MINUTES OF THE meeting
of the
ASSEMBLY Committee on Health and Human Services
Seventy-First Session
February 28, 2001
The Committee on Health and Human Serviceswas called to order at 1:40 p.m., on Wednesday, February 28, 2001. Chairman Ellen Koivisto presided in Room 3138 of the Legislative Building, Carson City, Nevada. Exhibit A is the Agenda. Exhibit B is the Guest List. All exhibits are available and on file at the Research Library of the Legislative Counsel Bureau.
COMMITTEE MEMBERS PRESENT:
Mrs. Ellen Koivisto, Chairman
Ms. Kathy McClain, Vice Chairman
Ms. Sharron Angle
Ms. Merle Berman
Ms. Dawn Gibbons
Ms. Sheila Leslie
Mr. Mark Manendo
Ms. Bonnie Parnell
Ms. Debbie Smith
Ms. Sandra Tiffany
Mr. Wendell Williams
COMMITTEE MEMBERS ABSENT:
Mrs. Vivian Freeman
GUEST LEGISLATORS PRESENT:
Lynn C. Hettrick, Assembly District #29
Chris Giunchigliani, Assembly District #9
STAFF MEMBERS PRESENT:
Marla McDade Williams, Committee Policy Analyst
Darlene Rubin, Committee Secretary
OTHERS PRESENT:
Carol Broersma, Parent
Emil DeJan, Bureau Chief, Health Planning and Statistics, State Health
Division
Jean Gunter, Program Manager, Office of Vital Records
John W. Jackson, Sr., Grandparent, Grandparents Raising Grandchildren
David C. Love, Grandparent, Grandparents Raising Grandchildren
R. Alexis Miller, Planned Parenthood Mar Monte
Steve Shaw, Administrator, Division of Child and Family Services
Michael Willdin, Administrator, Welfare Division
In Las Vegas:
Jane Horner, Grandparents as Parents (G.A.P.)
Antoinette Moore, Grandparent
Note: Simultaneous videoconference to Legislative Counsel Bureau, Room 4100, Grant Sawyer State Office Building, 555 East Washington Avenue, Las Vegas, Nevada
Assembly Bill 12: Revises provisions governing issuance of supplementary certificates of birth by state registrar of vital statistics. (BDR 40-458)
Chairman Koivisto opened the hearing on A.B. 12 and asked Assemblyman Hettrick to introduce his bill.
Lynn C. Hettrick, Assembly District 39, explained that his bill solved a unique problem in Nevada and that Mrs. Broersma would talk more about that. Also the Health Division (HD) was present to address some of the bill’s language. Further, he had spoken to the Governor’s Office and although no one from that office was able to be present, Mr. Hettrick was authorized to inform the committee of the Governor’s full support.
Carol Broersma, a Gardnerville resident, addressed the committee on behalf of her husband Michael and family. She provided her written testimony, Exhibit C, highlights of which were as follows:
Three years ago the Broersmas made plans to adopt a child in need from a foreign country. They had researched many countries and found the greatest need among orphaned children of the world was in Africa. They chose the country of Liberia from which to adopt their child. In 1989 a civil war broke out; there was no international intervention to stop the war. The consequence of the violence was that thousands of children were orphaned.
In the process of completing the adoption process and traveling to Liberia to get their child, the American Embassy was fired upon by rebels and permanently closed. American personnel were evacuated leaving incomplete paperwork inside the embassy. The Broersmas traveled to Africa nonetheless, and in working through the State Department and American Embassy in the neighboring country of Cote d’Ivoire were allowed to seek an adoption-by-proxy due to war.
During their weeks in Africa, their newly adopted son Samuel was very near death due to lack of food in the wartime conditions. They finally returned safely to the United States and began the process in Nevada to finalize Samuel’s adoption and obtain a Nevada birth certificate from the Nevada State Registrar. However, the Broersmas were dismayed to learn they could not finalize the adoption because Samuel’s birth certificate was written in English, not in the native tongue of his birth country. They had two choices: return to war-torn Liberia to attempt to secure such certificate, or “trying to pass off an African birth certificate printed years after the birth on a bad copy machine with the word ‘unknown’ filling most of the blanks.” Without a birth certificate, Samuel could not be admitted to school or function in the American way of life.
Mrs. Broersma explained that under the current law there was no allowance for adoptees from English speaking countries with poorly functioning governments or who had no working relationship with America. She asked that the law be changed and make it impartial to children from all parts of the world.
Assemblyman Hettrick said that even with intervention from the Governor’s Office and others, the birth certificate was unable to be obtained. He explained that after Mrs. Broersma contacted him, he in turn enlisted the help of Judge David Gamble and George Keel, Attorney, who volunteered his services, the paper work was written and submitted, a court order was issued, and ultimately the birth certificate was obtained. Mr. Hettrick said that the law needed to be changed.
