Children and Youth Initiatives Entangled in Health Care Uncertainty

Abstinence education, teen pregnancy prevention, family visitation and health care for foster kids – these are just a few of the youth field’s favored things that might be in jeopardy if health care legislation goes down in the wake of this month’s Senate election in Massachusetts.

“There really are some good programs” that “I do fear” could be lost, said Lisa Guernsey, director of New America Foundation’s Early Education Initiative.

Lost, that is, if Congress can’t reach final agreement on sweeping health care legislation or if bills are stripped down to their essentials, as a result of the Democrats losing their 60-seat, filibuster-proof Senate supermajority when Republican Scott Brown won a special election to replace the late Sen. Edward M. Kennedy (D-Mass).

As Washington tries to figure out what to do, here is some of what’s at stake for youth services:

Home Visitation

One proposal youth advocates fear is in jeopardy is a multi-million-dollar home visitation grant program and a provision to ease funding for such programs under Medicaid. Both the House and Senate health care bills include measures to provide mandatory, multi-year grants to states for evidence-based interventions that send nurses or other paraprofessionals into homes to teach child-rearing and other skills to pregnant women and new mothers. The House bill added an option to fund nurse home visitation services under Medicaid as well as the Children’s Health Insurance Program.

No funds were included in the 2010 budget for home visitation services because the administration assumed a health reform package including it would pass. And a U.S. Department of Health and Human Services (HHS) spokesman said Monday that he knew of no plans to provide a stopgap solution for the current fiscal year. The 2011 budget request is scheduled to be released next week, and it could include supplementary funds for this program and others in case health reform stalls indefinitely.

Child welfare advocates say that many randomized control group studies show that quality home visitation can reduce rates of child abuse and neglect, improve youth health and safety, and reduce chances of later involvement in the juvenile and criminal justice systems.  

A study published last month in the Archives of Pediatrics & Adolescent Medicine found that girls from families that had been enrolled in a New York Nurse-Family Partnership program – perhaps the most well-known and thoroughly studied visitation model – were less likely to enter the criminal justice system by age 19, compared with a control group.

Lauren Baker, national director of marketing and communications for Nurse-Family Partnership said this home visitation model has enjoyed bipartisan support on Capitol Hill for years. She said she was “optimistic” that the funding will come through “in one place or another.”

Medicaid Expansion

Beyond home visitation, the health care legislation has other provisions important to the overall health and development of youth, according to Tim Briceland-Betts, coordinator for government affairs at the Child Welfare League of America (CWLA). Those include an expansion of Medicaid that CWLA believes will reach more youth aging out of foster care as well as a House provision to expand Medicaid coverage for therapeutic foster care services. Subsidies to help more working families purchase health care insurance also contribute to the health and well-being of children and youth, Briceland-Betts said.

Abstinence and Teen Pregnancy

The Senate health care bill includes mandatory funding of $50 million for abstinence education and $75 million for teen pregnancy prevention that could be lost if health care reform bills are scuttled or stripped down.

“Both of these provisions could survive, neither could survive, or one or the other might survive,” Bill Albert, chief program officer for The National Campaign to Prevent Teen and Unplanned Pregnancy, said in an e-mail.

James Wagoner of Advocates for Youth, a Washington-based organization that promotes youth health and reproductive rights, said that the greater the differences in the Senate and House versions of health care, the more at risk they may be of not surviving one scenario being discussed of the House adopting the already passed Senate health care bill and then both chambers passing a measure that improves it right away through a practice called reconciliation.

“We feel strongly that whatever process is pursued here” that abstinence-only education be “dropped,” Wagoner said, while acknowledging that the teen pregnancy prevention funding he favors and other smaller provisions that “impact youth dramatically” also could “fall to the side.”


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