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11/30/98 MON 15:35 FAX 202 4015783
CHIEF OF STAFF
002
DEPARTMENT OF HEALTH & HUMAN SERVICES
placty
Chief of Staff
Washington, D.C. 20201
Memorandum to Melanne Verveer
From:
Mary Beth Donahue MED
Chief of Staff
Subject:
Addendum to the 1999 State of the Union proposals
The Department of Health and Human Services (HHS) provided a memorandum to you on
November 20 outlining proposed thematic ideas for the 1999 State of the Union address. I am
writing as a follow-up to that memorandum to request that an addendum to this document be
considered.
Please find attached, a paragraph regarding Enacting Federal Privacy Legislation. We propose
that this paragraph should be included in the November 20 document within the section entitled,
"Improving the Health of All Americans". You will note that within this section we highlight
concrete steps that the Administration can take to improve the health care system. We suggest
that the addendum be inserted following the paragraph on Enacting a Patients Bill of Rights.
For your reference, I have attached a copy of the comprehensive memorandum forwarded to you
on November 20.
Thank you for taking the time to consider this request. If you have any questions, please feel free
to contact me at 202-690-7431.
ATTACHMENTS
Addendum to November 20 document
Copy of the November 20 document
11/30/98 MON 15:36 FAX 202 4015783
CHIEF OF STAFF
003
Add to Section II, page 4, just after the "Enact a patients Bill of Rights" section:
Enact Federal Privacy Legislation: The American people expect, and are entitled to,
confidential, fair, and respectful treatment of their health information. Over a year ago, Secretary
Shalala sent a Report to the Congress recommending that the Congress enact legislation
requiring that treatment. Since then, progress in crafting such legislation has been made by both
Republicans and Democrats. Now its time to get serious about protecting the privacy that we in
the United States cherish as essential to personal freedom and well-being. The need for such
legislation is found in the rapid changes in the ways that health care is provided, documented,
and paid for in the United States. These changes pose a challenge to American values that are
both complementary and competing. On the one hand, patients have a legitimate need for
confidentiality so that they can be frank with their physicians about their health conditions and
behavior. That assurance is fundamental to effective diagnosis, treatment and healing. On the
other hand, participants in the health care system -- insurers, governments at all levels, managed
care organizations -- have legitimate needs for access to health records in serving patients and
performing their roles in the system. Our challenge is to work together to balance these
competing values.
11/30/98
MON 15:36 FAX 202 4015783
CHIEF OF STAFF
004
THE SECRETARY OF HEALTH AND HUMAN SERVICES
WASHINGTON, D.C. 20201
NOV 20 1998
MEMORANDUM TO BRUCE REED AND GENE SPERLING
FROM:
Donna E. Shalala
Discue
Secretary of Health and Human Services
As you begin to prepare for the 1999 State of the Union Address, I want to share with you some
thematic ideas to stress the accomplishments of the Administration and its agenda for further
improving the health and welfare of the American people. I strongly believe that these issues
have wide public support and can form the basis for some bipartisan progress in Congress. They
build on our past accomplishments and will help to ensure a long-lasting legacy for the
Administration in the area of improving the quality of life for the American family. My staff
will be happy to work further with you and other White House staff on the details of these
proposals.
In the President's speech in Poland, he quoted an ancient Irish proverb: "May you live a hundred
years." In the 20th Century, medical, scientific and public health breakthroughs have added 20
years to the average life expectancy of the American people. The President should declare a
national goal of meeting or exceeding this accomplishment in the new century to come so that by
the end of the 21" Century, the average life expectancy of an American can be nearly 100 years.
Imagine what such an accomplishment will mean to the productivity and creativity of our people
and our nation.
In that light, this memorandum lays out four major themes for the President's address:
Helping Working Families Help Themselves: This includes renewed efforts to improve child
care and support working families and new initiatives in the area of long-term care.
Improving the Health of All Americans: This includes enacting a Patients' Bill of Rights and
continuing our efforts to eliminate historical racial and ethnic disparities in health status,
particularly those disparities affecting American Indians.
Making the World Safer for Children: This includes a renewed effort to combat tobacco use
by children as well as new initiatives to reduce the number of accidental injuries and a
new effort to combat the rising prevalence of asthma in children.
Improving Public Health Capacity: This includes continuing efforts to protect the safety of
our food supply, countering the threat of bioterrorism, and ensuring the safety of drugs,
medical devices, and the blood supply.
The following pages of this memorandum discuss each of these themes in greater depth and offer
rhetorical language that might fit within the context of the State of the Union Address.
1
11/30/98 MON 15:36 FAX 202 4015783
CHIEF OF STAFF
005
I.
Helping Working Families Help Themselves
The American family is stronger and more able to deal with the unexpected today thanks to the
far-sighted policies we have adopted during these last six years. The Family and Medical Leave
Act allows working parents to spend the time they need with a newborn or sick child. A higher
minimum wage, the expanded Earned Income Tax Credit, and the $500 child care credit have
helped to lift working families out of poverty. Parents can move from job to job without
worrying that their health insurance won't move with them. More pre-school children are fully
immunized than at any time in our history. And more than two million additional children have
health insurance that will help them to grow up healthy and strong.
But our work is far from complete. Today, too many parents still must worry that they cannot
afford quality child care for their children. Too many families are adversely affected by
substance abuse problems. And too many families worry that the cost of long-term care could
wipe out a lifetime of savings. That is why I am so pleased to announce that my fiscal 2000
budget includes a series of initiatives designed to help working families help themselves.
Quality Child Care: We must make child care more affordable, more accessible, and of
consistently high quality. We know that 70 percent of today's mothers depend on child care
professionals to help them care for and educate their children. Currently, only one in ten families
eligible to receive assistance for child care do so. And in three-quarters of our states, families
living in poverty are ineligible for child care assistance. Last year, the First Lady and I hosted the
historic White House Conference on Child Care. We know that the early years of life are critical
to the development of children's brains and their ability to enter school ready to learn. We also
know that the experiences that older children have in non-school hours are critical to their
positive development and education. There is no better investment of our resources than
assuring that our children grow up in safe and healthy learning environments. We need to make
sure that mothers and fathers who hold jobs outside the home are secure in the knowledge that
their children are being cared for in high-quality child care facilities. So let's finish the job and
enact a child care bill that helps parents get their kids off to the right start.
Working Families Initiative: In the two years since I signed the welfare reform law we have
made remarkable progress in helping families move from welfare to work and in supporting
working families. The welfare rolls are at an historic low and our employment rates are at an all-
time high But it is clearly not enough to just help families find jobs. We must keep them out of
poverty by again raising the minimum wage. We need to build secure and reliable supports for
work, such as Food Stamps, child care, health care, housing, and transportation. And we must
help them improve their education and skill development.
Substance Abuse: We must strengthen our efforts to assist families whose substance abuse
problems threaten their ability to lead healthy and productive lives. More than 8 million children
in our nation are now living in families where at least one parent has a serious alcohol or drug
problem, and drug use rates among our young have recently been rising. Indeed, research tells us
2
11/30/98 MON 15:37 FAX 202 4015783
CHIEF OF STAFF
1
006
that the children of substance abusers are at higher risk of developing such problems themselves.
