As the percentage of Kansas children living in poverty continues to climb, the number receiving welfare assistance is falling, according to a new report.
In 2012, more than 23 percent of children lived in poverty — that's up from 21 percent the previous year, according to a report released today by the Topeka-based advocacy group Kansas Action for Children.
The report also indicated that the average monthly enrollment in Temporary Assistance for Needy Families (TANF) had dropped from nearly 26,000 in 2011 to about 21,600 in 2012.
In 2007, there were also about 21,000 Kansans receiving TANF, but in that year only 18 percent of children were living in poverty.
The poverty line for a family of four is about $23,000 a year.
“Many Kansas families haven’t yet rebounded from the recession. These are working parents who aren’t able to earn enough to make ends meet — they need these programs to help them feed their children and keep them healthy and safe,” Shannon Cotsoradis, chief executive of Kansas Action for Children, said in a prepared statement accompanying the report.
“And yet the Department of Children and Families (DCF) continues to make administrative changes without legislative oversight or consideration for the impact on families. It’s time to reverse course.
“The greatest threat to the well-being of children is a lack of economic security,” said Cotsoradis. “Making it more difficult to access safety-net programs only hurts our chances of reducing poverty.”
Among the administrative changes cited by Cotsoradis were:
- More work and job training requirements for TANF,
- Requiring new mothers to return to work after two months — instead of six months — to receive TANF aid,
- Reducing the lifetime limit on TANF benefits from 60 months to 48 months,
- Changing the way household income is calculated to qualify for foodstamps,
- Eliminating funding for programs that spread awareness of foodstamp availability,
- Separating the application processes to apply for TANF and for Medicaid.
The state has also instituted new drug screening for TANF and has stepped up fraud detection.
And last week, Gov. Sam Brownback proposed diverting about $18 million from TANF — which typically consists of cash payments to families — to help pay for a new reading initiative.
‘Helping adults achieve self-sufficiency’
Theresa Freed, spokeswoman for DCF, said the agency "is making every effort to reduce childhood poverty" by helping families find work.
"Previous efforts to reduce poverty by eliminating work requirements have proven ineffective in helping Kansas families. It is a top priority to help adults achieve self-sufficiency so that they can meet their own needs and those of their children," Freed said in an email.
"We understand that some jobs do not pay enough to make ends meet. That is why we have various assistance programs available and with job training through our state partners, families can achieve complete self-sufficiency," she said.
She said the reading program also would help reduce poverty by providing children the skills they need in the workforce.
"The Reading Roadmap programs that are supported by TANF funds are strictly for out-of school literacy efforts. This is again, to encourage the prevention of the cycle of poverty. By empowering young people with the tools they need to succeed later in life, we are supporting the objectives of the federal TANF program," Freed said.
Officials have said another goal of the reading program is to reduce teen pregnancies.
"A 2012 study by Dr. Ian Bennett at the University of Pennsylvania found that seventh grade girls with a less-than-average reading skill were 2.5 times more likely to have a child in their teen years compared with those with average reading skill," Freed said.
The Kansas Medicaid program seems to be catching up with the rest of the nation when it comes to dental care for children.
In the past dozen years the state has doubled the number of Medicaid children receiving dental services, said Kamyar Nasseh, an economist from the American Dental Association. Nasseh spoke at the Oral Health Kansas conference held here last week.
Nasseh said about 20 percent of Kansas children on Medicaid logged a dental visit in 2000. But in 2012, that figure was up to 40 percent, he said, citing statistics from the federal Centers for Medicare and Medicaid Services.
One explanation for the greater percentage of Kansas Medicaid children seeing a dentist could be the state’s school-based screening and sealant program, said Jennifer Ferguson, manager of the Kansas Children’s Oral Health Program. The program targets low-income students.
The program screened approximately 154,000 students during the 2012-2013 school year, more than double the number served just three years prior, according to a presentation by Ferguson.
But despite the improvements, the Kansas percentage remains slightly below the national average, Nasseh said.
Yesterday, KHI News Service reported that Kansas’ Medicaid-reform program, known as KanCare, had effectively shut down a grant-funded initiative that provided Medicaid dental services to children in Head Start programs.
Nasseh gave the keynote speech at the two-day conference, which drew about 160 people. It was held at Johnson County Community College.
Nasseh cited other Kansas figures:
Approximately 49 percent of low-income adults saw a dentist in 2010, down from about 53 percent in 2002. There was a similar decline in the national percentage.
Assuming full implementation of the federal health-reform law, approximately 545,000 Kansas children would have dental benefits by 2018, a roughly 16 percent increase over 2010. A key requirement of the law is that private health insurance plans must include pediatric dental and vision benefits starting next year.
The Medicaid reimbursement rate for dental services is less than half (46.9 percent) the commercial payment rate, which is about in line with the national average of 50.3 percent.
And he described a national survey by the dental association that found that more than a third of dentists reported they were not busy enough and could accept more patients.
Conference presentations are available online, along with the first-ever county-by-county oral health snapshot of the state, which was produced by Oral Health Kansas and released at the conference.
90 percent of counties short on dental providers
Tanya Dorf Brunner, executive director of Oral Health Kansas, said she was surprised to hear that given that 95 of Kansas’ 105 counties do not have enough dental providers.
Members of an oral health task force established by the Kansas Board of Regents recommended last year that the state open a dental school to help address the shortage.
