.5 million.
      • While admissions at CCCA dropped to 50 percent capacity during the pandemic, ongoing mental health needs will likely cause a surge in admissions to the state’s only inpatient psychiatric hospital for children in the following months. To date, CCCA has incurred $115,333 in COVID-19 related expenses that remain unmet. To maintain a safe and therapeutic environment at CCCA, additional clinical staff is needed.

    For too long, the stigma of mental health needs has influenced both policy, funding and practice in Virginia, leading to unnecessary and unfair suffering. While our battle against COVID requires all our collective will, we hope lawmakers will prioritize the mental health needs of children and families as they make tough decisions about our state budget.