Under the leadership of General Barry McCaffrey, the Office of National Drug Control Policy
has developed a comprehensive, long-term drug control strategy for our nation. This strategy
lays out a road map for making treatment and prevention services more available to parents and
their children. You have all seen the ads on TV. These are the first steps in raising awareness,
changing attitudes, and getting families and children to take action. Through the budget process
we are also moving to reduce the treatment gap, so that families will be able to get the treatment
they need. Through these efforts, we are providing the tools that working families need so that
they can address their alcohol and drug problems and provide healthy family environments for
their children.
Long Term Care: Last year's budget made an unprecedented investment in medical research
and my budget for this year keeps us on a path of doubling the NIH budget in five years. These
investments will help us to unlock the mysteries of the human body and help to extend the length
and quality of every human life. But we also must recognize that longer lives will increase our
need for innovative ways to care for our parents and our grandparents. Every year over 50
million Americans spend time caring for sick and disabled family members and friends. They
struggle to keep their loved ones at home for as long as possible. Yet they get remarkably little
help in doing SO. That is why I am proposing to establish a National Family Caregiver Program
to help these heroic men and women care for their loved ones and why I am also proposing a new
Bridge to Independence Initiative that will work to expand the availability of home and
community-based care for the elderly and the disabled.
Today, more than four million Americans are living with Alzheimer's disease, including
President Reagan. That number is projected to quadruple in the next 40 years. That is why my
budget also includes funding for Alzheimer's disease research.
IL
Improving the Health of All Americans
Our nation has the best health care system in the world. We have the best doctors, the most
advanced technology, and the most exciting research. But we can make the American health care
system even better.
Enact я Patients Bill of Rights: Quality health care should not be a partisan issue. Quality
health care is a practical issue for patients and their families. The first task of this new Congress
must be to finish the work we began last year and enact a Patients' Bill of Rights that will
guarantee high-quality care for all Americans. Virtually every member of this body sponsored
legislation to provide Americans with a Patients Bill of Rights. There were many very real issues
that divided us in 1998, but these are not issues that should stop us from acting. We must
provide Americans with a real choice of doctors, with real access to specialists, and with real
emergency care when and where they need it. They must be able to take their disputes with their
health plans to independent, external experts for a binding final decision. They must know that
their medical records are secure. And they must be able to have recourse against health plans
3
11/30/98 MON 15:37 FAX 202 4015783
CHIEF OF STAFF
007
that injure them or their loved ones.
Eliminate Racial Disparities in Health Status: For too long our nation has seen shocking gaps
between the health of white Americans and that of African Americans, Hispanics, Asian
Americans, American Indians and other racial and ethnic minorities. Last year, we began a
national initiative with the bold goal of eliminating these shameful disparities by the year 2010 in
six critical areas of health status: infant mortality, cancer screening and management,
cardiovascular disease, diabetes, HIV/AIDS infections, and child and adult immunizations. We
also launched a national effort to deal with the crisis that HIV and AIDS present to minority
communities. I propose doubling our efforts in these areas so that the health of any American
does not depend on the color of their skin.
Improve the Health of American Indians and Alaska Natives: While we work to improve the.
health of communities of color we must pay particular attention to the needs of the oldest
American communities - American Indians. For far too long, these Native Americans have been
accorded second-class status. We must enter the next millennium by making a national
commitment to meet our legal and moral obligations to these citizens. We must provide health,
education, and economic opportunities that will make the first Americans as economically
productive, educationally competitive, and as healthy as those who followed them to these
shores. We have begun by assisting tribal nations to develop innovative approaches that
encourage community-based solutions for health status disparities effecting Indian families and
communities.
III.
Making the World Safer for Children
If parents are to have the opportunity to raise healthy children, we have the obligation to make
the world around them as safe as possible. Every day, parents struggle to raise their children in
an environment that nurtures their bodies and their souls. We can't do that job for them, but we
can make it easier for them to do it successfully.
Reducing Tobacco Use: We have fundamentally changed our understanding of smoking. There
can be no debate that the nicotine in cigarettes is addictive. We know that smoking is a pediatric
disease. Three thousand young people become regular smokers each day and nearly one
thousand of them will die prematurely. No legal obfuscation by the industry, nor slick TV ads
can fool the American people. They know the truth often from the industry's own data. If
Congress wants to act, we will work with them. Science and common sense lead to the
conclusion that a strong, comprehensive approach to the problem is best. But we will not wait on
Congress. Any state, any community that wants to act on the knowledge and facts of this public
health threat will have this Administration's full support.
Reducing the Incidence of Injuries: More than 400 Americans including 50 children - die
every day from preventable injuries and thousands more are injured every year, suffering
permanent disabilities. Such injuries cost our society $224 billion a year in lost productivity,
4
11/30/98 MON 15:37 FAX 202 4015783
CHIEF OF STAFF
$
008
health care and rehabilitation costs. Yet every dollar we invest in preventing injuries saves us
millions. For example, smoke alarms save $69 for every $1 spent, bicytle helmets save $29 for
every $1, and child safety seats save $32 for every $1. We need to make Americans safe at home,
safe at school, safe at work, and safe as they move about in their communities. That is why my
budget includes money to help protect our children by creating a safer environment in which they
can grow and mature.
Fighting Asthma: Over the last 15 years, the number of Americans afflicted with asthma
has doubled to more than 15 million and the largest increases have been among children.
In fact, asthma is one of the leading causes of school absenteeism and a major reason for
emergency room visits by parents and young children. Our investment in asthma research
has increased our understanding of the root causes of this condition. Now it is time to invest
in getting that information in the hands of doctors and their patients. My budget will help
prevent the onset of asthma, help parents manage asthma in their kids, and improve the
treatment of this manageable disease.
IV.
Improving Public Health Capacity
If we are to protect our nation and our planet against disease in the new century, we
must continue to build our public health infrastructure. Without a solid and stable system of
public health, we cannot fight the threats we know and we cannot be prepared for those that we
don't know. Working in partnership with the states, we must develop and maintain a rapid
response approach to contain the outbreaks of the future. This investment will enable us to
increase the number of trained scientists and public health professionals in our communities.
Food Safety: With bipartisan support we have made major progress toward making our nation's
food supply as safe as possible. The CDC has established a nationwide surveillance network that
alerts us to any threats to the food supply. This allows us to quickly identify and act on
foodbome outbreaks anywhere in the country. We have instituted new agricultural practices
designed to detect and prevent contamination of fruits and vegetables. And we are
taking measures to reduce the potential for bacteria contamination by applying new scientific
approaches to assure the safety of fruit juices. To make all of this work, I have directed that a
national food safety council be established to monitor food safety and help us maintain a safe
national food supply.
Drug Safety: By assuring the quality of the drugs we take, the medical devices we need, and
the blood supply upon which we rely, we relieve a major source of concern for the people of
this nation and others. Our new FDA Commissioner Jane Henney will work closely with you
to implement the bipartisan FDA reform bill that I signed in the last Congress.
