A Voice for Kids: November 9, 2021

2021 State of Children’s Health Care Report Shows More than 2 in 5 children in PA now rely on publicly funded or supported health insurance

We recently released the 2021 State of Children’s Health Care in Pennsylvania: Health Insurance During the COVID-19 Pandemic to highlight practical and policy steps to connect Pennsylvania children to health insurance better and reduce known racial disparities.

Due to the unique circumstances of the COVID-19 pandemic and the limited data available as a result, this year’s report takes a different approach by using alternate data sources. 

We found that families have weathered the pandemic storm under the umbrella of public health coverage because enrollment increased in the last year. Statewide, Medicaid and CHIP have enrolled 10% more children since the beginning of the pandemic, and every county has seen an increase.

Medicaid is the single largest health insurer for Pennsylvania children, covering 41% of all kids. A key factor affecting the increase is the disenrollment freeze implemented in the Families First Coronavirus Response Act in March of 2020, which will be in place for as long as the federal public health emergency (PHE) is in effect.

However, an estimated 500,000 individuals stand to lose coverage once the PHE expires and routine Medicaid operations resume if Pennsylvania does not carefully plan. 

Threats to safety net programs existed before the pandemic. We cannot understate the importance of ensuring that every eligible child and pregnant or postpartum individual does not unnecessarily lose coverage, and keeping eligible people connected to Medicaid once the public health emergency ends is avoidable.

In partnership with other Pennsylvania health advocates, we offer best practices to assist DHS, the state’s Medicaid agency, in its planning efforts for the enormous task ahead, some of which can start now, before the PHE ends.

Those recommendations include ensuring those with existing coverage stay connected without unnecessary gaps in coverage through auto-renewal strategies, updating current mailing addresses, and more extended time frames for continuous coverage. 

In addition, data shows disproportional impacts of the pandemic by race and ethnicity on Pennsylvania households with children.

We acknowledge that we do not have all of the pieces of the puzzle. What we do know is that these disparities will continue to deepen if not directly addressed.

The report also covers the impact of the pandemic on routine immunizations. The early part of 2021 shows vaccination gaps continued among children, particularly preschool and young school-age children ages 4-10.

Media Coverage of the Report

Infrastructure Down, Build Back Better Act to Go

Congress is on a break this week, but Speaker Nancy Pelosi has promised a vote on the Build Back Better Act (BBBA) the week of November 15th. This comes as the U.S. House approved the $1 trillion (over ten years) bi-partisan infrastructure package last Friday, which the U.S. Senate passed in August with 19 votes from Republican Senators. There was also a procedural vote passed along party lines to allow the House to quickly consider the BBBA when it comes up for a vote.

President Biden has signed the infrastructure bill into law and is urging swift action on the BBBA. However, already tense negotiations could be further complicated as Pelosi added four weeks of paid family leave back into the now-$1.85 trillion BBBA proposal. Sen. Joe Manchin specifically had insisted that paid family leave be left out when the bill was negotiated down from its original price tag of $3.5 trillion. With another major piece of legislation passed by this Congress, it remains to be seen if they can come to an agreement with a looming deadline of December 3rd to pass a budget and address the federal debt ceiling.

As a reminder, the current iteration of the BBBA contains the following provisions PPC supports and is prioritizing in final passage of the bill:

  • Child Care – Provides over $100 billion to support high-quality child care during the first three years and such sums in the following three years via a new child care and early learning entitlement program to provide high-quality, affordable child care for children ages birth to five, increase wages for the early childhood workforce, and invest in child care quality and supply (including facilities). Caps families’ child care copayments to ensure that no eligible family pays more than 7% of their income on child care by creating a sliding scale fee system.
  • Pre-K – Provides over $18 billion during the first three years and such sums as may be necessary in the following three years for the HHS Secretary in collaboration with the ED Secretary, to carry out a universal, high-quality, free, inclusive, and mixed delivery preschool program. Eligible providers include licensed child care programs, Head Start grantees, LEAs, or a consortium of those entities. Requires states to develop and implement state preschool standards and ensure all eligible providers meet such standards
  • Health Care
  • Authorizes permanent funding for CHIP;
  • Requires 12 months of continuous Medicaid and CHIP eligibility to postpartum women;
  • Requires 12 months of continuous eligibility to children enrolled in Medicaid and CHIP;
  • Allows states to smoothly transition out of the coverage requirements put in place during the public health emergency;
  • Provides over $1 billion in grant funding to various programs addressing social determinants of health in maternal and postpartum health, reducing racial/ethnic disparities in maternal health outcomes, growing, and diversifying the public health workforce – including doulas – for maternal health, serving maternal mental health needs, and improving maternal morbidity/mortality outcomes.
  • Provides $5 billion to address lead paint and other health hazards in the housing stock of the United States and $970 million to make grants under the Consolidated Farm and Rural Development Act to replace service lines that contain lead.
  • Career and Technical Education – Provides $700 million over six years to carry out activities related to Career and Technical Education, of which $600 million is provided for state grants authorized under the Carl D. Perkins Career and Technical Education Act of 2006, and $100 million is provided for innovation and modernization grants authorized under that Act.

