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

July 2015HSFO Annual MeetingSparks, NV

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 Must Do May DoCHIP Extension Appropriations Older Americans

Act (OAA) Reauthorization

Health Extenders Reconciliation Child Welfare Financing Reform

Human Trafficking

TANF Extension TANF Reauthorization

Child Nutrition Extension

Child Nutrition Reauthorization

Debt Limit

Budget Resolution Process

Appropriations Process

Divergent paths create problems

…and the future is uncertain

FY 2015 FY 2016 FY 2017 FY 2018 FY 2019 FY 2020 FY 2021 FY 2022 FY 2023 FY 2024 FY 2025Defense: BCA/CBO Baseline* $521 $523 $536 $549 $562 $576 $590 $605 $620 $635 $651 Budget Resolution $521 $523 $536 $549 $562 $576 $590 $623 $636 $649 $662 President $522 $561 $573 $584 $592 $598 $610 $622 $635 $648 $661

Non-Defense: BCA/CBO Baseline* $492 $493 $504 $516 $530 $543 $555 $569 $583 $598 $613 Budget Resolution $492 $493 $477 $478 $487 $495 $503 $509 $515 $521 $527 President $506 $526 $535 $545 $554 $559 $570 $582 $595 $608 $620

*CBO baseline figures as reflected in House Budget Resolution

Comparison of Current Law/CBO Discretionary Baseline, FY 2016 Budget Resolution, and President's Budget($ in billions)

Differences of magnitude, not direction

Appropriations Subcommittee FY 2015 House Senate House SenateAgriculture $20.6 $20.7 $20.5 0.2% -0.4%Commerce-Justice-Science 50.1 51.4 51.1 2.5% 1.9%Defense 490.2 490.2 489.1 0.0% -0.2%Energy-Water 34.2 35.4 35.4 3.5% 3.4%Financial Services 21.8 20.3 20.6 -7.1% -5.7%Homeland Security 39.7 39.3 40.2 -0.9% 1.3%Interior-Environment 30.4 30.2 30.0 -0.8% -1.3%Labor-Health and Human Services-Education 156.8 153.1 153.2 -2.4% -2.3%Legislative Branch 4.3 4.3 4.3 0.0% 0.2%Military Construction 71.8 76.1 77.6 5.9% 8.0%State-Foreign Operations 40.0 40.5 39.0 1.3% -2.5%Transportation-Housing and Urban Development 53.8 55.3 55.6 2.7% 3.4%TOTAL $1,013.7 $1,016.6 $1,016.6 0.3% 0.3%

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

FY 2016 Change from FY 2015

The most progress in years

Appropriations Subcommittee Level Veto? Level Veto?Agriculture Full Committee * Full Committee *Commerce-Justice-Science House X Full Committee *Defense House X Full Committee XEnergy-Water House X Full Committee *Financial Services Full Committee * Full Committee *Homeland Security Full Committee * Full Committee *Interior-Environment Full Committee X Full Committee *Labor-HHS-Education Full Committee * Full Committee *Legislative Branch House * Full Committee *Military-Veterans House X Full Committee *State-Foreign Operations Full Committee * Full Committee *Transportation-HUD House X Full Committee *

Approval Status of FY 2016 Appropriations

House Senate

*The Offi ce of Management and Budget has stated that it would recommend that the president veto any legislation "that implements the current Republican budget framework."

Note: X = specifically threatened with veto

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?($ in

millions)Proposed FY 2016 vs.

FY 2015Federal Agency FY 2015 President House SenateAgriculture $6,902 0% -2% -1%Education 36,547 6% -4% -2%HHS 26,714 5% -2% -1%HUD 42,269 8% 3% 2%Energy/EPA 2,599 0% -22% -20%Justice 1,255 1% 6% -3%Homeland Security 1,482 1% 0% -1%Labor 6,066 10% -0% -4%Transportation 55,568 29% -0% -1%Total – Discretionary 179,614 13% -1% -1%

A few programs may see increases

($ in millions)

Proposed FY 2016 vs. FY 2015

Program FY 2015 President House Senate

Head Start $8,598 18% 2% 1%Child Care & Development Block Grant 2,435 11% 0% 6%Family Violence/Battered Women’s Shelters 135 11% 7% 0%Poison Control Centers 19 0% 16% 0%Rural Outreach Grants 59 0% 0% 8%Garrett Lee Smith State Grants 35 0% 34% 0%Heart Disease and Stroke 130 0% 31% 0%Diabetes 140 0% 28% 0%Oral Health 16 0% 27% 0%

Some programs are at risk

($ in millions)

Proposed FY 2016 vs. FY 2015

Program FY 2015 President House Senate

Refugee Assistance $1,560 3% -8% -10%State Health Insurance Program 52 0% 0% -42%Developmental Disabilities – State Councils 72 0% 0% -5%Developmental Disabilities – Protection and Advocacy 39 0% 0% -5%Teen Pregnancy Prevention 108 4% -81% -81%Rural/Community Access to Emergency Devises 5 -100% 0% -100%Maternal and Child Health Block Grant 637 0% 0% -3%

Some programs are at risk($ in

millions)Proposed FY 2016 vs.