Fighting Bioterrorism: Ensuring the health and well-being of our citizens requires thinking
the unthinkable and preparing accordingly. That is why I am requesting $370 million to
enhance our ability to protect the American people against terrorism involving infectious
5
11/30/98 MON 15:38 FAX 202 4015783
CHIEF OF STAFF
009
microorganisms. We will help state and local health departments and the Centers for Disease
Control and Prevention improve their capabilities to detect unusual infectious-disease outbreaks
that might be caused by terrorists. We will also strengthen local, state, and national capabilities
to mount rapid medical responses to such incidents. Our overarching goals will be to prevent
bioterrorism whenever we can and, when we can't, to limit the toll of death and suffering that those
heinous crimes can inflict upon our communities.
Attachment
Tab A - Background Information on the Health Status of American Indians and Alaska Natives
6
11/30/98
MON 15:38 FAX 202 4015783
CHIEF OF STAFF
010
TAB A
Background Information on the Health Status of American Indians and Alaska Natives
Focus on the Tools of Opportunity. Develop economic
opportunities in Indian communities, raise the health status of
Indian people and their communities, and improve their
educational status.
Health Status. American Indians and Alaska Natives have the
lowest life expectancy of any group in the nation and
disproportionately higher morbidity/mortality rates than the
total population, as shown below.
Alcoholism
579% greater
Tuberculosis
475% greater
Diabetes
231% greater
Unintentional Injury
212% greater
Suicide
70% greater
Pneumonia and Influenza
61% greater
Homicide
41% greater
Gastrointestinal Disease
23% greater
Heart Disease
8% greater
The health of Indian people is measurably different than other
Americans at all life stages. Indian infants die from sudden
infant death syndrome at a rate 1.8 times the U.S. All Races
infants rate of 2.1. Indian children, 5-14 years, die of
traumatic injuries at twice the U.S. All Races rate, and suicide
among Indian children, 15-24 years, is 2.7 times the U.S. All
Races rate. The alcoholism death rate for Indian youth, 5-14
years, is over 17 times the rate for U.S. All Races. One in
three adult Indians suffer from diabetes -- nearly twice the
rate of U.S. All Races. Indian elders still die earlier than
their U.S. All Races counterparts. American Indian and Alaska
Native homes lack safe water and sanitary means of waste
disposal 7.5 times that of homes of U.S. All Races.
Eliminate Health Disparities for Six Target Areas. The
Administration's Initiative to Eliminate Racial and Ethnic
Disparities in Health targets six areas: diabetes, heart
disease, cancer screening and management, HIV/AIDS, infant
mortality, and immunization.
Develop Economic Opportunity. Disparities exist in other
programs aimed at improving the social and economic status of
low-income and disadvantaged populations, including TANF and
other ACF programs and Medicaid/CHIP outreach. This is the case
for both reservation-based and urban-based American Indians and
11/30/98 MON 15:38 FAX 202 4015783
CHIEF OF STAFF
011
Alaska Natives. This is not just a reservation issue.
Sixty-five percent of Indian people live in urban or suburban
areas. Indian people are the most disadvantaged population in
the nation. Their median household income (1989) was $19,897
compared with $31,435 for Whites, $19,758 for Blacks, and
$24,156 for Hispanics.
Living Below the Poverty Level
31.6%
Males 16 & Over Unemployed
16.2%
Bachelor's Degree or Higher, Ages 25 and older
8.9%
Improve the Academic Performance of American Indians and Alaska
Native Students. Census data show that the Indian population
has increased in the last three decades. of the total Indian
population, the age group 10-19 years represents a significant
concentration. There are approximately 600,000 American Indian
and Alaska Native children in the United States -- less than 1%
of all school-aged children. They have the highest dropout rate
in the nation. Thirty-six percent of American Indian and Alaska
Native tenth graders drop out of school, more than twice the
national percentage for white students. Thirty-two percent of
American Indian and Alaska Native students showed a "below
basic" level of performance in math, which represents twice that
for white students (15.5%) Twenty-two percent of white
students showed an "advanced" level of performance in math,
which is almost five times that for Indian students (4.8%). The
Bureau of Indian Affairs funds a K-12 educational program for
51,000 Native Americans in 185 school systems in 23 states. of
the 3,000 facilities in the BIA school system, 25 percent are
more than 50 years old, 50 percent are more than 30 years old,
and 3 percent are more than 100 years old. Twenty thousand
American Indian and Alaska Native students attend classes in
portable classrooms. The conditions of these facilities reflect
significant operational and new school construction needs. The
turnover rate for BIA teachers is 35%.
The White House Domestic Policy Council Working Group on
American Indians and Alaska Natives approved a Policy Initiative
for Indian Children and Adolescents as proposed by the IHS in
1997. The Policy Initiative focuses on directing resources from
a number of Federal agencies and private sources. The Policy
Initiative's intent is to improve the conditions and quality of
life for American Indian and Alaska Native children and
adolescents and help them become healthy adults. The IHS will
continue to work with the Domestic Policy Council by providing
additional information about the potential outcomes of the
Initiative and other basic information on the status of Indian
children and youth. The IHS will continue to pursue a potential
presidential Executive Order or other administrative policy
11/30/98 MON 15:39 FAX 202 4015783
CHIEF OF STAFF
012
statement in support of Indian children and youth. In addition,
the IHS is planning the development of a major campaign in 1999
that will address the need for establishing healthy lifestyle
programs for Indian youth. Tribal consultation will be a
cornerstone of this campaign.
Continue the Momentum of Past Progress. The Administration has
made progress on American Indian and Alaska Native health issues
even though significant disparities remain. Mortality rates for
American Indians and Alaska Natives have decreased significantly
in many areas since 1973, as shown below, showing that investing
in Indian health works!
Tuberculosis
79% reduction
Gastrointestinal Disease
76% reduction
Maternal Deaths
68% reduction
Infant Deaths
58% reduction
Unintentional Injury
56% reduction
Pneumonia and Influenza
52% reduction
Homicide
40% reduction
Alcoholism
37% reduction
Suicide
23% reduction
SEP-02-1998 10:04 FROM ACF/OFC OF PRGM SUPPORT
TO
94569412 P.01
human SERVICES USA
&
HEALTH
OF
DEPARTMENT OF
Administration for Children and Families
Office of Legislative Affairs & Budget
OLAB
370 L'Enfant Promenade, S.W.
Washington, D.C. 20447
FAX: (202) 401-4562
TO:
Jennifer Klein
FROM:
Lisa Bernhardt
PHONE:
456-2599
PHONE: (202) 401-4805
FAX:
456-9412
DATE:
9/2/98
COVER + Pages
Message:
Latest child came spending duta that's be
made public Cper your request to foan). Please
call if any questions.