The disconnect between the findings in the dental association survey and the Kansas statistics could boil down to differences among safety-net providers and private-practice dentists.
If state-run Medicaid had its problems, one part that was working well in Kansas was providing oral health care to kids through programs such as Kansas Cavity Free Kids, Head Start officials say.
By the fifth year of the pilot program, which began in 2007, more than 7,000 children in 41 rural counties had received regular cleanings, fluoride varnishes and sealants from dental hygienists in Head Start classrooms.
It worked so well that program officials planned to expand it to other areas of the state where access to dental care is chronically limited.
But the program was effectively shut down after the launch of KanCare on Jan. 1, when day-to-day management of the state's Medicaid program was turned over to three for-profit managed care companies.
UnitedHealthcare, one of the state’s three KanCare contractors, chose to not authorize payment for teeth cleanings performed at Head Start, a decision that effectively put the entire program on ice.
"United does not recognize (a hygienist's) services if she's working under Head Start for doing cleanings for kids or for pregnant women," said Kathy Hunt, the Head Start official who coordinated Kansas Cavity Free Kids.
The other two KanCare companies — Amerigroup and Sunflower State Health Plan, a Centene subsidiary — continued the previous state policy of allowing dental care performed at Head Start facilities to be billed under Medicaid.
But Hunt said the program could not continue serving children covered by those companies while turning away others covered by United.
"Quite frankly, we have not provided services since" KanCare began, Hunt said. "We can't say 'I'm going to provide services for this child and not for this child.'"
Hunt also serves on the board of directors for Oral Health Kansas. She testified about the problem last month at the first meeting of the Legislature’s KanCare oversight committee.
A month later, she hadn’t had any response from legislators, state officials or representatives of UnitedHealthcare.
A state senator says he’s working on a bill that would give some foster parents more say in the legal process for determining whether children in their care should be returned to their biological parents or put up for adoption.
“It seems to me that foster parents are the ones who spend the most time with these kids, but they have no authority, no power,” said Sen. Forrest Knox, an Altoona Republican. “They’re just babysitters.”
Knox said he plans to propose creating a “new tier” of foster parents who would be allowed to participate in the decision-making process in exchange for being better trained and taking on more difficult children.
“We’d expect a lot more out of them, but we’d pay them a lot more, too,” he said.
Knox and his wife, Renee, have nine biological children, two of whom still live at home. The couple adopted four brothers — then ages 5, 7, 8 and 13 — two years ago after caring for them two years as foster parents.
Too little say
Knox said he thought more “good people” would agree to become foster parents if they knew they “would be given the tools to make a difference in kids’ lives.”
Many compassionate adults, he said, don't become foster parents because they know they would have little or no say in what happens to the children placed in their care.
“The kids get jerked out of their homes and they’re not told why,” Knox said. “They have no standing. They’re just a place to put kids.”
Knox said his proposal would not increase overall costs.
“I’m looking at spending less money total,” he said, “but spending it more effectively.”
In Kansas, foster-care decisions are the subject of court proceedings during which a judge rules on evidence presented by attorneys representing the state, the children, and the biological parents.
Foster parents are allowed to file written reports with the court, letting the judge know how the children in their care are faring. But they are not considered an ‘interested party’ with legal standing in the case.
Decisions affecting the services children receive while in foster care are made by the Kansas Department for Children and Families, which contracts for services with two nonprofits: KVC Behavioral Health and St. Francis Community Services.
St. Francis and KVC, in turn, each have networks of licensed foster homes. They also rely on networks developed by other charitable organizations.
'A lot of inefficiencies'
Kansas privatized most if it’s foster care responsibilities in 1996.
“I haven’t seen (privatization) really work,” Knox said. “I see a lot of inefficiencies.”
According to the latest reports on the DCF website, 5,780 children were in the state’s foster care system last month. Currently, the system includes 2,546 licensed foster parents.
Knox said he hoped his proposal would be the subject of a pilot project somewhere in the state next year.
Bruce Linhos, executive director with the Children’s Alliance of Kansas, an advocacy group that helps train foster parents, said similar proposals similar have been tried in the past with varying degrees of success.
All of the foster care contractors and subcontractors, he said, have foster parents who have more training than most and who are willing to take on children with especially difficult behaviors.
“That kind of family has always been around and they’re of huge value,” he said.
Still, Linhos said, Knox’s proposal appears to be “entirely plausible” in light of an ongoing effort to lessen the state’s reliance on residential facilities for mentally ill children. He said it might also complement a recent Office of Judicial Administration initiative aimed at helping parents and children better navigate the foster care system.
Marcia Allen, who runs Kansas Family Advisory Network, a Wichita-based group that advocates for parents whose children are in state custody, said Knox’s proposal would raise several issues that have proven to be contentious in the past.
“I fully support more training for foster parents and I understand that they want more say in the process," she said. "But is that to say they should have more say than the birth parents? Should they have more say than the children? And what about grandparents? Shouldn't they have a say? Everybody wants more say in the process. And you know what? They all probably deserve more say.”
WASHINGTON, D.C. — Kansas policymakers seem to be at the forefront of a controversial national movement to make it more difficult for people to qualify for a federal program that helps more than 46 million low-income Americans — including more than 300,000 Kansans — buy groceries.