Assemblywoman Leslie asked what the changes in the law would accomplish. Mr. Hettrick responded that it was primarily clean-up language on the first page. In Section 2, where it stated “outside of this state” they listed “in another state” and then listed some of the districts that would apply, so none would be missed, and also included United States and Canada. The part that applied to the current situation was on the back, the new Section 3, which allowed for the writing of a certified report of adoption.
Mrs. Leslie asked where in the bill was the information that applied to the Broersma case. Mr. Hettrick said it was Nevada Revised Statutes (NRS)440.310, Foreign Born Statute. Mr. Hettrick explained that on the surface there seemed to be no conflict because it stated that if it was written in English then one should be able to have it rewritten in English, but the fact was that because it came from Liberia there was no way to go back and get it rewritten. Mrs. Leslie clarified that what would be accomplished, then, would be that if one had a valid birth certificate from any country it was transferable.
Vice Chairman McClain asked why a change was being made in Section 1, persons born in Nevada. Mr. Hettrick said all parties, Vital Statistics, the Governor’s Office, and so on had agreed to it. Initially the bill came from Vital Statistics and they wanted to adjust all of the problems they felt were necessary. When it reached the Governor’s Office, because of the bill limits set in the 1999 Legislative Session, they preferred not to handle the bill. Thereafter, Mr. Hettrick took on the bill because the Broersmas were in his district.
Emil DeJan, Bureau Chief, Health Planning and Statistics, State Health Division, was accompanied by Jean Gunter, Program Manager, Office of Vital Records. Mr. DeJan explained that NRS 440.310, the first part clarified Nevada births, the second part dealt with births in the states and territories outside of Nevada, and the third part was the part referred to earlier regarding those who were foreign born, and eliminating the provision that if the foreign born birth certificate was in English the registrar would not issue another certificate.
Mrs. McClain asked if that was new language concerning a person born in Nevada, and if they were adopted then was a new certificate of birth needed.
Jean Gunter, Program Manager, Vital Statistics, responded they currently created a new birth certificate based on the information provided in the adoption decree.
Mr. DeJan interjected that Linda Anderson, Deputy Attorney General, felt that new language was the best way to clean the language up. He added that the Health Division firmly supported the bill.
Chairman Koivisto asked if there was anyone wishing to speak in opposition; there was no one. She then asked if committee wished to discuss the bill further; they did not.
ASSEMBLYWOMAN ANGLE MOVED DO PASS A.B. 12.
ASSEMBLYWOMAN PARNELL SECONDED THE MOTION.
THE MOTION CARRIED UNANIMOUSLY.
Chairman Koivisto opened the hearing on A.B. 15.
Assembly Bill 15: Requires establishment of program to provide supportive assistance to certain persons who obtain legal guardianship of their grandchildren. (BDR 38-368)
Chris Giunchigliani, Assembly District 9, introduced her bill and explained during the interim while the Health Committee looked at the whole senior program the issue had come up, however it had not been within the jurisdiction of the committee but she believed there was some interest in considering the bill. She presented Exhibit D, comprised of her written testimony and a packet of background information and statistics from National Conference of State Legislatures (NCSL) and other states, and excerpts from a book entitled, Subsidized Legal Guardianship Update. The entire book was available in the Legislative Counsel Bureau Research Library.
Ms. Giunchigliani said the idea for the bill had come from Jane Horner in Las Vegas, whom she thanked for educating her on the issue of kinship care. She added the grandparents and relatives who were present at the hearing also deserved a “thank you” for the work they did and caring enough about taking their grandchildren in and trying to preserve their family.
Ms. Giunchigliani, in her role as a middle school special education teacher, had seen more and more grandparents over the years raising their children. She had learned from Mr. and Mrs. Jackson, later to testify, that 4 million grandparents in the United States were raising their grandchildren. In most instances those children would have been in a Child Haven program, juvenile court services, or just wallowing away someplace, and many of those children had mental health needs that were not being met while they lingered within the system. While some of the grandparents could count on welfare dollars, they did not begin to cover the cost of caring for those children. Further, there was a lack of foster care homes and the informal arrangements with grandparents or other relatives, called “Kinship Care” helped them meet the placement needs for state or local governments.
Ms. Giunchigliani continued that with the advent of the Adoption and Safe Families Act (ASFA), a shift finally occurred from presuming that everything should be done to place the child back with the birth parents even if they were in an abusive situation. Instead, ASFA gave more weight to the health and safety of the child. It was the perfect time, she added, for kinship subsidies for grandparents. Eleven states had enacted laws providing adoption subsidies, additionally 93 percent of the children placed for adoption had special needs which called for more services, such as the respite care training, mental health services, and support groups, and some of those opportunities were outlined within the bill. Moreover, the National Conference of State Legislatures (NCSL) found that 20 states had enacted into law permanent guardianship as another alternative. Permanent guardianship did not terminate parental rights, and it was not as permanent as an adoption status would be; it usually severed itself at the age of 18.
