Medicaid Cut Puts Schools in a Jam, Children With Disabilities and Others Disadvantaged at Risk

Our Secretary of Education seems still confused (charitable word) about our equal opportunity in education laws.

She was asked again in a Congressional hearing whether her department would deny federal funds to private schools with students who have vouchers her budget would pay for if they discriminated. And she said again she thinks that’s a choice for states to make.

But the Individuals With Disabilities Education Act is one of three major federal laws prohibiting discrimination in federally-funded education programs. And it’s by far and away the most specific.

Schools must assess children with disabilities and develop plans for each that will meet their unique needs, enable them to learn as much as they possible can of what’s expected of their classmates and in the “least restrictive environment,” i.e., by including them in regular classrooms and other such settings, except in special child-specific circumstances, rather than routinely segregating them.

States get federal grants to help defray their school districts’ costs. But that’s not the only source of funds they use. They tap Medicaid to reimburse them for the costs of screening and providing appropriate health services to their low-income disabled students.

They may also use Medicaid funds for the early and periodic screening, diagnostic and treatment services that the law entitles all enrolled children to. Their parents may not even know their children can get them until the school informs them and perhaps helps them apply.

Needless to say, I hope, the House Republicans and Trump administration plans to convert Medicaid to a block grant or set a per beneficiary reimbursement limit have school officials very worried.

A recent member survey conducted by the American Association of School Administrators tells us why, both in summary form and numerous personal responses.

Once the federal government shifts costs to states by whichever means, they foresee a losing competition with other institutions that rely on Medicaid funds, e.g., hospitals, doctors, other providers like the Federally Qualified Health Centers I wrote about.

States will have the flexibility to choose who’s eligible for their programs, what services they can receive and, as we now learn, time limits perhaps, work requirements, premiums they’ll have to pay or get kicked out of the program.

States may, AASA says, decide that school districts can’t get any Medicaid funds at all. But schools will still have to comply with the IDEA requirements. Where will that money come from?

A top line answer is that schools would lay off health professional staff and others with expertise in educating children with disabilities. Alternatively — or perhaps in addition to — schools would cut back on services for all students in so far as they legally can.

AASA and some members quoted cite mental health services in particular. About one in five children show symptoms indicating needs each year.

Neglect them and children suffer not only anxiety, depression and other effects due to trauma or toxic stress. Their academic performance suffers, setting them on the path to drop out when they’re teens.

Their abilities to control their emotional impulses, plan and manage their activities productively and relate well to others suffer too.

These so-called social and emotional competencies obviously give those that have them advantages in both their personal lives while young and long thereafter — and advantages that make getting and keeping a job every so much more likely.

Seems like a lot I know to pack into a post on only one — and hardly the most consequential — impact of what Trump’s roughly estimated $1.3 trillion cut to Medicaid funding would do — or even the House Republicans’ $839 billion.

But the well-being and futures of school-age children ought to matter to all of us. And as I said, it’s not only children with disabilities those cuts would put at risk, but all their peers.

Most at risk are the other educationally disadvantaged students for whom Title VI of the Elementary and Secondary Education Act—now called the Every Child Succeeds Act—aims to make the equal educational opportunity guarantee in the Civil Rights Act a reality.

Trump’s budget would increase ESSA by $1 billion, but channel the extra only to districts that promote parental choice.

It would also siphon off money from high-poverty schools by shifting each student’s share to any publicly-funded school s/he transfers to. And we know that’s not going to be another high-poverty school.

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A Slice of the Trump Budget’s Shrunken Pie for the Needs of Low-Income People

Well, we finally have the full version of Trump’s proposed budget for upcoming fiscal year. And we’ve all seen and/or heard news reports, op-eds, social media takes and the like.

They generally have one of two focuses — new cuts, both total and by cabinet-level department or cuts to certain specific programs.

These tacks are basically the same as when the administration released its skinny budget preview, except that we now have a shift prompted by a range of cuts to safety net programs that don’t depend on annual appropriations.

I expect to deal with some of both, but for the time being, I’ll stick with a large perspective on a subset of programs intended to serve human needs — the non-defense discretionary programs, i.e., those annually funded as Congress chooses and the President approves, as Presidents generally do.