Under federal law, able-bodied adults without young children are generally only eligible for food stamps — also known as Supplemental Nutrition Assistance Program, or SNAP — if they are working at least 20 hours per week, are looking for work, or are in a qualified job-training program and earn less than 130 percent of the federal poverty level. Otherwise, the limit on food stamps is three months out of every three years.
But states can get exemptions from those federal requirements and nearly all — including Kansas — have loosened the restrictions since the nationwide economic recessions that hit in 2001 and 2008.
But now, Republican conservatives from Kansas and elsewhere have been pushing to stiffen the work requirements as a way to cut government spending.
For example, Kansas Congressman Tim Huelskamp offered an amendment during recent debate on the Farm Bill that would have rolled back the state waivers and made it mandatory for each state to adopt stiffer work requirements. Had it passed, it was projected to have cut food stamp spending by about $31 billion over ten years.
"I think we have a once-in-a-generation opportunity to put some real work requirements" on food stamps, Huelskamp told KHI News Service. "Most Kansans I talk to are not opposed to helping those in need. Overwhelmingly, that's what they say. But they are opposed to helping those who don't need it. Whether it's waste, fraud and abuse or outright provisions...I think those are the kind of reforms people would like to see.”
But critics say if the stiffer work requirements pushed by Huelskamp and other GOP conservatives were adopted, the results would be “draconian” with millions left without the food aid at a time when unemployment remains high in many parts of the country.
“I have been working on SNAP for 41 years and have always supported reasonable work requirements,” said Robert Greenstein, founder of The Center for Budget and Policy Priorities, a Washington D.C. think tank, writing in a recent blog post.
“There is a bright yellow line down the middle of the road between: 1) Requiring people to try to find jobs, to take jobs that are offered, and not to quit jobs, and 2) Denying benefits to people who do everything they can to get jobs but can’t find them and aren’t ever offered a work program or job training slot. The former is reasonable. The latter is not, and it should offend anyone with a sense of fairness and compassion,” he said.
There has been no estimate developed of how many Kansans would have lost SNAP benefits had the Huelskamp amendment become law. But an earlier version of the Farm Bill approved by a U.S. House committee, which was less restrictive than Huelskamp’s plan, would have eliminated the benefit for more than 13,000 Kansans, according to state welfare officials.
Huelskamp, a Republican from Dodge City, represents the state’s predominantly agricultural 1st District. He was one of two House members who proposed stiffer work requirements for the food stamp program during the recent Farm Bill debate.
Though his amendment failed, a similar one from U.S. Rep. Steve Southerland, a Florida Republican, was approved minutes before the overall bill was voted down, 195-234. Many observers blamed the Farm Bill’s defeat in the House on that amendment.
But Huelskamp laid the blame at the feet of the chamber’s Republican leadership, with whom he has quarreled for months. In December last year, House Speaker John Boehner pulled Huelskamp off the agriculture and budget committees after Huelskamp crossed Boehner during the “fiscal cliff” negotiations.
"It's very rare that leadership — whether it's Republican or Democrat — brings something to the floor that loses so spectacularly. It didn't even get 200 votes. That was quite surprising," Huelskamp said, describing the Farm Bill’s failure. "Republican leadership fell very short.”
Huelskamp, who was among those who voted against the bill, said it was just as likely that the measure failed because it did not go far enough in stiffening the SNAP work requirements.
"On my particular amendment we got 175 votes (with 250 voting against), and more Republicans voted for my amendment than voted for the Farm Bill. So if we can move in the direction of my amendment, I think there's a real chance we can find" agreement, he said.
Ballooning food stamp rolls
Persistent high unemployment after the last recession has resulted in nearly twice as many people — some 47 million — receiving food stamps than there were just five years ago.
The soaring cost of the SNAP program has made it a lightning rod in the recent congressional debates over renewing the Farm Bill, a measure historically renewed every five years. The bill’s reauthorization has been stalled in Congress the last two years. Besides the food stamp program, the measure also includes programs such as crop insurance and farm subsidies that affect thousands of Kansas farmers.
After the U.S. Senate approved its version of a new Farm Bill last month, the U.S. House — for the second year in a row — became embroiled in debate over how to best shrink the swelling rolls of food stamp recipients and cut program costs.
The Senate has tentatively approved a bill that could lead to some school districts holding back first graders who fail a reading test.
The measure was based on Gov. Sam Brownback’s proposal for improving fourth grade reading scores by holding back third graders known to be having trouble reading.
“We need to be getting to these kids as early as we can,” said Sen. Laura Kelly, a Topeka Democrat, who proposed changing the focus of Senate Substitute for House Bill 2140 from third graders to first graders.
Kelly’s amendment was endorsed by Sen. Steve Abrams, an Arkansas City Republican and chair of the Senate Education Committee.
“It’s fairly well known that through the third grade children are learning to read,” he said. “After the third grade, they’re reading to learn.”
Abrams said he considered Kelly’s amendment to be “friendly.”
The Senate endorsed the bill on a voice vote shortly before 8 p.m. Tuesday. A formal final action vote is set for Wednesday morning.
Abrams said an earlier version of the bill had stalled in the education committee after several members argued that it constituted a mandate and was likely to do more harm than good.
Those concerns were resolved, he said, by adoption of a number of amendments in the committee and during the floor debate aimed at exempting students in special education or English-as-a-Second-Language classes, allowing students to take the test more than once, limiting the mandate to school districts with below-average reading scores, and giving parents the final say in whether their children were promoted.