FY 2015

Program FY 2015 President House Senate

Substance Abuse Block Grant $1,820 0% 0% -3%Family Planning 287 5% -100% -10%Section 317 Immunization 611 -8% -4% 0%Sexually Transmitted Infections 157 0% 0% -20%REACH 51 -100% -2% -100%Community Prevention Grants 80 -25% -100% -100%Primary/Behavioral Health Integration 50 -48% -14% 0%Screening, Brief Intervention, Referral and Treatment 47 -36% 0% -36%Access to Recovery 38 -100% 0% -100%Projects for Assistance in Transition to Homelessness 65 0% -15% -38%

Will any new initiatives be funded?

• Prescription Drug Abuse (SAMHSA, CDC)

• Antibiotic Resistance Initiative (CDC)– House ($120M), expand state laboratory capacity– Senate ($30M), support collaborations

($ in millions)

Proposed FY 2016 vs. FY 2015

Program FY 2015 President House Senate

Prescription Drug Overdose (CDC) $20 $68 $70 $32Targeted Capacity Expansion (SAMHSA) 23 36 36 29Grants to Prevent Prescription Drug/Opioid Overdose (SAMHSA) 0 12 0 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

Committee Savings/10 years Committee Savings/10 yearsEducation-Workforce $1,000 Finance $1,000Energy-Commerce 1,000 Health, Education, Labor, Pensions 1,000Ways and Means 1,000 TOTAL $2,000TOTAL $3,000

House Senate

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

Illustrative examples

Area Illustrative ExampleFoster Care Increase state flexibility, including privatizationHealth Repeal ACA Prevention and Public Health FundHealth Repeal ACAHealth Covert Medicare to premium support (2024)Health Convert Medicaid to "State Flexibility Fund"Health Combine Medicaid and Children's Health Insurance Program (CHIP)Labor Further consolidate job training programsLabor Prohibit individuals from collecting disability and unemployment insurance (UI)Nutrition Eliminate Supplemental Nutrition Assistance Program (SNAP) outreach activitiesNutrition Convert SNAP to "State Flexibility Fund" (2021)Nutrition Eliminate eligibility for SNAP via Low-Income Home Energy Assistance Program (LIHEAP)

Nutrition Eliminate SNAP eligibility via Temporary Assistance for Needy Families (TANF)Social Services Eliminate the Social Services Block Grant (SSBG)TANF Block administration waivers for work requirementsTANF Allow pilot projects for work-based state reforms

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

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 FY 2015 FY 2016 FY 2017Maternal, Infant, and Early Childhood Home Visiting $400M $400M $400M Health Profession Opportunity Grants 85M 85M 85MPersonal Responsibility Education Program 75M 75M 75MAbstinence Education 50M 75M 75MCommunity Health Centers (mandatory funding) 3.5B 3.6B 3.6BNational Health Service Corps 287M 310M 310MFamily-to-Family Health Information Centers 5M 5M 5M

Aging and Disability Resource Centers 5M 5M 5MArea Agencies on Aging 7.5M 7.5M 7.5MState Health Insurance Programs 7.5M 13M 13M

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

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 AgencyAnnual Authorization

Funded inFY 2015 Eligibility

Grants to State and Local Law Enforcement for Anti-Traffi cking Programs

DOJ $10 million No State and local law enforcement

Grants for Victim Services DOJ $11 million Yes State and local governments, tribes, nonprofits

Victims Assistance for U.S. Citizens and Lawful Permanent Residents (LPR)

DOJ and HHS $19 million No States and local governments, tribes, nonprofits

Local Children’s Advocacy Centers DOJ $15 million Yes States and local governments, institutions of higher education, tribes, nonprofits

Grant Program for Certain Persons Subject to Traffi cking

DOJ and HHS $8 million No State and local governments

Victim-Centered Child Human Traffi cking Deterrence Block Grant Program

DOJ and HHS $7 million New State and local governments

Internet Crimes Against Children Task Force

DOJ $60 million Yes 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

Vermont 18.25% California 11.76% Illinois 11.74% Florida 9.80%

Idaho 13.47% Alaska 11.76% North Carolina 11.50% Iowa 9.55%

Texas 12.96% Connecticut 11.76% Maine 11.43% South Dakota 8.55%

Arkansas 12.91% District of Colombia 11.76% Indiana 11.39%

Oregon 12.86% Maryland 11.76% South Carolina 11.37%

Oklahoma 12.85% Massachusetts 11.76% New Mexico 11.27%

Colorado 12.67% Minnesota 11.76% Kansas 11.25%

Utah 12.66% New Hampshire 11.76% West Virginia 11.06%

Ohio 12.62% New York 11.76% Hawaii 11.06%

Montana 12.47% North Dakota 11.76% Delaware 10.84%

Louisiana 12.32% Pennsylvania 11.76% Nebraska 10.82%

Rhode Island 12.21% Virginia 11.76% Georgia 10.69%

Missouri 12.09% Washington 11.76% Alabama 10.50%

Tennessee 12.05% Wyoming 11.76% Nevada 10.42%

Wisconsin 12.03% New Jersey 11.76% Mississippi 10.33%

Michigan 11.92% Arizona 10.25%

Kentucky 11.80%

Percent Change in Clawback Multiplier, December 2015-December 2016

Less than 10%Between 10% and 11.76%11.76%Greater than 11.76%

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

• Child abuse prevention and treatment programs

• Universal Newborn Hearing Screening

October 1, 2016

• 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, ttomsic@ffis.org,

202-624-8577