We have a broad range of these, of course. They include, bur aren’t limited to programs that support:

• Some healthcare services, mainly for veterans.
• Sufficient, healthful diets for mothers and their young children, plus food for nonprofits to give low-income people and/or serve as meals.
• Public education, mainly for low-income children and those with disabilities.
• Other opportunities to achieve financial self-sufficiency and security.
• Child care so that parents can participate in such programs and afford paying jobs.
• Safe, stable housing that leaves enough income to help pay for other needs.

The Coalition on Human Needs chose 185 such programs and tracked their funding from 2010, the year before Congress passed the Budget Control Act, through the budget the federal government’s operating under now.

All but 32 had been cut, either directly or for want of adjustments to keep pace with inflation, it found. Nearly a third had lost at least 25%, even though the Obama administration and wise heads in Congress agreed to temporarily modify the spending caps the BCA imposed.

Seems that Republicans over on the Senate side aim for another bipartisan agreement to suspend or at least modify the caps, lest they have to ax spending below the too-low levels already in force.

What’s sure as dammit, as the Washington Post reports, is that they’ll not try to push through the extraordinarily harsh cuts the Trump administration proposes as-is.

Most of the new news rightly focuses on the billions of cuts to so-called mandatory spending programs — also sometimes called entitlements.

They’re mandatory because the laws that authorize them require the federal government to spend as much as necessary to cover the costs or its share of costs for the benefits of everyone eligible to receive and enrolled to get them.

Truth to tell, I’m torn between delving into these unprecedentedly sweeping proposals to gut the safety net and giving them short shrift because they’re DOA. So I’ll end here with just a few examples of the proposed NDD cuts and consequences.

The Trump budget would deny affordable housing to more than 250,000 of the country’s lowest-income individuals and families who could otherwise have vouchers to cover all but 30% of their income for rent.

At the same time, it would reportedly increase tenants’ rent responsibility to 35% of adjusted income and impose a $50 minimum on those who had no or virtually no countable income at all. Income regardless, tenants would have to pay for their household utilities, which current law folds in with rent.

Public housing, which subsidizes rents at the same rate, would lose another $18 billion — nearly 29% more than it’s lost through this fiscal year. The stock available has been steadily shrinking due to lack of funds for repairs and renovations.

For these, as well as other reasons, we have and foreseeably will have some 550,000 people who’ve become officially homeless or very soon will unless they get some one-time or temporary help with rent.

Some have been homeless for a long time or repeatedly because they need not only an affordable place to live, but services to help them with physical and/or mental disabilities.

The Trump budget, however, would cut the grants local communities receive for shelters, permanent supportive housing for the chronically homeless I’ve just cited and homelessness prevention or when that’s not possible swift support so people can leave shelters for affordable housing.

The budget would terminate the Low Income Housing Energy Assistance Program, another homelessness prevention program — and a lifesaver too, since people, especially the frail and elderly can freeze to death in their homes or die because they depend on medical equipment that uses electricity, as 26% did when the last survey was conducted.

Roughly 6.7 million families would lose the subsidies they need to keep their homes warm if Congress moves from under-funding LIHEAP to excising it from the safety net altogether.

Turning then to those job opportunities. The Trump budget would cut a range of programs that help people prepare for gainful work — adult basic education, including preparation for GED exams, career and technical education programs in high schools and colleges and the diverse programs funded by the Workforce Innovation and Opportunity Act.

The Trump budget would cut WIOA funding by 43%, as compared to 2015 funding, the Center for American Progress reports. Nearly 571,000 workers nationwide — close to half of the total then served — could be left to muddle through with only what has failed to net them a decent paying job or any at all.

Pretty ironic — or one might say hypocritical — for a President who’s made such a big deal about job opportunities and, more recently, about how he’ll change safety net programs so they no longer discourage work.

More as the dust clears or perhaps as I find angles you’re unlikely to see highlighted in the plethora of conventional and social media stories, analyses and overt budget-bashing.

Meanwhile, we do have ways we can support the defensive campaigns that will give Congressional Republican pause.

CAP and fifteen partners, including CHN have launched an initiative called Hands Off—and #HandsOff as a hashtag for those who want to tweet about programs they want protected.

They’ve got a website where we can contribute stories about how the programs have helped us and what would happen to us, our families or others we know if they’re cut. With our permission, they’ll share our stories.

Reporters, as you know, are always looking for the personal lead-in or thread.