What A.B. 15 attempted to do was to give grandparents the same amount of subsidies as foster parents. The bill called for the legal guardianship, but there may be a need to work on the language to determine the direction needed. Under custody, for example, there was an opportunity to obtain health insurance, but under guardianship that might not be the case. Ms. Giunchigliani said it was important not to create another barrier or problem. She added that in speaking with the Governor recently, he felt the program was important and should be looked at. There may be Temporary Assistance to Needy Families (TANF)-dollars or other budgetary dollars available and she asked for the committee to allow her time to work on the funding mechanism with the various staff, and to consider any amendments for cleanup language.
Assemblywoman Gibbons asked what was the reason that a parent of a child could not reside in the same household with the child under legal guardianship. Ms. Giunchigliani responded in drafting the language they worked with a variety of groups. Part of the problem was in defining the “grandparent.” They had wanted to broaden it to include other relatives but felt it would be too expensive, so they decided to start with grandparents because that was where the need was greatest. The issue about the parent residing, she believed, was to make sure the dollars were cleanly kept. There could be grandparents just taking their grandchildren in for the money, and the grandparents were concerned about making sure that would not occur. She offered to do further research on that and provide a more concrete answer.
Assemblywoman Parnell echoed Ms. Giunchigliani’s comments about what she saw as a middle school teacher, that the number of grandparents taking care of their grandchildren had increased dramatically. She thanked Ms. Giunchigliani for bringing the bill forward and also thanked all the grandparents who were so lovingly and unselfishly caring for their grandchildren.
Assemblywoman Smith also thanked Ms. Giunchigliani and commended her for bringing the bill forward. She added that in her occupation she worked with many retired citizens and one of the experiences they had was that even if they had custody or guardianship, their health plans did not allow grandchildren to be included. Consequently, there was a huge need. She was sure the committee could work through the questions and do the right thing.
Assemblywoman Leslie said the fiscal note projected was $1.5 million for the first fiscal year, $4.1 million the second, and the effect in future of over $10 million. Ms. Giunchigliani said the Welfare Department wanted to work with her on that, however she thought at the time that note was created they were looking at all relatives not just grandparents. It was not her intent to impact the department or make it a difficult procedure; she wanted to keep the regulations and procedures very simple. Mrs. Leslie asked if they would just apply foster care rates to the qualified grandparents. Ms. Giunchigliani said that was part of the intent.
Mrs. Leslie asked if Ms. Giunchigliani was going to work on the bill further and return it to the committee. Ms. Giunchigliani said yes, she wanted to see if TANF could match and what dollar stream could be used so as not to impact the general fund. Also to make sure the definitions were correct as to what constituted “kinship care.” She felt she would have the additional work completed in another week or perhaps two. Mrs. Leslie wanted to know how the bill would affect the counties; was the bill just for the long-term foster parents and not the short-term foster care. Ms. Giunchigliani said that was correct.
Vice Chairman McClain asked if the scenario was a child who would probably go to foster care, but instead a grandparent stepped in to take the child. Ms. Giunchigliani said that was correct. Mrs. McClain wonder why, then, was there such a huge fiscal note. Ms. Giunchigliani said because it was an entirely new population that was not currently being subsidized. Mrs. McClain asked if there would be a “needs basis” attached to the bill. Ms. Giunchigliani said she had not anticipated that but it could be discussed. Mrs. McClain felt that might be a way to save some money. For instance, if a grandparent made very good money why would they be subsidized. Ms. Giunchigliani said those cases were diversions from foster care, the grandparents had been taking the children in rather than burdening the state. She felt that was a different realm than a case where a grandparent had taken the child in because of a family problem. She added the fiscal note definitely needed to be worked on.
Chairman Koivisto pointed out that the dollar amount was not what the committee would be dealing with. The committee would deal only with the policy, the dollars would be dealt with by another committee. Mrs. McClain said that was true, however, when it came down to the money it often did not matter to the Committee on Ways and Means. Ms. Giunchigliani reminded she was vice chair of that committee and she would listen. Mrs. McClain was emphatic that policy committees made policy and “money” committees needed to find the money to carry out those policies.
Chairman Koivisto invited individuals in Las Vegas to testify. She provided a bit of background regarding Jane Horner, who had been the driving force behind the drafting of the legislation, and had worked so hard to get help for grandparents who were taking care of their grandchildren.