SEP-02-1998 10:04 FROM ACF/OFC OF PRGM SUPPORT
TO
94569412
P.02
DRAFT
Cumulative Outlay Rates as of June 30
for the Mandatory & Matching Child Care Funds
Grant Awards
Outlays
Outlay Rate
June, 1998:
FY97 Funds
$1,959,958,593
$1,862,811,370
95%
FY98 Funds
1,640,385,511
1,105,483,404
67%
June, 1997:
FY97 Funds
1,441,609,153
889,716,796
62%
ACF/DHHS 8/3/98
Call HITS
JEN - How for off
they?
BR
NUMBER OF CHILD CARE SLOTS FOR LOW-INCOME FAMILIES THROUGH
THE CHILD CARE BLOCK GRANT
1.8m?
FY 1998
PY 1999
FY 2000
FY 2001
FY 2002
FY 2003
Baseline # of children
1 million
1.07 million
1.13
1.2
1.26
1.32
served through
children
children
million
million
million
million
CCDBG (current
children
children
children
children
law)
Option One:
$0.8 billion
$0.8 billion
$0.8 billion
$0.8 billion
$0.8 billion
$4 billion increase
over 5 years
100% federal dollars
1.29 million
1.35 million
1.42 million
1.49 million
1.54 million
children
children
children
children
children
80-20% match
1.34 million
1.41 million
1.48 million
1.54 million
1.6 million
children
children
children
children
children
Option Two:
$1.2 billion
$1.5 billion
$1.6 billion
$2.0 billion
$2.7 billion
$9 billion increase
over five years
100% federal dollars
1.39 million
1.55 million
1.6 million
1.82 million
2.07 million
children
children
children
children
children
80-20% match
1.48 million
1.65 million
1.75 million
1.96 million
2.26 million
children
children
children
children
children
*The Child and Development Block Grant (CCDBG) is funded through three streams: discretionary, mandatory
non-matching, and mandatory matching (based on FMAP: average of 56% federal, 44% state). Each stream is
funded at roughly $1 billion in FY 1998. The mandatory matching stream is responsible for nearly all of the
block grant growth in the outyears.
*These calculations use FY 1998 dollars and assume a per-child cost of $3,617, which largely represents the
subsidy, but also includes set-asides and administrative costs.
Nicole R. Rabner
12/22/98 01:10:41 PM
Record Type:
Record
To:
Elena Kagan/OPD/EOP, Jennifer L. Klein/OPD/EOP
CC:
Subject: Summary of Head Start options
Attached below is an e-mail from Barbara to Gene (sent at his request) outlining the Head Start
options for the President's FY 2000 budget. No decision has been made, but it's clear that OMB
plans to up the Head Start budget to stay on track to serving 1 million children by 2002. Assuming
OMB and HHS can find the budget authority for it, I would favor OMB's suggested resolution
described below $5.267 billion for FY 2000 to add 44,000 new Head Start slots, bringing the
program to a total of 881,000 slots.
Forwarded by Nicole R. Rabner/WHO/EOP on 12/22/98 11:46 AM
Record Type: Record
To:
Gene B. Sperling/OPD/EOP@EOP, Charles R. Marr/OPD/EOP@EOP
CC;
Melissa G. Green/OPD/EOP@EOP, Peter A. Weissman/OPD/EOP@EOP, Sandra
Yamin/OMB/EOP@EOP, Jennifer Friedman/OMB/EOP@EOP
Subject: Summary of Head Start options
Information on Head Start.
Forwarded by Barbara Chow/OMB/EOP on 12/22/98 11:05 AM
Jennifer Friedman
12/21/98 07:23:11 PM
Record Type: Record
To:
Barbara Chow/OMB/EOP@EOP
CC:
Barry White/OMB/EOP@EOP, Jack A. Smalligan/OMB/EOP@EOP, Matthew McKearn/OMB/EOP@EOP,
Sandra Yamin/OMB/EOP@EOP
Subject: Summary of Head Start options
Following is an overview of options for the Head Start funding level for the FY2000 President's Budget.
All options remain on the path toward serving 1 million children by FY02, including 80,000 infants and
toddlers in Early Head Start. The options range in cost from $4,997 million to $5,395 million in FY00, with
five year costs that are $5.3 billion to $6 billion over guidance levels. The table attached below
summarizes the options proposed by HHS and considered by OMB.
As you know, the Head Start reauthorization greatly increased the set-aside for quality activities. Due to
this law change, as well as other program policies, the cost of new slots has risen dramatically. While the
FY99 P.B. assumed that the request level of $4,660 million would create 30,000 to 36,000 new slots, this
funding level as enacted will now only provide for approximately 15,000 new slots in FY99, for total
enrollment of 837,000.
In HHS' FY00 budget submission, the Department originally requested $4,997 million ($337 million over
FY99 enacted), and subsequently revised this request to $5,395 million ($735 million over FY99 enacted).
The passback level was at guidance, and equal to their original request of $4,997 million.
In HHS' first appeal, the Department reiterated their request of $5,395 million, proposing to add 54,000
slots, for total enrollment in FY00 of 891,000. Subsequently, HHS revised their appeal downward. Their
second appeal is in the same ballpark as the OMB proposed resolution of $5,267 million. This funding
level would create 44,000 slots, for total enrollment of 881,000. There is a logic to adding 44,000 slots in
FY00, as the FY99 P.B. assumed the addition of 44,000 new slots in FY00 (albeit, to a higher base).
HHS' third appeal, a $100 million increase over passback to $5,097 million, would provide for 29,000 new
slots and a total enrollment of 866,000.
Summary of Head Start Expansion Options
(All dollars in millions)
Date Submitted
FY00
New Slots
Total Slots
HHS Request
9/98
$4,997
20,000
857,000
HHS Revised Request
11/9/98
$5,395
54,000
891,000
Passback
11/24/98
$4,997
20,000
857,000
HHS First Appeal
12/1/98
$5,395
54,000
891,000
OMB Proposed
12/3/98
$5,267
44,000
881,000
Resolution
HHS Second Appeal
12/18/98
$5,267
44,000
881,000
HHS Third Appeal
12/21/98
$5,097
29,000
866,000
DEPARTMENT
OF HEALTH
AND HUMAN
SERVICES
HUMAN SERVICES USA
OF HEALTH
Fiscal Year
DEPARTMENT
2000
OMB Submission
Administration for
Children and Families
DEPARTMENT OF HEALTH AND HUMAN SERVICES
ADMINISTRATION FOR CHILDREN AND FAMILIES
EXECUTIVE SUMMARY
General Statement
The Administration for Children and Families (ACF), within the
Department of Health and Human Services, is responsible for programs
which promote the economic and social well-being of families, children,
individuals, and communities. Many of these programs are at the
forefront of the Administration's domestic agenda; including welfare
reform, child care, child support, foster care and adoption, and Head
Start.
Consistent with the President's focus, the Secretary has provided a
framework for the budget request in her goals for the Department. The
goals include building strong foundations for families and children, and
strong management. The Administration for Children and Families is
responsible for programs which make major contributions to the
achievement of these goals.