The coalition, CAP says, will also ensure that members of Congress learn from the stories how their own constituents would be affected. How then they may vote, as it doesn’t say, but needn’t.

Some members lean toward — or out-and-out support — less federal spending, especially on so-called welfare programs. But getting reelected and preserving their majority will trump the Trump proposals handily.

Inclusive Prosperity Programs Shortchanged in Mayor Bowser’s Budget

My last post merely mentioned shortfalls in the Mayor’s proposed budget, due at least partly to the $100 million or so she chose to forfeit by doing nothing to halt the automatically triggered tax cuts.

I’ll turn now to my picks for programs she shortchanges, based on how she styles her budget — a roadmap to inclusive prosperity.” Still only summaries. And not all programs some advocates have flagged.

Nevertheless, more than I can cover in a single post with enough substance to convey what’s under-funded — or unfunded — and why that violates the budget’s promise. So I’ll deal here with what seem the most obvious and followup with a couple of others that matter too.

Education and Training

We also all know that education and relevant job training generally move people along the road to some modicum of prosperity. For many adults in the District, the first step must be remedial education — basic literacy in reading and math, help in preparing for the GED exams.

For others, appropriate programs include those leading to a regular high school diploma and /or vocational education courses in other publicly-funded institutions, e.g., charter schools and alternative education in regular public schools like the Ballou High School’s STAY program.

Several surveys have found that adult learners miss classes because they can’t come up with the transit fare. Eighty-six percent of the youngest who had subsidized transportation said it would hard or altogether impossible to attend without it.

No reason to believe that’s not true for at least as many older adults, who’ve often got to spend more of such income as they have on basic needs for both themselves and their children. And, of course, we’ve got to assume that some of all ages drop out.

The Deputy Mayor for Education recommended an adult learner parallel to the Kids Ride program, which covers the public transit costs of getting to and from school.

Not a big ticket item—a mere $1.5–2 million. But no money in the Mayor’s budget for it.

Double-Duty Work Support

The full, unsubsidized cost of child care in the District is higher, on average, than in any state. Though low-income parents are officially eligible for subsidies that help pay for it, as a practical matter it’s difficult, if not impossible to find a center that will accept them.

This is a long-standing problem rooted in the insufficient rates the District uses to reimburse providers. For this, among other reasons, it was shy roughly 14,000 slots for infants and toddlers in 2015.

They’re the most costly to care for properly, what with diaper changing, feeding and all — hence local center charges averaging $22,658 a year.

The kids are too young for pre-K, of course. But the quality of care, e.g., nurturing relationships, talking to, has more impact on brain development than at any later stage. The very young children who get it will do better in school — and thus have a better chance of sharing in prosperity.

Now, if you can’t find trustworthy care for your child, you’re unlikely to work. Nor enroll in an education or training program that would prepare you to do so. And you won’t do either if you can’t pay for it.

Charges for licensed childcare are likely to increase, since the District recently set new licensing standards that require not only teachers, but their assistants to have at least a two-year college degree, unless they’ve got an independently-awarded Child Development Associate credential.

Those who manage to get either surely — and reasonably — will expect increases in their pay. It’s already, on average, extremely low — $26,470, on average, according to the latest figures.

If they don’t get them they can find employers that will. And that’s likely to further reduce open slots, since replacing them would be as difficult as keeping those who left.

Yet the Mayor’s budget doesn’t nothing about this. It would instead put $15.3 million into a new initiative to increase center capacity. But the new slots would be market rate — helpful for better-off parents, but no help at all for the most in need of affordable care to move down her road.

Paid Family Leave

The Mayor proposes no funding to translate the paid family leave law the Council passed into an operating program.

That requires both the creation of a new agency to administer the law, e.g., to ensure employers pay what they owe, pay out to eligible workers for the time off they take, and a new computer system to make all this possible.

We know the Mayor doesn’t like the law. But the essence of being an executive is executing laws.

Forcing more than half a million workers to wait for who knows how much longer to either keep working when they need time off for compelling  for compelling family reasons — or at least as likely forgo needed income — hardly comports with including them in prosperity.

Her refusal to propose the $20 million needed to get the program started doesn’t, I think, reflect only spending constraints imposed by her deciding not to even hit the pause button on the tax cuts. But they do perhaps provide some cover.

No Proof Trump-Targeted Programs Work?