Jane Horner, a resident of Las Vegas, Nevada, and founding member of Grandparents as Parents (G.A.P.), informed the committee she and her husband had gotten their two grandchildren, ages 14 and 4, on February 14, 2000. The children’s parents were divorced, the SWAT team had broken the mother’s door down looking for methamphetamines, and the father was an alcoholic on the street. Mrs. Horner’s argument with the system was that they, Mr. and Mrs. Horner, had not known their rights. Most grandparents in G.A.P. did not know their rights because no one in the system told them. The Adoption and Safe Families Act (ASFA) was a wonderful thing, but it did not consider the grandparents. From her observation, TANF would give them $383 a month for two grandchildren and foster parents received three times that amount. She felt the grandchildren were entitled to that same amount. It was their money, no matter how much money the grandparents had. Mrs. Horner’s second objection was that workers would come in through ASFA or caseworkers and say that if they had a young child, after a year’s time they could pull the child out of the home and the child could be adopted out.
Mrs. Horner stated under the current bill grandparents would be out of the state system, entitled to foster money, and to medical care for the children, which they would also still be receiving whether they were with their grandparents or in foster care. A child 13 to 18 years old was moved in foster care 30 to 35 times, simply because the foster parents did not want to deal with teenage rebellion. Grandparents would continue to provide a home for their grandchildren in that age group, thereby saving the state money. Also, if they were out of the system it saved the caseworker money. That money could then be put into a “kinship” bill fund.
Mrs. Horner added there were approximately 400 grandparents in Clark County that were in the state system raising their grandchildren. Ninety percent were on Social Security and consequently had very limited resources. However, rather than send the children to foster care for the state to support, they gladly took in those children. The grandparents would take the teenagers to counseling, or whatever was needed, but they would not pass them around from home to home, which was in the best interests of the child. Mrs. Horner believed there was a TANF surplus of about $4 million. She had written to Governor Guinn and received an answer. He was in favor of the bill. She also received a letter from Assemblyman Joe Dini who was in favor of the bill, as was the Lieutenant Governor Lorraine Hunt.
Mrs. Horner asked that the bill include a provision that state workers be mandated to tell the grandparents who pick their grandchildren up at Child Protective Services (CPS) or at Child Haven, where they could go, what their rights were. It was not being done. She began G.A.P. so there was an advocate for the children so they would know someone was working for them. She noted her 14-year-old grandson called her the “Crusader Grandma,” and she would continue working on the children’s behalf until the work was done because the children deserved it; they had already lived through terrible situations. She confided her grandson had already been in ten schools, and her four-year-old granddaughter was born addicted to drugs. The foster care money and the medical aid she was asking for they deserved just as much as non-related foster parents.
Mr. Horner brought up the point that the amount of money received by the grandparents should definitely be exempt from income tax.
Chairman Koivisto asked for committee questions; there were none. She thanked the Horners for their work on behalf of grandchildren and grandparents.
Returning to witnesses from Carson City, next to speak was John Jackson.
John W. Jackson, Sr., representing Grandparents Raising Grandchildren (G.R.G.) in Reno, said his group of grandparents had run into the same problems as in southern Nevada. Many grandparents did not know where to turn, grandchildren were “dropped” on them. When grandparents called many of the governmental agencies they were often given no information, the various people they spoke to claiming not to know or saying it “was not their job,” or “I can’t give you legal advice.” As a result, the grandchildren were falling between the cracks. In a situation where a child was placed in foster care, the foster parents had all of the benefits afforded by statute. Mr. Jackson explained he and his wife had raised a granddaughter for 11 years; they were one of the success stories. She returned to her mother who had been “clean” for five years. He noted that his granddaughter had been with them six years before they could even get guardianship, and until that legal status was attained the Jackson’s insurance company would not cover the child. They did not know where her mother or father were in order to start the process, so during that six years the Jacksons paid for all the child’s medical care.
Mr. Jackson reiterated there were over 4 million grandparents raising grandchildren, according to American Association of Retired Persons (AARP). His group had worked with the grandparents who did not know where to turn. That work had resulted in Grandparents Raising Grandchildren: A Resource Guide (Exhibit E), which had been published in cooperation with the University of Nevada, Reno (UNR). The guide was a starting point for grandparents of where to obtain legal services, school records, insurance, and so on. Exhibit E also included a participant packet from a satellite videoconference held on February 27, 2001, that discussed legal and policy issues. The conference had been sponsored by AARP, Purdue University Cooperation Extension Service, The Brookdale Foundation Group, and the University of Wisconsin-Extension. That packet contained information on other states and parties to contact who had enacted bills pertaining to grandparents, kinship, and guardianship. Mr. Jackson noted his Reno group had approximately 50 members but was growing rapidly; in fact he received about 15 calls per week. Most of the grandparents were on Social Security with limited funds to care for the many special needs grandchildren in their care. It was often a choice between buying additional food for the child or taking the child to the doctor for needed care.