“The concern that what was initially proposed did not include parental involvement ended up being resolved in this bill,” Kelly said.
The amended bill also would allow teachers to declare whether students who fail the test should be allowed to advance.
It wasn't immediately clear how many first graders might be affected by the bill or what the cost might be for school districts. Neither question was raised during the debate.
Child advocates had testified against the initial bill, arguing that state resources would be better spent on early childhood development programs, many of which have long waiting lists.
Shannon Cotsoradis, chief executive for the advocacy group Kansas Action for Children, welcomed the changes to the bill.
“Tonight’s floor debate in the Senate underscores the commitment to early intervention and to investments in early learning programs as a path to literacy,” she said. “The amendments will also provide the flexibility to act in the best interests of individual students rather than mandating a one-size-fits-all approach.”
The bill calls for spending $10 million — $5 million a year for two years — on a grant program aimed at helping children learn to read.
It also would set aside $1 million a year for two years to reward school districts with the most improved reading scores.
If the bill passes on final action, as expected, it would be sent to the House, where it’s likely to be referred to a conference committee.
Related stories on khi.org
→ Brownback reading initiative questioned by education experts
→ Governor's office restates support for reading initiative
Some experts at Kansas universities are questioning Gov. Sam Brownback’s plan to cut spending on established early childhood development programs in order to fund a proposed new initiative aimed at improving the reading scores of the state’s fourth-graders.
Though the governor hasn’t yet provided much detail on how the new Kansas Reads to Succeed program would work, he has said he favors requiring third graders to pass a reading test before being advanced to the fourth grade.
‘Irresponsible and cruel’
“Passing children up the grade ladder when we know they can’t read is irresponsible and cruel,” Brownback said in his State of the State speech to the Legislature last month.
But reading specialists at two Kansas universities said research has shown that holding children back a year often does more harm than good.
“Children who are retained, typically, are more likely to not graduate from high school,” said Suzanne DeWeese, a reading recovery specialist with the Jones Institute for Education Excellence at Emporia State University. The university trains many of the state’s K-12 teachers.
“Children who aren’t learning to read need better instruction, not a repeat of a curriculum that’s already failed them,” she said. “And the sooner they have access to that instruction, the better.”
Diane Nielsen, an associate professor of education at the University of Kansas, said waiting until students were in third or fourth grade to address reading deficiencies was shortsighted.
“To do what it appears the governor wants to do, it would need to be done in the grades below fourth, beginning with support in preschool,” said Nielsen, a specialist in reading instruction.
“The emphasis should not be on a single year’s test results,” she said. “It should be on early intervention because there are so many things that need to be in place before a child reaches the fourth grade. Reading is not the simple process that people tend to think it is. It can be very complicated.”
Brownback, who campaigned for governor promising to boost 4th grade reading skills, told KHI News Service that he has been disappointed by the proficiency ratings.
“They’ve been fairly level for a long time,” he said. “We need to do better.”
Sherriene Jones-Sontag, the governor’s chief spokesperson, said details of Brownback’s new initiative would be made public in a bill that would be introduced by a legislative committee probably sometime this week.
“We reviewed models for potential legislation from several other states, including Florida,” she said. “Some aspects will be similar, some will be different and some completely unique to what other states have done to help struggling readers.”
The governor’s plan has been endorsed by the Kansas Policy Institute, a conservative think tank based in Wichita.
“What we’ve seen in places like Florida, which has had practices like this in place for over a decade, is that when you set up the (reading) test in third grade, the (school) districts and teachers see the significance and start building in interventions early on,” said James Franko, the institute’s director of policy.
“So instead of waiting for students to reach the third grade, they’re taking a soup-to-nuts look at how they do reading for (kindergarten) through third grade, identifying those students who are struggling, and getting them the help they need so there isn’t this rude awakening when, all of a sudden, they get to the third grade and can’t read with their peers,” Franko said.
Like many Kansans, Rick Cagan spent much of last weekend reading and listening to news reports about the gunman who killed 20 children and six adults at an elementary school in Newtown, Conn.
Cagan had a professional reason for learning what he could about the tragedy. He runs the National Alliance on Mental Illness-Kansas Chapter office in Topeka.
“It’s devastating,” he said. “It’s heartbreaking.”
According to initial news reports, the gunman, 20-year-old Adam Lanza, may have suffered from a personality disorder or had been diagnosed with Asperger’s, a form of autism. However, there is no indication that he had the kind of severe mental illness suffered by others responsible for mass shootings.
Jared Loughner, the man convicted of shooting former Arizona Congresswoman Gabrielle Giffords and killing six others, for instance, suffered from schizophrenia, a mental illness that causes disordered thinking and delusions.
And James Holmes, the man accused of shooting 12 people to death and wounding 58 others last summer at a movie theater in a Denver sought mental health treatment before the attack, according to multiple news reports.
Mass shootings nearly always rekindle debates about gun control and the adequacy of the nation’s mental health system. Commenting on the later, Cagan said many Kansans with mental illness are not getting the early treatment they need to avoid crises.
“More than 60 percent of the adults who have a serious mental illness are untreated,” he said, noting that in Kansas half the admissions to the state hospitals for the mentally ill involve people who’ve had no previous contact with their community’s mental health center.
In Kansas, state-hospital admissions are reserved for adults who are seriously mentally ill and have been deemed a danger to themselves or others.