Congress set in motion a sensible response to the incessant claims from the right that anti-poverty programs don’t work.

It passed a bill that creates an expert commission to review federal program data and make recommendations for using it to support program evaluations and improvements based on results.

Now we’ve got justifications for Trump’s budget that fly in its face — specifically that certain programs that serve low-income people’s needs should cease to exist right now because we don’t have enough proof they work.

The Community Development Block Grant would end because it’s “not well targeted to the poorest populations and has not demonstrated results.”

Communities use CDBG funds to meet various needs. That’s what a flexible block grant is supposed let them do. Some unknown number support Meals on Wheels. They collectively supplied prepared meals for more than 2.4 million homebound seniors last year.

The OMB Director says that Meals on Wheels “sounds great,” but we can’t keep giving states money for “programs that don’t work.”

We do, in fact, have some research showing Meals on Wheels does—probably behind his ken. In any event, he brushes off the lost benefits by donning the mantle of fiscal responsibility.

The Trump budget would also zero-fund grants to local Community Learning Centers, which channel them to afterschool programs, especially in high-poverty, low-performing schools.

The director says more or less the same about them. “There’s no demonstrable evidence that they’re .. helping kids do better in school.” Again, we’ve got some evidence they do, though limited. Not, one infers, demonstrable enough to make the administration even pause.

The budget would also eliminate the Low Income Home Heating and Energy Assistance Program because it’s among the “lower-impact” programs and “unable to demonstrate strong performance outcomes.”

Now, we truly don’t want to fund programs that have no positive or only minimal effects. On the other hand, measuring a program’s effects by the so-called gold standard, i.e., a multi-year comparison of impacts on those who received benefits or services and a control group that didn’t, is a costly business — and still not conclusive.

One need only look at the gold-standard Head Start impact studies. The second, which tracked recent participants through the third grade found that gains didn’t last.

But when research teams at the Brookings Institution and UCLA looked instead at the long term, they found that the children fared better in significant ways

The real issue here, however, is what evidentiary standard a program has to meet for it to be considered funding-worthy.

Consider LIHEAP. It’s done less than it might for quite awhile because it’s been under-funded — and increasingly so. Its appropriations were small, even before the Budget Control Act capped spending on non-defense programs — just $5.1 billion in 2010. Less ever since.

At the same time, home heating costs have increased, as I’m sure you’ve noticed. So states, which get shares of the funding as block grant, have had to cut back on the number of low-income households whose home energy costs they subsidize and by how much.

The program nevertheless keeps the heat on for nearly 6.1 million poor households. Seventy percent are especially vulnerable, the National Energy Assistance Directors Association states, protesting what Trump intends.

Now, common sense tells us that that having heat in the winter averts new or aggravated illnesses due directly to the cold — even death, since roughly a quarter of LIHEAP households include a member who uses electrically-powered.medical equipment.

Bills paid for electricity also prevent injuries, since rooms can be lighted at night and food poisoning by keeping refrigerators running and stoves operating. (This last would be true of natural gas as well, of course.)

Whatever the energy source, the assistance LIHEAP provides can prevent homelessness and other hardships, e.g., food insecurity, because low-income households otherwise have to spend far more on home energy than the less cash-strapped—16%, as compared to 4%, according to findings when energy costs were lower.

Do we really need to find out what happened to another similar group of people who had their utilities cut off and couldn’t scrape up the money to get them turned back on?

It would be bad enough if the Trump administration were holding programs to an unreasonable standard — or merely ignorant of research-based evidence that they work.

But when it says it won’t fund programs without proof of that, it’s putting a self-serving, deceptive gloss on decisions made to cut spending on safety net and other non-defense programs.

How do we know? Well, Trump is bound and determined to fund private school vouchers. Do we have evidence of their outcomes? We do, to some extent, each focused exclusively on one state’s voucher program, plus the District of Columbia’s.

The earliest two found positive effects, e.g. higher graduation rates and, in the District, higher reading, but not math scores.

On the other hand, three of the four most recent, including one financed by a pro-voucher institute found that children in voucher programs scored lower in both reading and math than children in public schools. The fourth found no effect, as measured by graduates going on to college.

A foolish consistency isn’t always the hobgoblin of little minds. In this case, it’s minds of greater capacity engaging in inconsistency to justify their policy preferences — hoping futilely that no one will challenge their alternative facts.