In closing, Mr. Jackson urged the committee to pass A.B. 15 and volunteered that his group and the G.A.P. group would help in anyway they could.
Next to speak was David C. Love, executive director of the Bethel Senior Council, a member of Grandparents Raising Grandchildren (G.R.G.), and a health educator, retired, before taking on the care of his five grandchildren which necessitated returning to work. He said the needs assessment that Assemblywoman McClain spoke of was important because grandparents raising grandchildren had to use their retirement or Social Security income which created a great hardship. He voiced the feelings of others who believed grandparents should be treated the same way as foster care parents.
Mr. Love stated that A.B. 15 was extremely important because it would enable grandchildren 18 and under in their grandparents’ care to receive needed subsistence in a “kinship connection” program. As it now stood, grandparents often went without needed food or care for themselves to support their grandchildren. Grandparents or other relatives’ health insurance did not cover the health care needs of those children. Mr. Love pointed out that grandparents had developed a new role since the 1980’s and were again raising grandchildren, taking them away from foster care situations to make sure they had some stability. That affected them because there had been an explosion of teenage births, increased substance abuse, increased poverty and homelessness among single youth, as well as young adults having children out of wedlock. Grandparents were often called in to take over the care of those children because they loved them very much. Additionally, there had been an increase in domestic violence including child abuse, consequently children were often taken from their homes and put into protective custody. The first place the caseworker called was the grandparents. Many times the grandparents would take them in if they could afford it. Often they cannot afford to do that, therefore a compelling reason for grandparent support to be included in A.B. 15. Further, with the influx of AIDS and children who had AIDS and associated special needs, the medical costs for grandparents was enormous.
Mr. Love urged support of A.B. 15 because it would place grandparents in line with the foster care system and afford the same income. It was important to make sure the bill provided kinship care and information and referral systems. He reported that of the 225 grandparents raising grandchildren in northern Nevada, only 56 grandparents received any kind of support, primarily because they did not have information or had not found the legal way to access that support. He also felt there was a need to provide services related to respite care support, and to include the entire family in the health and wellness care so that the grandparents were healthy as well as the grandchildren.
Mr. Love mentioned another neglected area was in the education of unwed fathers and some means for providing that education needed to be included in drafting the kinship initiative, just as parenting skills training was important for that day when the grandchildren could be returned to their parents. Mr. Love said there was also a need to develop what he termed an “inter-generational navigator’s program” in order to assist grandparents who were not familiar with the legal process of filling out applications as well as maintaining support.
Additionally, Mr. Love informed that 11 states had adapted regulations that dealt with support services in their foster care program for grandparents and he hoped Nevada would join those states.
Chairman Koivisto acknowledged that Mr. Love had brought up some very good points and those would be taken into consideration, along with the fact that many children for whom the grandparents were the legal guardians might qualify for the Nevada Health Insurance Program. Mr. Love said his grandchildren were enrolled in that program. However, many grandparents had difficulty in enrolling their grandchildren.
Assemblywoman Parnell thanked Mr. Love and Mr. Jackson for their testimony. She added that it sounded as though case managers might be needed for follow through and asked Assemblywoman Giunchigliani to look into that as well. In particular, she felt many children had lived through difficult circumstances and came to their grandparents with a number of issues, as did foster children in general, and it was necessary to be sensitive to their needs in dealing with the situation.
Assemblywoman Leslie concurred with Ms. Parnell and believed information sharing needed to be considered and perhaps the divisions could address that. A better job had to be done in getting the Resource Guide out. She asked if G.R.G. was nonprofit. Mr. Jackson said it was, and they had distributed the Resource Guide to governmental agencies, schools, counselors, and so on. Washoe County had helped in that effort with an additional 80 copies above the group’s initial 40 copies. Mrs. Leslie asked Ms. Giunchigliani if she intended to look into the health insurance issue, because not all the children would qualify for Check-up.
From Las Vegas, Antoinette Moore reported she was raising two of her grandchildren as a foster parent and one as a guardian. The problem with the foster parent program was having the state in her life much more than with the guardianship. As guardian of her oldest grandson, age 15, she was able to put him on her dental plan through her employer. With the foster grandchildren she was unable to do that. One child needed braces and few dentists in Las Vegas accepted Medicaid. If she could include him under her insurance it would save the state money. Further, getting the state out of her life would make it easier because she would not have to deal with the social workers or be relicensed as a foster care provider every year. Over the past year she had taken 15 classes and at the end of the fifteenth class she was told she had only needed to take 3. She felt there was a lack of knowledge by state workers on what was actually needed.