Overview
Under the requirements of the Government Performance and Results Act,
and within the framework of the Department goals, agency strategic goals
and performance standards and measures have been developed. We remain
committed to results, to the measurement of results, and to joint work
with partners. The priorities reflected in the Administration for
Children and Families' FY 2000 budget are in support of the strategic
goals which have been developed in the ACF performance plan:
Improve the economic independence and productivity of
families;
Increase the healthy development, safety and well-being of
children and youth;
Deliver high quality services to help develop healthy, safe
and supportive communities and tribes;
Be a high-performing, customer-focused, results-oriented
organization.
The Administration for Children and Families supports activities for a
range of critical Administration priorities under these four goals,
including:
Welfare Reform: Enabling families to move from welfare to work
and to succeed at work (Vice President's Bold Goal and Secretarial
Initiative);
Child Care: Creating access to affordable, quality child care for
low-income working families (Presidential and Secretarial
Initiative);
1
Child Support Enforcement: Increasing the number of children with
paternity established and child support collections in place, so
that they can grow up with the financial and emotional support of
both parents (Vice President's Bold Goal);
Adoption and Child Welfare: Doubling adoptions and other
permanent placements from the public child welfare system (Vice
President's Bold Goal and Presidential Initiative) and, protecting
the safety, permanency, and well-being of children in danger of
abuse or neglect;
Head Start: Enrolling 1 million children by 2002, and ensuring
that they receive a high quality Head Start experience that will
enable them to start school ready to learn (Presidential
Initiative); and
Infants and Toddlers: Reaching more infants and toddlers with
Early Head Start and quality child care, reflecting what we know
about the rapidity of brain development in the first three years
of life (Presidential Initiative to double Early Head Start).
2
Summary of Major Budget Initiatives
Head Start
The requested increase in Head Start, of $337 million, will
fund 32,000 additional children as well as expanded services
to infants and toddlers and continued quality improvement,
moving toward the President's goal of serving 1 million
children in Head Start and doubling the size of Early Head
Start by 2002.
Child Care
The second year of funding for the President's Child Care
Initiative for working families represents an increase of
$125 million in mandatory funding over the Administration's
FY 1999 request. This initiative reflects the critical role
of quality, affordable child care as a support for low-
income working families, essential both to parents'
continued employment and children's healthy development and
learning. This proposal assumes enactment of the child care
initiative in FY 1999. If that proposal is not enacted in
full, we would incorporate enactment at the originally
proposed funding levels in the FY 2000 budget.
Developmental Disabilities and Welfare to Work
A new investment of $11.1 million in the Programs for
Persons with Developmental Disabilities programs is proposed
for two major purposes -- to strengthen the program's focus
on accountability and results through an incentive funding
strategy and improved formula; and to provide technical
assistance and demonstration resources that will promote and
strengthen state welfare-to-work strategies that meet the
needs of families with a developmentally disabled member.
Family Violence
We are proposing an increase of $24.6 million for battered
women's shelters and related services as part of a
comprehensive $71.3 million Departmental initiative to
improve and expand services for victims of domestic violence
and to bolster prevention activities to change the social
norms that allow this violence to occur. Given the scope
and magnitude of the problem of violence against women and
the relatively limited services and supporting activities we
now fund, efforts that allow us to expand and extend
services and foster new ways of approaching the problem are
critical. The ACF increase will support the enhancement and
expansion of existing services, improvements in data
collection, monitoring, and evaluation; and technical
assistance and demonstration strategies to strengthen
collaboration between domestic violence services and other
service networks, building on the first steps already taken
in child support, child welfare, TANF and criminal justice.
Refugee Resettlement
Based on the State Department's projections of new entrants
and on the continuation of key social services programs, we
3
Child Support Enforcement: Increasing the number of children with
paternity established and child support collections in place, so
that they can grow up with the financial and emotional support of
both parents (Vice President's Bold Goal);
Adoption and Child Welfare: Doubling adoptions and other
permanent placements from the public child welfare system (Vice
President's Bold Goal and Presidential Initiative) and, protecting
the safety, permanency, and well-being of children in danger of
abuse or neglect;
Head Start: Enrolling 1 million children by 2002, and ensuring
that they receive a high quality Head Start experience that will
enable them to start school ready to learn (Presidential
Initiative); and
Infants and Toddlers: Reaching more infants and toddlers with
Early Head Start and quality child care, reflecting what we know
about the rapidity of brain development in the first three years
of life (Presidential Initiative to double Early Head Start).
2
Summary of Major Budget Initiatives
Head Start
The requested increase in Head Start, of $337 million, will
fund 32,000 additional children as well as expanded services
to infants and toddlers and continued quality improvement,
moving toward the President's goal of serving 1 million
children in Head Start and doubling the size of Early Head
Start by 2002.
Child Care
The second year of funding for the President's Child Care
Initiative for working families represents an increase of
$125 million in mandatory funding over the Administration's
FY 1999 request. This initiative reflects the critical role
of quality, affordable child care as a support for low-
income working families, essential both to parents'
continued employment and children's healthy development and
learning. This proposal assumes enactment of the child care
initiative in FY 1999. If that proposal is not enacted in
full, we would incorporate enactment at the originally
proposed funding levels in the FY 2000 budget.
Developmental Disabilities and Welfare to Work
A new investment of $11.1 million in the Programs for
Persons with Developmental Disabilities programs is proposed
for two major purposes -- to strengthen the program's focus
on accountability and results through an incentive funding
strategy and improved formula; and to provide technical
assistance and demonstration resources that will promote and
strengthen state welfare-to-work strategies that meet the
needs of families with a developmentally disabled member.
Family Violence
We are proposing an increase of $24.6 million for battered
women's shelters and related services as part of a
comprehensive $71.3 million Departmental initiative to
improve and expand services for victims of domestic violence
and to bolster prevention activities to change the social
norms that allow this violence to occur. Given the scope
and magnitude of the problem of violence against women and
the relatively limited services and supporting activities we
now fund, efforts that allow us to expand and extend
services and foster new ways of approaching the problem are
critical. The ACF increase will support the enhancement and
expansion of existing services, improvements in data
collection, monitoring, and evaluation; and technical
assistance and demonstration strategies to strengthen
collaboration between domestic violence services and other
service networks, building on the first steps already taken
in child support, child welfare, TANF and criminal justice.
Refugee Resettlement
Based on the State Department's projections of new entrants
and on the continuation of key social services programs, we
3
are projecting an increase of $6 million in funding for
refugee programs. The estimate does not assume any
carryover from prior years. We will be working with the
State Department over the next few months as they finalize
their entrant ceiling numbers.
Independent Living and Child Welfare
The budget proposal continues existing spending levels on
the discretionary side in support of the Administrations
adoption goals, but proposes an increase of $37 million on
the mandatory side for two purposes:
A $35 million increase in the Independent Living Program
(which has remained constant at $70 million since 1992)
will help keep children aging out of the child welfare
program from becoming homeless, jobless, or drug
addicted. As we seek to ensure stable permanent homes
for children and to promote work and self-sufficiency, we
must include those children who, despite all our efforts,
have not been adopted and reach adulthood directly from
the foster care system without the supports most children
and young adults are fortunate to have.