“NAMI is always reluctant to jump in with some sort of comment when these kinds of incidents occur because there’s so much that we don’t know,” Cagan said, referring to the shootings. “But, still, blaming the individual only goes so far. At some point, we have to look at the overall well-being of our mental health system.”
Budget cuts in the mental health system
Kansas’ system, he said, hasn’t fared well in recent years.
“I don’t like saying this,” Cagan said, “but we’re just lucky this didn’t happen in Kansas.”
A child advocacy organization is criticizing Gov. Sam Brownback for restricting access to some programs that help low-income Kansans while more children and families are slipping into poverty.
Shannon Cotsoradis, chief executive of Kansas Action for Children, said recent changes made by the Brownback administration to tighten eligibility criteria for cash and child-care assistance programs are making it harder for some struggling families.
Cotsoradis cited data in 2012 KIDS COUNT report released on Thursday. It showed that the numbers of Kansas children enrolled in Medicaid and receiving food stamps had gone up significantly while the numbers receiving cash and child-care subsidies had gone down.
“You see this huge discrepancy in the data,” Cotsoradis said. “It just doesn’t make a lot of sense.”
Angela de Rocha, a spokesperson for the Kansas Department of Children and Families, defended the administration’s policy changes as efforts to encourage people to become more self-reliant.
“I think we should be praised, not criticized,” she said.
According to the new KIDS COUNT report, 21 percent of Kansas children are living in poverty, up from 18 percent in 2007. The average number of children enrolled in the Supplemental Nutritional Assistance (food stamp) Program rose to more than 136,000 in 2011 – an increase of nearly 40,000 since 2007.
Also, nearly half of all school-aged children in Kansas – 48.6 percent – qualified for free or federally subsidized lunches this year. That is an increase of almost 10 percentage points in four years.
Over the same period, the report shows that the number of families receiving cash-assistance through the Temporary Assistance for Needy Families program has been trending down. In 2011, there were 25,981 families that received assistance, down from 26,633 in 2007. Families receiving child-care assistance decreased to 19,735 in 2011 from 21,025 in 2007.
Officials at the Kansas Department of Children and Families anticipate that the TANF numbers will continue to drop. The official caseload estimate released earlier this month by the Kansas Legislative Research Department says the agency anticipates spending $2.4 million less from the state general fund to support the program in the 2014 budget year “due to the continuation of recent changes in policies.”
Cotsoradis said that explanation “confirms that they (administration officials) are creating barriers to those programs.”
But de Rocha said the declining numbers of families receiving cash and child-care assistance isn’t necessarily the result of the policy changes. She said it could mean that many have gotten full-time jobs because of the department’s insistence that they comply with job-search, training and part-time work requirements.
“It is either people who got a job or who don’t want to cooperate with the job-search and work requirements,” she said. “All we’re saying is ‘we’re happy to help you get back on your feet, but you need to find a job.’”
Cotsoradis said the changes to the assistance programs seemed at odds with Brownback’s campaign promise to make reducing childhood poverty one of his administration’s top priorities.
On Wednesday, the governor appointed a 12-member task force and charged its members to report back with “concrete ideas” on reducing childhood poverty.
“All too often in our state, children who are living in poverty today become tomorrow’s poor parents,” Brownback said. “Intergenerational poverty such as this affects our state’s long-term productivity and wellbeing. We need concrete ideas on how to change this pattern.”
The first task force meeting is scheduled for 10 a.m. Monday in the Kansas Board of Regents Conference Room on the 5th floor of the Curtis State Office Building in Topeka.
Kansas has done a good job the past couple of years covering more children with health insurance.
In 2009, 8.2 per cent of children in Kansas were uninsured, according to a new report from the Georgetown Center on Children and Families. Two years later, the figure was down to 6.4 percent.
That 1.8 percentage point change was the seventh best improvement among states over the period, according to the report. Oregon and Texas improved the most, at 3.1 percentage points each. Missouri — which improved coverage by .2 percentage points — was among the bottom 10 states in reducing the percentage of its uninsured children.
Much of Kansas' increase in coverage for children is attributable to the state's Healthwave program — which insures children whose families earn a little too much to qualify for Medicaid — said Suzanne Wikle, director of policy and research for the non-profit advocacy group, Kansas Action for Children.
“In 2010, the eligibility level for our Healthwave program was increased to account for the fastest-growing group of uninsured children, who were just above the eligibility line at that point. So we made the program available to many more uninsured children in the state. That’s had a very big impact,” Wikle said.
Wikle said the state has also done a better job of marketing the Healthwave program. She's worried, though, that when Healthwave is incorporated into KanCare the name change may confuse some families and cause them to miss out on coverage they’re eligible for.
KanCare is Gov. Sam Brownback's plan to move most of the state's 380,000 Medicaid enrollees into managed care plans operated by three insurance companies.
Currently, large managed care companies only provide services to children and pregnant women from low-income families through HealthWave.
The authors of the Georgetown report say full implementation of the Affordable Care Act is the next opportunity to make substantial progress on insuring children.
In what could be a first for the state, if it is chosen, Kansas officials are considering contracting with an out-of-state organization to provide services for children in foster care.
Since the state privatized its foster care program in 1997, it has relied on a group of Kansas-based, non-profit organizations to manage the care provided to children who have been deemed wards of the state due to parental abuse or neglect.
Typically, there are about 6,000 children in the state’s foster care system at any given time. The state's lead foster care contractors collectively employ about 800 people.