 PA Legislature Meets Before Long Break

While activity in Washington has been taking-up airspace, the Pennsylvania General Assembly continues to meet in Harrisburg, including session weeks occurring the week of October 25th and this week, November 8th. Recent activity PPC is following includes:

  • The House Children & Youth Committee approved two bills and one resolution the week of October 25th: House Bill 159, House Bill 1737, and House Resolution 119. PPC provided feedback in support of HR 119, under which the PA Joint State Government Commission would study the development of a comprehensive statewide child welfare reporting system. The resolution is on the House calendar this week for final passage. House Bill 159 and House Bill 1737 are also currently seeing activity on the House floor, including amendments proposed to HB 1737 that would exempt medical marijuana from drug testing in the child welfare system.
  • This week the House Education Committee subcommittee on Basic Education held a hearing on learning loss because of the pandemic. Members gathered input from district superintendents about how students are faring. One superintendent testified that there needs to be an awareness of students’ mental health. The PA Department of Education is still waiting on data to assess the pandemic’s impact on learning loss.
  • The Senate Education Committee held a voting meeting this week on a litany of bills, including several that address amendments to the state’s Educational Improvement Tax Credit (EITC) program such as House Bill 1642, Senate Bill 931, and Senate Bill 932.
  • The Senate Aging and Youth Committee today is voting on House Bill 1650, which is an administrative rewrite of Title 67 in the Human Services Code (speaks to topics including kinship care, family finding, and adoption) and does not make substantive policy changes.
  • The politicization of the current COVID-19 pandemic continued, with the Senate Health and Human Services Committee voting on Senate Bill 471, which prohibits mandatory COVID-19 vaccinations, and the Senate Education Committee voting on Senate Bill 937, which would prohibit COVID-19 vaccination requirements for children attending public schools. Both bills passed their respective committees and may see debate on the Senate floor this week.

While the House is supposed to be in session next week and activity has already been sun shined in the House Education Committee of interest to PPC (including bills about lead in schools and school stability for children in the child welfare system), the next time both chambers will be in Harrisburg isn’t until the week of December 13th. PPC will continue to keep you updated on other bills that impact our work to build better futures for Pennsylvania kids and families as we move closer to 2022.

Centers for Disease Control and Prevention Reduced the Level of Concern for Elevated Blood Lead Levels

There is no safe level of lead exposure – even the smallest amount can damage a child’s ability to learn – and children are most at risk of lead toxicity. Recently, the Centers for Disease Control and Prevention (CDC) announced new standards for lead poisoning in young children, lowering the blood reference level from 5 micrograms per deciliter to 3.5 micrograms per deciliter. The change would grow the number of children ages 1 to 5 in the U.S. considered having high blood lead levels from about 200,000 to about 500,000.

States can implement the new guidelines, and while no formal announcement has been made, it is anticipated the commonwealth will adopt them.

PPC and other advocates welcome the change because it will help prioritize the children most at risk of lead poisoning. In Pennsylvania, nearly 8,000 children are poisoned every year, with paint hazards in homes as the primary source of lead poisoning. Pennsylvania ranks 5th for old housing stock, with 70% of residential homes built before 1980.

PPC is a part of the Lead-Free Promise Project working on policy changes to remediate more homes where lead is found and increase screening rates of children before 2-years old. The coalition’s work also includes giving children exposed to lead access to Early Intervention services to help catch any delays caused by exposure.

In Case You Missed It…

  • The Office of Children, Youth, and Families issued a policy clarification on delayed notification to subjects of a child abuse investigation when there is an ongoing criminal investigation. The policy clarification and quick reference guide define “reasonable delay” and outline documentation requirements and timelines for the county to complete its investigation.
  • Unaddressed truancy concerns can lead to child welfare or court involvement, whether through a local Magisterial District Judge or a dependency court proceeding. However, before seeking court involvement, local education agencies should work to remedy the situation through a Student Attendance Improvement Conference and offer community-based interventions. Learn more about myths involving truancy and strategies to get children and families back on track.
  • The Office of Child Development and Early Learning (OCDEL) announced an Impact Project with the National State Capacity Building Center to rewrite Pennsylvania child care regulations, focusing on equity, quality, and decreasing burdens placed on providers. You can learn more by watching this video by Deputy Secretary Tracey Campanini.
  • Pennsylvania’s Mission: Readiness recently released a report that highlights the disproportionality of females in the workforce who were impacted by COVID and the lack of child care.