A $2 million setaside will support monitoring of child
welfare and family service programs in the States --
including family preservation and support, time-limited
reunification services, adoption support services, child
protective services, foster care, adoption, and
independent living -- and will provide technical
assistance and monitoring of critical systems
development. This is the system which provides us with
the information necessary to make payments under the
Adoption Incentives Program.
Community-Based Resource Centers
We are proposing an increase of $7.2 million for this
program in support of the goal of minimizing the risk of
harm to children, protecting them from child abuse and
neglect and enhancing families' capacities to provide for
their children's needs by increasing public awareness,
parent education, and family support services available to
parents in their own communities.
Accountability and Administrative Support
A new investment of $11.7 million for administrative
resources and information systems will provide
accountability and oversight for key priorities, including
quality and expansion in Head Start and Early Head Start;
implementation of the Adoption and Safe Families Act;
implementation of the Administration's child care
initiative; and TANF data collection, analysis and
dissemination. As part of this investment we are proposing
a fellows program similar to the Service Fellowship Program
at PHS. This will provide ACF with the flexibility to
recruit approximately 12 persons with expertise in specific
programmatic areas for limited periods of time.
4
Summary of FY 2000 Legislation
Reauthorizations
Programs for Persons with Developmental Disabilities (DD)
ACF will seek a 5-year reauthorization of these critical programs which
help empower persons with disabilities and their families to receive
support at home and in their communities. Families are the greatest
natural resource available to their children and many persons with
disabilities are the major providers of support, care, and training for
their children. A growing number of families are searching for ways to
care for their children with disabilities and these programs can be an
efficient and cost-effective means of developing supports for the DD
families.
P.S part of the reauthorization package, first we will seek changes to
the State Grant formula to simplify the methodology for computing
state/territory allocations and acknowledge and encourage the
achievement of valued results, including a focus on working families
with persons with disabilities, through a new incentive provision. In
addition, we will convert the University Affiliated Program to a formula
grant program. Second, we propose to include technical assistance
setasides that will allow us to focus resources on linkages between the
Developmental Disabilities networks and other critical priorities. In
FY 2000, we propose to focus on links to employment-related services for
TANF recipients moving to work. Third, we will include language in the
proposal to allow the cost of making and monitoring grants to be paid
from program funds.
Refugee Resettlement Programs
ACF plans to seek a 5-year reauthorization of the refugee program with
only minor legislative amendments. Through the regulations process,
however, ORR will be drafting alternatives to the current refugee cash
and medical assistance programs to promote more effective cooperation
between the States and the voluntary agencies. These regulations are
being developed after a series of consultations conducted by ORR with
hundreds of key partners in refugee resettlement.
Family Violence/Domestic Violence Hotline
ACF will seek a 5-year reauthorization of this Violence Against Women
Act program that addresses issues of domestic violence with minor
legislative amendments. In addition, as in the Programs for Persons
with Developmental Disabilities reauthorization, we will seek language
to allow the program to pay for costs associated with the making and
monitoring of grants out of program funds.
Incidents of domestic violence disrupt communities, destroy
relationships, and harm hundreds of thousands of Americans each year.
In addition to the personal burdens domestic violence causes, the
financial burdens run into the billions of dollars each year. Among the
most tragic effects of family violence is the cycle of abuse perpetuated
by children and teenagers who see and experience brutality at home.
5
Other Technical Proposals
Child Welfare and Foster Care
This legislative proposal includes a setaside for monitoring of child
and family service reviews, to encompass the range of Federally-assisted
child and family services programs, including family preservation and
support, time-limited reunification services, adoption support services,
child protective services, foster care, adoption, and independent
living. These reviews are essential to the safety, permanency and child
and family well-being goals of the Adoption and Safe Families Act.
Fellows Program
To address some of the specialized staffing needs of ACF, we are
proposing legislation to establish a fellows program similar to the
Service Fellowship Program at PHS. This will allow ACF to recruit
persons with expertise in specific programmatic areas for designated
periods of time.
6
ADMINISTRATION FOR CHILDREN AND FAMILIES
FY 2000 Discretionary Budget Request
The FY 2000 budget request for the Administration for Children and
Families (ACF) discretionary programs is $9.1 billion, an increase of
$418 million over the amended FY 1999 President's Budget and $81 million
over the FY 2000 column of the FY 1999 President's Budget. This
increase includes $20 million to restore program levels to amounts
before bioterrorism amendments to the President's FY 1999 Budget.
The major changes in the FY 2000 discretionary budget request compared
to the amended FY 1999 President's Budget are:
Head Start
+$ 337,000,000
Programs for Persons with
Developmental Disabilities
+$
11,120,000
Family Violence
+S
24,560,000
Refugee Resettlement
+$
6,000,000
Community-Based Resource Centers
+$
7,225,000
Federal Administration
+$
11,654,000
ECONOMIC INDEPENDENCE AND PRODUCTIVITY FOR FAMILIES
One of the Department's priorities is moving people from welfare to
work. In support of that priority, in FY 2000 the Administration for
Children and Families will continue to give particular attention to
programs designed to support and stabilize working families.
Child Care for Working Families
While the average family spends about seven percent of their income on
child care, low-income families spend approximately a quarter of their
income for child care services
The Child Care and Development Block Grant, the General Child Care
Entitlement program and the Dependent Care Tax Credit are the major
Federal programs that help low-income working families pay for
affordable, safe care for their children. Even with these programs and
the new programs proposed in the FY 1999 President's Budget, resources
are stretched far too thin. Now that welfare reform focuses on ensuring
that families move from welfare to work, there is = greater need for
child care support, to ensure that families that have entered the labor
force are not forced back onto welfare.
In FY 2000, ACF is requesting the second year of funding for the
President's five year initiative to address and expand activities
related to three key issues: affordability, quality and availability.
These funds will help provide support for working families in their
effort to access quality care for their children. This will move us
toward achieving the President's goal of increasing by one million the
number of children in child care in 2003.
This budget request assumes passage of the President's Child Care
Initiative in the FY 1999 President's Budget. If that proposal is not
enacted, or if only a portion is enacted, we would incorporate enactment
at the original proposed funding levels in the FY 2000 budget.
I
Programs for Persons with Developmental Disabilities
ACF is requesting an additional $11.1 million in FY 2000. We will seek
changes to the State Grant formula to simplify the methodology for
computing state/territory allocations and acknowledge and encourage the
achievement of valued results, including a focus on working families
with persons with disabilities, through a new incentive provision. In
addition, we will convert the University Affiliated Program to a formula
grant program. We propose to include technical assistance setasides
that will allow us to focus resources on linkages between the
Developmental Disabilities networks and other critical priorities. In
FY 2000, we propose to focus on links to employment-related services for
TANF recipients moving to work. We will include language to allow the
cost of making and monitoring grants to be paid from program funds.