Jane Horner returned to comment that those grandparents were in the state system and getting them out of the system would save the state money, lighten the caseworker load, and the courts would have fewer cases. In her own situation she did have health care for the children and knew a dentist who accepted Medicaid; but that information was not readily available as it required making 200 to 300 calls to dentists in the phone book to find that dentist. Mrs. Horner said the committee could make it so much easier on grandparents with the bill.
The main objective, however, was to get the grandparents out of the system because within a year or two the state would be allowed to adopt the children out of their homes. Mrs. Horner explained that for a child in foster care and adopted out, the state received $6,000 from the federal government. She said she did not want the state to say to her: “If we find an adoptable couple for your granddaughter, we are going to take her.” Mrs. Horner said she would not allow that to happen. The grandparents needed to be protected from the state.
Chairman Koivisto said the way she was reading the bill it would help grandparents who obtained legal guardianship.
Alexis Miller, representing Planned Parenthood, and speaking for Nevada Women’s Lobby, said both organizations supported the bill.
Steve Shaw, Administrator, Division of Child and Family Services (DCFS), Department of Human Resources, provided his written testimony (Exhibit F). He supported the concept of kinship care and said he had been working with Governor Guinn, Assemblywoman Giunchigliani, and Jane Horner, who, he noted, was one of the most effective advocates for grandparents. He had also worked with Mike Willdin, Welfare Division (WD), to design an affordable, simple, and efficient kinship care program for grandparents.
A.B. 15 would allow grandparents raising grandchildren placed by the child welfare system to obtain subsidized guardianship. Three major benefits would be:
· Children would be assured a stable, safe, and permanent home;
· Grandparents would be subsidized at a foster care rate for the care of their grandchildren;
· The foster care system could terminate their supervision and oversight and get out of their lives.
The division looked forward to working on creating a meaningful program. Over the next two weeks DCFS would examine available funding and make recommendations regarding the scope and content of the program.
Michael Willdin, Administrator, Welfare Division, informed the committee that grandparents entered the system either through foster care and received the appropriate payment that system provided, or, through the Welfare Division to the Temporary Assistance to Needy Families (TANF) program. They were not coming through Child Protective Services (CPS), they were caring for their children and came to the WD for assistance. They could be treated in that program either as a needy caretaker, where they applied to also receive money for their needs, or they could apply as a non-needy caretaker. In the latter instance, they had no legal liability to support those children and were there simply as a caregiver, thus WD would not consider their income in determining eligibility for the children and WD would provide a grant to the grandparents to care for the children. Every child on the TANF program was also eligible for Medicaid coverage. Currently there were nearly 2,100 cases on TANF where someone other than a parent was the primary caregiver for the child. Of that number, almost 1,100 were grandparents caring for 1,700 children. The foster care system had one payment structure and the TANF program had a much lower payment structure, however the TANF program did not have the case management and oversight issues that the courts required in child welfare. Mr. Willdin added that currently the TANF payment for one child was $417 per month, $476 for two children.
Mr. Willdin added that the struggle with the fiscal note came about when bringing the grandparents up to the foster care level where there was a significant difference in the payment; it was nearly doubled.
Assemblywoman Leslie remarked she was still struggling with the needy versus non-needy caregiver. She felt every grandparent would qualify for the non-needy status, if only the children’s income was considered and there was no income. Mr. Willdin said they would qualify, unless the child had a trust or some Social Security income. Mrs. Leslie wondered, then, did the grandparents not know or not want the children on Medicaid. She was still worried about making sure the children had access to health care.
Mr. Willdin did not know why the children were not getting health care. He commented that the system, himself and Mr. Shaw, as administrators, owed an apology for not seeing that enough information was available. He had not been aware of the Resource Guide (Exhibit E) until the meeting, and would see that his staff became familiar with its contents. He reiterated his apology and said he and his colleagues could remedy that situation in a matter of days.
Mrs. Leslie asked Mr. Shaw about how guardianships fit with the new Adoption and Safe Families Act (ASFA) regulations. Mr. Shaw responded it fit very well. They looked toward relatives as caretakers from the inception when they had a child in custody; children did best when they were with relatives. Guardianship was one of the permanent solutions for a child, there could be adoption, there could be permanency, and there could be return home, so it did fit well. Mrs. Leslie asked if that would actually help our state meet ASFA criteria. Mr. Shaw said it would. Additionally, guardianships would enable DCFS to get the children out of their system and focus on other children who did require case management.
Jane Horner, from Las Vegas, commented that 80 percent of grandparents had never heard of TANF, and, when they did hear about it and go to sign up, they did so in their own names and had no idea what non-needy caretaker meant. She added that ASFA was wonderful but it was not for grandparents, because in the situations being discussed, the grandchildren had mothers and/or fathers who were gone, they had refused to do what the court had ordered for years. They would not take drug tests, go to Alcoholics Anonymous, or anything else. She asked how long the grandchildren had to wait when they, as parents, had waited 15 years for their own children to straighten up. She added that as a grandparent she did not want to adopt her own grandchildren, which was the case with most grandparents.