Each of the organizations that have secured the state’s foster care contracts since the privatization initiative 15 years ago has been active for decades in Kansas child welfare services and are well known by the state’s foster care parents, welfare workers, and court and law enforcement officials.
The current contract holders are: TFI formerly known as The Farm, Inc., which has offices in Emporia and Topeka; KVC Behavioral Healthcare, Olathe; United Methodist Youthville, Wichita; and St. Francis Community Services, Salina.
Now, they face a potential, nonprofit competitor from Florida that provides similar services in multiple states: Florida, Louisiana, Texas, Iowa, North Carolina and Vermont.
“A large part of what we do is very similar to the work that’s being done in Kansas,” said David Dennis, chief executive of Eckerd, which was one of six organizations that met the state’s Sept. 20 deadline for submitting contract proposals.
Eckerd was founded in 1968 by Jack and Ruth Eckerd. The couple, now deceased, also started the Eckerd drug store chain in the 1950s.
In Florida, Dennis said, Eckerd manages the state’s foster care contracts in Pinellas, Pasco, and Hillsborough counties.
“It’s pretty much the Tampa Bay area,” he said, noting the contracts there involve more than 6,100 children.
The State of Florida pays Eckerd about $120 million a year for its services. Kansas spends about $140 million a year on its foster care program, not counting about $10 million spent on family preservation programs.
“Our piece of what’s going on in Florida is larger than the (foster care) systems in 14 other states and the District of Columbia,” Dennis said.
Florida privatized most of its foster care system in the late 1990s and early 2000s.
Another new entry
Another new entry to the contract competition is Olathe-based Kids TLC. The nonprofit organization has a history of providing child welfare services as a subcontractor, but has never before bid on a lead Kansas foster care contract.
The group seeks to provide services in the region that includes Atchison, Douglas, Johnson, Leavenworth, and Wyandotte counties.
“We’re known for having the largest PRTF (psychiatric residential treatment facility) in the state of Kansas,” said Jeremy Brenneman, the organization’s marketing and public relations coordinator. “But we also have a foster care program, an outreach program that goes out and looks for homeless and runaway kids, and a case management program that helps families that are at risk.”
Most of the program’s current services, Brenneman said, are provided in Douglas, Johnson, and Wyandotte counties.
Kids TLC is ready to expand its reach, he said, noting that its bid for the foster care work “really fits in with what we want to do.”
With the new contracts, which are expected to become effective July 1, 2013, the state is reducing its five foster care service regions to four. The new contracts are for four-year terms with two, optional, two-year extensions.
Organizations are allowed to bid on providing services in more than one of the four regions.
Members of the governance committee for the Kansas Board of Regents have agreed that the full board should hear the pros and cons of a proposal to train mid-level dental practitioners.
Regents' officials said this week that discussion among board members likely would happen before the Legislature convenes in January, perhaps when the board that oversees state universities, junior colleges and technical schools next meets in November.
Bills authorizing the licensing of "registered dental practitioners" as a way of improving access to dental care for Kansans in rural and other underserved areas were considered by lawmakers in each of the past two sessions of the Legislature but were not advanced because of stiff opposition from the Kansas Dental Association, which represents about 75 percent of the state's dentists, of which there are fewer than 1,500.
Had the proposals become law, the mid-level practitioners would have been allowed to perform about 30 routine services and procedures — such as extracting loose baby teeth, taking X-rays and administering local anesthetic — that currently are limited to dentists. The practitioners, similar to a nurse practitioner, would be required to work under a dentist's "general" supervision, though the dentist would not be required at the technician's side.
Spokespersons for the dental association have argued that routine procedures quickly can turn dangerous and that allowing lesser-trained practitioners to do what dentists now do could put patients at risk.
But supporters of the measure, including a coalition that includes the state's safety-net clinics, argue that some people in Kansas, including children, have died due to lack of dental care and that putting more oral health workers into the field is essential for meeting the state's needs. They also cite studies from countries and states where the practitioners are licensed showing they provide good quality, cost-effective care.
Not enough dentists
According to the Kansas Department of Health and Environment the state's dental workforce is below the national average and shrinking. More than a dozen of the state's 105 counties have no dentist and many more than that have too few.
A proposal to create the new class of dental technician is expected to be before the Legislature again in the 2013 session, which begins in January.
Five years ago, 184,000 low-income Kansans were on SNAP, the federal Supplemental Nutrition Assistance Program formerly known as food stamps.
Today, the enrollment tops 310,700 people.
A program that in 2007 cost the federal government about $190.3 million in Kansas outlays is expected to cost more than $450 million this year.
Congress, in recent months, has said SNAP has become too expensive and warrants serious belt-tightening.
In July, the Democrat-controlled U.S. Senate passed a five-year Farm Bill that would reduce SNAP spending by $4.5 billion over the next 10 years. The agriculture committee in the Republican-led House earlier this month passed a larger reduction of $16.5 billion over 10 years. Current SNAP spending is about $73 billion a year.
Looking for cuts
According to the Center on Budget and Policy Priorities, the House option would end assistance to between 2 million and 3 million people nationally. What portion of those might be Kansans has not been determined.
States have had some flexibility over the years to expand eligibility for SNAP, and Kansas has been among the few states where policymakers have not adopted what is called “expanded categorical eligibility.” The House plan would eliminate that categorical option for states.