Refugee Resettlement
The refugee resettlement program is designed to help refugees and Cuban
and Haitian entrants who are admitted to the United States to become
employed and self-sufficient as quickly as possible through providing
cash and medical assistance to refugee households that are not eligible
for TANF, Medicaid and SSI during their first months in the United
States; and English language training, employment-related services, and
a variety of special activities.
Based on the State Department's projections of 100,000 new entrants, of
which 20,000 are Cuban/Haitians, and on the continuation of key social
services programs, we are projecting an increase of $6 million in
funding for refugee programs. This will continue to support 8 months of
service. The estimate does not assume any carryover from prior years.
We will be working with the State Department over the next few months as
they finalize their entrant ceiling numbers.
2
HEALTH, SAFETY AND WELL-BEING OF CHILDREN AND YOUTH
The Department's commitment to the early years of life reflects this
Administration's efforts to support parents in providing young children
with a full opportunity to grow, learn, and thrive. Both research
evidence and the experiences of parents and caregivers demonstrate that
children's environment during those early years is critical to their
ability to succeed in school and later in life.
Head Start
Only about 40% of eligible preschoolers are now served by Head Start.
In keeping with this Administration's commitment to build a strong
foundation for success for all of America's low-income children, this
budget proposes $4.997 billion for Head Start, an increase of $337
million over the FY 1999 President's request. This request is
consistent with the goal set by the President during the FY 1994
reauthorization of the Head Start Program: one million children
enrolled in Head Start in 2002 including 80,000 children in Early Head
Start.
The FY 2000 funding will allow an increase of approximately 32,000
preschool children and their families, including up to 7,000 infants and
toddlers in the Early Head Start program.
Early Head Start. In recognition of the powerful evidence that
the period before age three is critical to healthy growth and
development and to later success in school and in life, the Head Start
Act established a new program for low-income pregnant women and families
with infants and toddlers. Called "Early Head Start," this program
began in 1995 to provide early, continuous, intensive and comprehensive
child development and family support services to low-income families
with children under age three. The FY 2000 funding level will include an
increase in the number of infants and toddlers and their families in the
Early Head Start program, as well as expanded technical assistance,
training, and research to support top quality infant and toddler
programs nationwide. This increase continues to move us toward meeting
the President's goal of 80,000 children in Early Head Start in 2002.
Quality. The 1994 Head Start reauthorization reflected a
bipartisan commitment to ensuring that every child in Head Start
receives the top quality, comprehensive services that are the hallmark
of the Head Start vision.
Partnerships. In keeping with the Department's own vision of
strong foundations for children's development that cut across
programmatic lines, ACF will continue to expand the ability of Head
Start programs to work with others in communities and states across the
country on an integrated vision of top quality early childhood services.
We are identifying and disseminating community models of Head Start-
child care collaborations; developing new and stronger links with the
Department cf Education and local school districts; and strengthening
the State Collaboration offices, which support linkages between Head
Start and state early childhood and related offices in all 50 states.
Violence Against Women Initiative - Family Violence
As part of the Department's Violence Against Women Initiative, ACF is
requesting an additional $24.6 million in FY 2000. While we are making
3
some progress in meeting the basic food, shelter, medical and crisis
counseling needs of survivors of violence, women and children need more
than this to recover from the devastating effects of domestic and sexual
violence. A comprehensive response to violence against women should
incorporate strategic community sectors to build and strenghten an array
of services and prevention strategies. The Department will be making
investment in two areas -- enhancing services and changing social norms.
The ACF request includes an additional $17.5 million to expand and
further strengthen the network of battered women's shelters and related
services, including the domestic violence coalitions and the network of
resource centers. This increase will provide services to approximately
72,000 women. An additional $2.5 million will increase culturally
appropriate services for underserved populations, $3.5 million will
provide innovative services beyond crisis care, $560,000 will provide
for evaluation and dissemination of model projects, and $500,000 will be
used to work with partners in the business community, education
community and youth-serving community to address the complex issues that
support violence against women behaviors.
In addition, we will include language to allow the program to pay for
costs associated with the making and monitoring of grants out of program
funds.
Community-Basec Resource Centers
We are requesting an additional $7,225,000 for the Community-Based
Resource Centers program to expand support to help minimize the risk of
harm to children, protecting them from child abuse and neglect in their
homes and enhancing families' capacities to provide for their children's
needs by increasing public awareness, parent education, and family
support services available to parents in their own communities.
4
A RESULTS-ORIENTED ORGANIZATION
The Administration for Children and Families has the responsibility for
providing assistance to America's most vulnerable populations. In
carrying out this mission we must provide high quality, cost-effective
and efficient services, meet customers' needs and expectations, and use
state-of-the-art information technology to improve management and data
systems.
Federal Administration
The FY 2000 request for Federal Administration is $156.8 million, an
increase in funding of $11.7 million over the FY 1999 President's budget
request.
This request maintains staffing at the number of staff that we expect to
have at the end of FY 1999 (approximately 1,550 with an additional 12
temporary experts in residence through our proposed Fellows Program).
However, this staffing level assumes considerable realignment of staff
to meet the areas of expanded responsibility described below. In
addition to maintaining staffing, the request adds additional
investments in systems and data collection capacity to enable us to work
more efficiently, and proposes a fellows program similar to the Service
Fellowship Program at PHS. ACF has a critical need for up-to-date
expertise in a variety of programmatic areas that may not stay the same
over time, a perfect setting for the use OÍ outside fellows.
Critical Workload Demands
ACF has responsibility for many of the programs which are at the
forefront of the Administration's domestic agenda; including welfare
reform, child care, child support, foster care and adoption, and Head
Start. ACF has seen significant staffing reductions in the last few
years, from a level of more than 2,000 FTEs in FY 1993 to fewer than
1600 in FY 1999, while experiencing a concurrent growth in its
programmatic responsibilities. For example:
0
The Head Start program has seen funding and enrollment levels
increase dramatically since 1992. The Administration's commitment
to quality means intensive staff involvement in monitoring,
technical assistance, and the time-consuming but critical tasks
associated with terminating a grantee that is not able to provide
quality services.
0
The Early Head Start program - a critical laboratory for
evaluating the impact of early intervention in improving the lives
of disadvantaged children and families - was begun in September
1995 and has quickly grown to the point where, in FY 1999,
approximately 400 agencies will be receiving Early Head Start
fundinc. ACF is responsible for assuring that each of these
grantees is providing comprehensive and quality services, and
therefore needs staff with expertise in early childhood
development. At a ratio of 12-14 grants per Federal project
officer, the 400 grantees added by FY 1999 should have led to an
increase cf about 30-35 staff. Further increases in Early Head
Start envisioned by the Administration would add considerably to
that total in FY 2000.
5
Child Care has experienced dramatic programmatic growth and will
continue to grow over the next few years as the Presidential
Initiative on Child Care is implemented.
With the much more visible role of child care in the states and at
the national level, the demands on staff for technical assistance,
data collection and analysis, policy development, and the
dissemination of information continue to grow. Passage of the
President's Initiative would bring with it a whole range of
important and urgent demands, including review and development
with states of benchmarks for the Early Learning Fund.