Mrs. Horner remarked that one reason grandparents may not be getting TANF was because of the requirement they “turn in their own children” to child support enforcement; many grandparents did not want to do that. She believed grandparents had to make a decision to start working for their grandchildren. If they did not turn their own children in, in the event they knew where they were which many did not, they would not qualify for TANF.
Chairman Koivisto agreed that grandparents had to decide where the priorities were.
Assemblywoman Giunchigliani thanked witnesses for their testimony and the committee for its questions. She complimented Mr. Shaw and Mr. Willdin, who she acknowledged were wonderful to work with, and Jane Horner for keeping “everyone whipped into shape.” She referenced the G.R.G.’s Resource Guide (Exhibit E), and acknowledged Lu Ann Mavromichalis,, MSW Student Intern, UNR, for a wonderful job in producing the guide. Ms. Giunchigliani said she looked forward to continuing to work with the all the individuals named and return to the committee with the amended bill.
Assemblywoman Gibbons wanted clarification whether the guardianship program would help people being able to access ASFA funding, but according to Mrs. Horner’s comments that was not the case. Ms. Giunchigliani said the issue was the interpretation of “help.” Mrs. Horner was correct if the interpretation was the intent to adopt. That was not the intent in all circumstances. It did help the state to comply with the act, but it was not the state’s intent to force grandparents into adoption.
Chairman Koivisto clarified for Ms. Gibbons, that ASFA dealt with not only adoption, rather safe, permanent planning for children. She then closed the hearing and returned A.B. 15 to committee where it would be held for a work session and input from Assemblywoman Giunchigliani.
The chair then turned to the work session document (Exhibit G). Marla McDade
Williams, Committee Policy Analyst, referenced the work session document and noted the first bill:
Assembly Bill 31: Requires department of human resources to include presumptive eligibility for certain persons in state plan for Medicaid and children’s health insurance program. (BDR 38-221)
No amendments had been proposed for the bill. However, pages G-2 and 3 (Exhibit G) was a response received by representatives from New York concerning that state’s presumptive eligibility option. The response was to a survey done by the National Conference of State Legislatures (NCSL) during the interim when the members of the Legislative Committee on Health Care heard that issue. The analyst from NCSL had developed the questions; the key responses were highlighted as follows:
Page G-4 of Exhibit G provided a copy of a presumptive application from Nebraska. Ms. Williams understood the application served as the temporary Medicaid card. If a pregnant woman was simply asking to get care as a presumptively eligible person for prenatal care, she would not be required to fill out a full Medicaid application. If she wanted additional services under Medicaid she would have to go forward and fill out another application. Thus, there were two distinct issues: She could be eligible for prenatal care which was granted by presumptive eligibility, and, if she wanted more services she would have to go through the full Medicaid eligibility process. If she did not go through the full process, the application served as her prenatal care eligibility. Details of Nebraska’s presumptive eligibility program were also provided.
Additionally, on page G-7 of Exhibit G, was information that had been requested by Jon Sasser at the initial hearing of the bill regarding a summary of a report concerning prenatal care. Nevada was ranked as 48th among the states in number of births to women who received little or no prenatal care.
Assemblywoman Gibbons asked about the Nebraska Finance and Support Manual, page G-7 (Exhibit G), if the federal programs used to match state dollars shown thereon, were the same federal programs applicable to match Nevada’s state dollars. Ms. Williams said those would be the providers qualified to make a PE determination. Then services would be given and the state paid for those services at whatever federal matching rate the state had in effect at the time. If an incorrect determination had been made, then the state would be responsible 100 percent for payment.
Ms. Williams continued, noting on page G-22 (Exhibit G), a memorandum from Debbra J. King, Administrative Services Officer, Department of Human Resources (DHR) contained the new assumptions for the estimates in A.B. 31. The amount had dropped significantly. Included was an outline that covered salary and associated expenses for one trainer to go out and train the presumptive providers, plus the medical payments cost. Additional pages covered the cost elements and calculations for the Children’s Health Assurance Program (CHAP). Finally, page G-29 (Exhibit G) contained a summary of revised estimates for PE, as contained in A.B. 31.
Assemblywoman Parnell said the initial amount for the bill was $31 million and she asked for an approximate new total amount. Ms. Williams said it would be approximately $5.4 million for first year of the biennium and $6.2 million for the second year. She added that $31 million had been for only one year so the drop had been significant.
Assemblywoman Leslie wondered, since they were a policy committee, why there was even a fiscal note to consider. Ms. Williams said when the issue had been heard in the Legislative Committee on Health Care, Jon Sasser said he would like to work with the department to develop numbers so they had a better idea when they went into session what the cost would be. When they received an estimate on PE last year they decided to go forward when they adopted the recommendation to put the money in.