It also would eliminate federal incentive payments to states that have improved their food aid programs. Kansas has received at least four of those performance bonuses since 2003, according to the Center on Budget and Policy Priorities.
The agriculture committee’s bill has yet to reach the House floor.
The Senate bill would find its savings by decoupling food stamp eligibility from a federal subsidy program (LIHEAP) that helps poor people with home heating costs. Currently, people who qualify for the energy subsidy also are automatically qualified for SNAP benefits because the income limits are nearly the same. According to the U.S. Department of Health and Human Services, 62,000 Kansas households qualified for LIHEAP subsidies in fiscal 2011, but the number of people who also received the food aid or the ramifications of the Senate plan for Kansas haven’t been determined.
Angela de Rocha, a spokesperson for the Kansas Department for Children and Families, which administers SNAP in Kansas, said the agency has a “neutral” stance on the federal proposals to scale back the nutrition program.
Stalled for now
For now, both the House and Senate plans are stalled on the SNAP issue despite considerable pressure on Congress to pass a Farm Bill, which includes the food assistance authorization.
“Typically, what would happen is that the ag committee would send a bill to the House floor, the House would pass a bill and then ‘conference’ with whatever was in the Senate bill,” said Helen Dombalis, a policy associate with the National Sustainable Agricultural Coalition. “That hasn’t happened because the speaker (U.S. John Boehner, R-Ohio) has kept the (House) bill off the floor. The speculation is that it doesn’t have enough votes to pass because the Tea Party-ers don’t think $16.5 billion is enough of a cut and the Democrats won’t vote for it because they think it’s too much.”
As the home of the University of Kansas, a thriving business community and many high-paying jobs, the city of Lawrence might not seem like the kind of place where hunger is a problem. And yet, it is.
Last week, hundreds of low-income residents of Douglas County lined up to receive free food and essentials, which were donated by the Oklahoma City-based international relief agency Feed The Children. The two-truckload donation — 38,000 pounds of cargo — is enough to provide 800 families with a 25-pound box of nonperishable food, plus a 10-pound box of personal care items.
Terry Claybrook, of Wichita, is one of the agency's truck drivers. He considers it the best job he’s ever had.
"Because I get to do what Jesus said — 'Feed me, clothe me and give me water when I’m thirsty,'" said Claybrook, while using a box-cutter to open a cargo box of food.
"Well, there’s cereal. There’s spaghetti. There’s rice. There’s all kinds of canned goods. Here’s some potatoes, and green beans, spaghetti sauce for this spaghetti. Here’s some macaroni and cheese — oh yes, All-American food there. Smart Balance popcorn. Skippy peanut butter. Diced tomatoes. That sounds good!" Claybrook said.
More than food
Jeremy Farmer is in charge of Just Food, the food bank serving Douglas County. He said the personal care items may be just as important to the recipients as the food.
"You know, if you’re a family, and left over at the end of the month you have $15 to spend, what are you going to spend it on? Are you going to spend it on toothpaste, or are you going to spend it on food?" Farmer said. "There are a lot of things that one can’t get on food stamps. Toilet paper being one of them, toothpaste, laundry detergent, feminine hygiene products, those are all things that are difficult to get on food stamps. One of the things that Feed The Children does is they provide hygiene items to people."
Not only that, this distribution includes hardcover children’s books and a special treat: bags of miniature candy bars.
"There was a kid that we met with a couple of months ago who ate a chocolate bar for the first time in his life, as a 10-year-old kid. That just blew me away. I could not believe that a 10-year-old kid had never had a chocolate bar. But some of these kids, that’s their story," Farmer said.
"And so, to be able to do this — to provide food and hygiene products, to be able to provide books, to be able to provide maybe a little sweet for them, for those that never had it before — it’s just a great opportunity."
The families in need
As volunteers continue to set up for the distribution, a line of cars begins to form at the entrance to the Just Food parking lot. Soon, the line stretches for blocks. Talking to the people in these cars, nearly all are raising children — either their own or their grandchildren.
Members of the Legislature's newly formed oral health caucus heard today how a school district in southeast Kansas reduced student tooth decay by half in five years, even though most of the students had no dental insurance.
Brian Smith, superintendent of schools in Galena, told the group of seven legislators and a dozen others who attended the first meeting of the caucus that his school-based dental care program had achieved far-reaching results in a short time span.
He said rate of tooth decay among the district's students had dropped from 50 percent in 2007 to 28 percent this year.
"That has had a tremendous impact on our school district, not just on the oral health of the kids but how they feel about themselves and on academics," Smith said. "It has also made a tremendous impact if you look at the cost of health care. A lot of time in the past, those kids were being taken to the emergency room when they got so bad their parents didn't know what to do."
In 2007, Smith began working with the Community Health Center of Southeast Kansas to annually screen all the students in the district, which has about 800 pupils.
The school nurse gets permission from parents for needed work or cleaning and schedules in-school appointments for the children. Smith said the health center arranges to send hygienists and dentists to the school so students miss minimal class time.
"The first intervention was like a war on oral health, repairing all the damage that was done," Smith said.
The first year took six weeks of appointments, but last year everything was done in less than three weeks.
"Now we're at the point where we're into prevention," he said, "and it doesn't take as much time or cost."
The community health center's chief executive, Krista Postai, said that any student given parental permission can receive care.
"If they have some kind of (health plan) coverage, we'll bill that," she said. "If they don't have coverage, we just write that off."
About half the students who have received care had no insurance, she said.
Postai cited "soda, candy and bad eating habits" as primary causes of tooth decay. And she said she suspected fewer parents were teaching good oral hygiene habits than were a generation ago.
She also said working parents have trouble getting time off for dental appointments.
"Imagine someone with five kids and a full-time job with both parents working, you don't get them to the dentist. It's not about bad parenting." Postai said.
The in-school program has since expanded to screen students in 11 counties in southeast Kansas. Five school districts have begun doing restorative dental care.
The $2.1 million program is funded by federal and state government programs as well as contributions from a dozen state organizations and health foundations, Postai said.
"This is a social justice issue. We either believe people should have access to these things or not. I don't know how we deal with that, but maybe we can address that next time," said Barbara Bollier, a Republican from Mission Hills. "Until we start talking about that, we're never going to get anywhere."
Phyllis Gilmore's appointment is drawing heat from some families of foster children.
Parents and grandparents of children who’ve been in the state’s foster care system are urging their senators to vote against confirming Phyllis Gilmore as secretary of the Kansas Department of Social and Rehabilitation Services.
“We need a person in that position who’s above reproach,” said Marlene Jones, a Wichita woman whose grandson was removed from her daughter’s home in 2005.
Jones said she and other parents and grandparents have been sending emails to their senators.
The emails were mentioned several times during Gilmore’s confirmation hearing Monday before the Senate Ways and Means Committee.
“We’ve all received these emails,” said Sen. Kelly Kultala, a Kansas City Democrat.
The emails accused Gilmore, a former executive director at the state Behavioral Science Regulatory Board, of not having done enough to investigate parents’ and grandparents’ complaints that social workers had lied in court or conspired against their families.
Gilmore said the complaints were misguided, noting that the decisions not to act on the complaints were not hers to make but were made by the board.
“I was not a decision-making person as it related to the board,” she said. “I carried out the board’s wishes and worked with licensees in that capacity.”
Social workers are licensed by the regulatory board.
Gilmore also told the committee that decisions to remove children from their homes are made by the courts, not by social workers or SRS.
In other testimony
Gilmore, a former Kansas legislator, also said she was comfortable with a recent policy change that led to more than 1,000 children being dropped from the state’s food stamp program.
Members of the Senate Ways and Means Committee today grilled a top welfare official about a controversial change in policy that has resulted in at least 1,000 children being dropped from the state’s food stamp program.
"Can you tell me how this fits in the governor's roadmap to take children out of poverty?" Sen. Laura Kelly, a Topeka Democrat, asked Michelle Schroeder, director of public policy and legislative relations at the Kansas Department of Social and Rehabilitation Services.
"This is a policy that's based on equality in the system," Schroeder said. "We had to look at the policy in totality as it affects every household."
"Which is easy to do when you're sitting in an office in Topeka dealing with them in the aggregate," Kelly replied. "It's a little harder to do when you're back home and can't go to the grocery store."
The previous policy for determining eligibility for the Supplemental Nutrition Assistance Program (SNAP) allowed households headed by non-citizens to earn, on average, about $900 more per month than households headed by citizens and still qualify for benefits, said Schroeder, repeating what she told a House committee last week.
Kelly said that rationale seemed to be flawed. She pointed to a document with four scenarios under the previous formula where all-citizen households fared better than the same household with an undocumented member.
"The premise that households with an undocumented resident (were) being treated better, that doesn't appear to be the case," Kelly said.
Prior to October, food stamp eligibility for Kansas children of undocumented parents — as in most states — was determined by a formula that counted a fraction of the household income to account for the parents’ ineligibility.
For example, if the non-citizen parents in a five-person household — two parents, three U.S.-born children — earned $2,000 a month, that $2,000 was divided by five and multiplied by three to determine whether the family met the program’s income threshold and to decide the amount of food aid it would receive. In this example, the monthly household income would be counted as $1,200, making the three children together eligible for about $365 a month in food stamps, or about $121 per child.
By contrast, if the parents were U.S. citizens, the five people in the household would be eligible for a total household benefit of about $425 a month, or about $85 per person.
SRS officials concluded that the potentially greater per-person benefit under the old “prorated” formula was unfair even though the total household benefit was less for the family headed by undocumented parents.
With the new policy, all household income is counted but only the number of citizens in the house is used to determine eligibility.
The change resulted in 1,042 children losing benefits in households with at least one undocumented parent, according to SRS.
Federal regulations do not allow illegal immigrants to apply for food stamps for themselves. They are, however, allowed to apply on behalf of their minor children, if the children were born in the United States. Citizenship is automatic for U.S.-born children regardless of the status of the parents.
SNAP, funded by the federal government but managed by states, is still commonly referred to as the “food stamp” program, even though beneficiaries now use a government-issued electronic swipe card to purchase groceries. About 141,000 households in Kansas receive SNAP benefits.
One of four states
Kansas is the fourth state to adopt the current eligibility requirements — Arizona, Utah and Nebraska are the others. The other 46 states use the eligibility formula previously used by Kansas, which changed its policy in October 2011.
"Why are only four states using this program?" asked Sen. Terrie Huntington, R-Fairway.
"I can't answer that," Schroeder said.
→ Continue reading, and view the document cited by Sen. Kelly, at khi.org/foodstamps.