0
The Presidential Initiative on Adoption which calls for doubling
the number of adoptions and other permanent placements by the
beginning of 2003, along with the implementation of the Adoption
and Safe Families Act add another set of critical
responsibilities. For example, ASFA expands the maximum number of
state demonstration waivers to be authorized by ACF from 10 total
to 10 per year; we are only barely keeping up with the enormous
interest in these waivers at the front-end. And, we have not
solved the problem of tracking and monitoring them.
O
In the area of child support enforcement, Congress did provide
set-asides for technical assistance and computer systems in order
to insure completion of the major new requirements imposed by
PWRORA. However, child support responsibilities outside those two
areas have also grown. For example, child support audit
responsibility has expanded to include administrative cost audits
and system reliability audits to assure proper use of Federal
funds and integrity of data to support program performance
measures. Additional funds for travel and systems support are
needed to allow completion of these critical audits.
Systems development for TANF is essential in order to provide
critical data collection and validation. In the area of welfare
reform, Congress has shifted the nature of ACF's role, to involve
less oversight of policy and program decisions but more attention
to data, results, and accountability. This data collection role
is both critical and urgent, and it requires investment. As
States and tribes put new data systems in place, ACF must build
the capacity to provide basic technical assistance to them, to
receive the data when submitted, and to verify and analyze the
data. Adequate analysis of TANF data reports and their
relationship to expenditures is essential to the continued success
of welfare reform. Data used to track caseload movement, and to
determine penalties and bonuses must be accurate so we can present
a clear picture of the impact of welfare reform.
Staff Reallocation and Other Strategies For Addressing These Demands
Over the past several years, as the tension between increasing workload
and decreasing staff has become acute, we have reallocated staff,
reorganized, identified strategies to use staff more flexibly, relied on
technology and on outside expertise to stretch our limited staff
capacity as far as it can go, and implemented savings steps to free up
resources for priority use. However, we are proposing to halt the
decrease in FY 1999 and maintain those staffing levels in FY 2000
because we believe that we will not be able compensate through
reallocations and other strategies for decreases below that level.
6
The Request
We are committed to taking advantage of all available strategies to use
our existing staff and administrative support resources as effectively
as possible. However, we have reached a point where we can no longer
achieve the results we are accountable for without investments in
systems capacity and in staff.
Therefore, we are proposing three investments in this administrative
request:
0
Maintaining existing staffing levels, so that we will not
lose further capacity and expertise through attrition;
O
Investing in systems and data analysis capacity; and
0
Creating a fellowship program, similar to the Service
Fellowship Program at PHS, to address some of our
specialized staffing needs. This will allow ACF to recruit
persons with expertise in specific programmatic areas for
designated periods of time, thus meeting our needs for
flexibility and easy access to priority areas of expertise.
7
ADMINISTRATION FOR CHILDREN AND FAMILIES
FY 2000 Mandatory Budget Request
The FY 2000 mandatory budget is $32.5 billion, an increase of
$826, 598, 000 over the FY 1999 current estimate. This request is
consistent with the FY 1998 mid-session review and reflects an increase
of $37 million over the FY 2000 column of the FY 1999 President's
Budget.
Welfare Reform and Working Families
Since August 1996, when the Personal Responsibility and Work
Opportunity Reconciliation Act (PRWORA) was enacted, we have seen many
changes in the welfare programs in this country. We have seen dramatic
declines in the welfare caseloads, with over 2.4 million recipients
leaving the rolls. More recipients are now working, and more of those
who have left the rolls are working. New partnerships are being forged
with government collaborating with business, community organizations,
transportation providers, the media and religious leaders to help move
families to work.
The passage of this legislation has presented all of us with a variety
of opportunities and challenges. We must continue to give particular
attention and support to programs designed to support and stabilize
working families, as demonstrated by the Secretary's Initiative and the
Vice President's Bold Goal, and we must build on the progress to date to
ensure two key next steps for the future: we must work with states and
communities to ensure that they reach and invest in all families
including those with particular needs such as substance abuse, domestic
violence, developmental disabilities, and those who live in isolated
rural and inner city communities; and we must complete transition to a
true focus on work by promoting success at work for low-income families
Child Support Enforcement
The Child Support estimate does not include any legislative proposals.
However, child support financing discussions continue to take place.
Independent Living
The FY 2000 request includes an increase of $35 million for Independent
Living. This program has remained constant at $70 million since 1987.
This increase will help keep children aging out of the foster care
program from becoming homeless, jobless, or drug addicted. As we seek
to ensure stable permanent homes for children and to promote work and
self-sufficiency, we must include those children who, despite all our
efforts, have not been adopted and reach adulthood directly from the
foster care system without the supports to fall back on that most
children and young adults can take for granted.
Child Welfare/Adoption and Safe Families Act Programs
All children deserve a safe and nurturing permanent home. When a
child's biological family cannot provide such a home, children deserve
prompt and permanent placement with a loving family, not a long period
of uncertainty. While foster care offers these children a safe and
nurturing temporary haven, as many as 100,000 foster care children will
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need permanent homes in the next few years. Many of these children have
special needs and require the security and stability of an adoptive
family to develop their full potential.
The President's Adoption 2002 initiative and the Adoption and Safe
Families Act signed by the President in November, 1997 address the
critical needs of these children for safety, permanence, and well-being.
The Administration is committed to implementing the wide-ranging
provisions of the statute designed to ensure that children's safety is
paramount, that foster care is temporary, and that children have
permanent, safe, loving homes. The President has set an Adoption 2002
goal of providing safety, permanency and well-being for at-risk children
by doubling the number of adoptions and permanent placements from the
public welfare system. The FY 2000 request will continue the joint
effort by Federal, State and local governments, child welfare and
adoption professionals, community leaders, and interested citizens to
achieve this goal, thereby improving the lives of children who are
backlogged, or at risk of being backlogged, in the child welfare system,
by creating permanent homes for them.
Efforts to reduce barriers to the adoption process and strengthen our
technical assistance to enable States to increase the numbers of
children adopted, especially children with special needs will continue.
To further these efforts we are proposing an investment of $2 million
from title IV-E funds for monitoring of child welfare and family service
programs in the states, including family preservation and support, time-
limited reunification services, adoption support services, child
protective services, foster care, adoption, and independent living is
requested. These reviews are essential to safety, permanency and child
and family well-being. These funds will be targeted to providing
technical assistance and monitoring of critical systems development, the
systems which provide us with the information necessary to approve or
disapprove state expenditures. A legislative proposal will be developed
to allow use of funds for these critical activities.
Conclusion
In summary, this budget proposes increases in Head Start, Foster Care
and Independent Living, Family Violence, Refugee Resettlement, Programs
for Persons with Developmental Disabilities, Community-Based Resource
Centers and Federal Administration. These choices represent our best
judgment as to how ACF can satisfy its many responsibilities to
America's vulnerable populations in a time of fiscal restraint. We
believe this budget proposal strikes an appropriate balance between
program responsiveness and fiscal prudence.
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