Mrs. Leslie said they would now have to amend the bill and put in the new numbers, which would afford an opportunity to talk on the floor about the lower fiscal note, so it might be worth doing for that reason. Still, she said, it was odd to pass a bill with a specific fiscal note. Chairman Koivisto found it interesting that the fiscal note had dropped by approximately 60 percent.
Chairman Koivisto asked the committee’s wishes regarding A.B. 31.
VICE CHAIRMAN MCCLAIN MOVED AMEND AND DO PASS A.B. 31.
ASSEMBLYWOMAN PARNELL SECONDED THE MOTION.
Assemblywoman Angle said she would vote “no” because of the discussion heard on the assets test and also the expedited eligibility situation coming down from the Governor, she believed, was a more positive approach.
THE MOTION CARRIED WITH NINE AYES AND ONE NAY.
The chair then opened the work session of A.B. 35.
Assembly Bill 35: Requires department of human resources to include presumptive eligibility for children who are less than 19 years of age in children’s health insurance program and to establish program of training to assist and encourage persons to enroll children in children’s health insurance program. (BDR 38-214)
Marla McDade Williams noted there was one amendment suggested for the measure submitted by Janice Pine, Saint Mary’s Health Network, page G-30 (Exhibit G). She had indicated she would like the training to go to all individuals who might potentially come in contact with someone who could be eligible for Medicaid or Check-up. Suggested new language was contained on line 1-10 of the bill, G-31 (Exhibit G) as follows:
Medical facility, as defined in NRS 499.0151 inclusive, each community clinic serving a population eligible for Medicaid, the Children’s Health Insurance Program, a county program of medical assistance and/or the uninsured
which broadened the language to include those providers eligible for training. However, on page G-30 (Exhibit G) Ms. Pine offered alternate language that was less specific and might be preferable to the committee, as follows:
The department shall establish and carry out a continuing program of training for employees of health care providers in this state to assist and encourage a person responsible for the care of a child.
Chairman Koivisto asked Assemblywoman Berman if she had discussed the amendment language. Ms. Berman had not seen that language previously, however, felt with the fiscal note of $1 million more she would have less chance getting the bill passed. She felt more comfortable getting the bill passed and then working with the people to get trainers, as she had done with Ms. Williams in the interim. Ms. Williams advised the fiscal note would not change; it would go forward with one trainer. If the language was broadened that may or may not change. Ms. Berman said it was a great idea but she would pass on accepting the proposed amendment because perhaps when the bill was implemented more money would be available.
Assemblywoman Leslie expressed confusion about Ms. Berman’s concern. She said the only new thing in the bill was the training component; the fiscal note was not being changed. Mrs. Pine was only suggesting the language be broadened so it was not so narrowly based and any hospital, like Saint Mary’s, for example, could take advantage of the trainer. It would not change the money, it just meant the trainer could also provide services to a broader group of people. She asked Ms. Williams’ opinion.
Ms. Williams felt it would be up to the department, if they felt with one trainer they could appropriately train anyone. In other words, if they got money for one position they would just have to prioritize where they went to provide training. The training would have to be focused on presumptive providers, those who could make eligibility determinations. She felt that would be the priority for any trainer if the state did presumptive eligibility, and then if the trainer had time left over they could broaden out to anyone else. It was not a requirement, rather something that was allowed.
Mrs. Leslie was in favor of the amendment.
Assemblywoman Gibbons had no problem with the amendment but understood Ms. Berman’s concerns. Nevertheless, she felt the bill should be processed.
Ms. Berman asked if there was a fiscal impact that would hold up the bill. Ms. Williams reiterated her previous statement, adding the trainer could only train within the resources given to them. The bill limited the training to disproportionate share hospitals (DSH) and federally qualified health centers. There would be less than 20 providers who would be eligible. Ms. Berman said she would accept the amendment if it did not add more money.
ASSEMBLYWOMAN GIBBONS MOVED AMEND WITH THE SECOND
AMENDMENT AND DO PASS A.B. 35.
ASSEMBLYWOMAN LESLIE SECONDED THE MOTION.
THE MOTION CARRIED, WITH ASSEMBLYWOMAN ANGLE VOTING NO.
Marla McDade Williams referenced a handout (Exhibit H), on presumptive eligibility, a presentation made by the NCSL representative to the Legislative Committee on Health Care. At the last meeting members had asked for the information on other states that had PE and that was included in the handout.
With no further business before the committee, Chairman Koivisto adjourned the meeting at 3:30 p.m.
RESPECTFULLY SUBMITTED:
Darlene Rubin
Committee Secretary
APPROVED BY:
Assemblywoman Ellen Koivisto, Chairman
DATE: