Mid-Session Report: House Passes Bills to Protect Students and Reform Welfare

This week marks the halfway point of the Missouri General Assembly’s very productive 2015 legislative session. Already the House has passed legislation to protect Missouri students, help low-income individuals find employment, spur job creation, and reform our state’s healthcare system.

The anti-bullying legislation I sponsored, House Bill 458, passed the House of Representatives by a bipartisan vote of 121 to 33. Too many young people in our state are victims of bullying at school or online. Such harassment can lead to poor grades, depression, and even suicide. We can and must do more to protect our children. HB 458 would define cyberbullying in law; prohibit bullying on school property, at school functions, or on school buses; and require school districts to implement more comprehensive anti-bullying policies. Schools’ policies would require staff to report bullying, define a range of responses to bullying, and outline a process for training employees and volunteers.

Speaking on HB 458 on the House floor.

I have filed similar legislation for the past three years, but these bills were stopped by a small group of legislators who wanted the bill to define select groups of students who would be protected from bullying. HB 458 requires every student to be treated equally because any child can be bullied and all of them are equally precious.

I also worked closely with several other Representatives on two welfare reform bills, House Bill 985 and Senate Bill 24, that will reduce wasteful spending and help low-income individuals find employment.

Too much of the money meant to help families get back on their feet goes instead to individuals who are not eligible for assistance. From 2010 to 2015, the federal government questioned millions of the Temporary Assistance for Needy Families (TANF) dollars spent by Missouri’s Department of Social Services (DSS), and our state faced a penalty after our food stamp error rate was more than double the national average in 2012. HB 985 would require DSS to contract with a third party to verify the eligibility of applicants and recipients based on their income and assets. The data verification service would also check for participants who have died, moved out of state, or are incarcerated.

The only real solution to poverty is to help individuals find gainful work and become self-sufficient. Senate Bill 24 would restructure Missouri’s welfare system by prioritizing permanent employment and personal responsibility rather than perpetual dependence on government assistance. Any ongoing savings from these reforms would be reinvested in child care, education, job training, and transportation assistance for low-income families. Rather than cutting welfare, SB 24 refocuses spending on the services that will help Missouri families permanently move out of poverty.

TANF recipients are currently supposed to complete work activities, but in 2009 Missouri’s TANF work participation rate was only 13.2%. Under SB 24, most able-bodied adults would have to complete work activities before becoming eligible for TANF. These activities could include unsubsidized employment, job search and readiness training, or community service, which will help individuals develop skills to find permanent jobs. If they fail to complete the necessary work activities, they would meet face-to-face with a DSS caseworker and have six weeks to comply. If not, their benefits would be reduced by 50% for up to 10 weeks. Further refusal to work, volunteer, or participate in job training would result in their case being closed. SB 24 would also restore work requirements for individuals receiving food stamps. Missouri currently has a waiver exempting individuals from the work requirements found in federal law.

SB 24 sets aside TANF funding for healthy marriage promotion, activities encouraging responsible fatherhood, and alternatives to abortion services. To further support families, income from a recipient’s new spouse would not be counted toward their eligibility limit for the first six months of their marriage.

The bill as passed by the House would also cap TANF eligibility at 30 months instead of five years. TANF is supposed to be temporary help for families going through a rough patch, not a long-term welfare trap. A lower eligibility cap will encourage individuals to find employment and free up state resources for those who are truly in need. The version passed by the Senate capped eligibility at 48 months, so the final number will be hammered out in conference committee.

Other bills passed by the House of Representatives include:

Pay Increase Rejection (HCR 4 – Rep. Jay Barnes) – One of the House’s first actions this session was to reject a proposed pay increase for elected officials.

Voter ID Legislation (HJR 1 and HB 30 – Rep. Tony Dugger) – Upon voter approval, these bills would require voters to show photo identification at the polls to preserve the integrity of our elections.

Big Government Get off My Back Act (HB 32 – Rep. Denny Hoskins) – Extends a tax relief program that has helped nearly 200 small businesses. It has a proven record of success and is responsible for hundreds of good-paying jobs.

Education Reform (HB 42 – Rep. David Wood) – Addresses the school transfer issue to give the 62,000 children in failing schools an opportunity to receive a world-class education. This bill would allow students in failing schools to move to better-performing schools in their district, attend a charter school, or take advantage of a virtual school option.

Worker Freedom Legislation (HB 116 – Rep. Eric Burlison) – Gives workers the freedom to choose whether or not to join a union. This is the first time a Chamber of the General Assembly has passed a Right-to-Work bill and sent it to the other side of the building.

Medical Malpractice Reform (HB 118 – Rep. Burlison) – Would tame skyrocketing healthcare costs and keep doctors in our state by restoring reasonable limits ($350,000) on medical malpractice non-economic damages.

Unemployment Reform (HB 150 – Rep. Scott Fitzpatrick) – Ties unemployment benefits to the unemployment rate and requires the unemployment fund to have more cash on hand. This will ensure that Missourians have access to unemployment benefits while protecting Missouri’s job creators from excessive taxes and fees.

Prosecuting Sex Trafficking Advertisers (HB 152 – Rep. Elijah Haahr) – Strengthens Missouri’s child sex trafficking laws by making it a crime to knowingly advertise a trafficking victim. Under this legislation, someone advertising a young child for commercial sex could face life in prison.

Safety Standards for Clinics (HB 190 – Rep. Kathy Swan) – Protects women from subpar medical care by requiring ambulatory surgical centers that perform abortions to be inspected annually.

Dairy Revitalization Act (HB 259 – Rep. Bill Reiboldt) – In the past decade 2,500 dairy farms in our state have closed their doors. This bill seeks to revitalize Missouri’s struggling dairy industry. It includes a premium assistance program to provide financial protection to dairy farmers when times get tough and a scholarship program to encourage young people to pursue agricultural careers.

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Medicaid Backlog Harms Vulnerable Missourians

For almost a year, vulnerable Missourians applying for Medicaid have faced application backlogs, lost materials, and call center hold times as long as thirty minutes. The Department of Social Services (DSS) has long acknowledged that this is unacceptable but was very slow to implement meaningful solutions. The Appropriations – Health, Mental Health, and Social Services committee held an oversight hearing on October 20 to gauge the department’s progress.

In early 2014 the number of pending Medicaid applications neared 50,000, and this backlog has resulted in excessively long processing times. A seventy-year-old woman waited three months for DSS to fix an error that caused her grandchildren’s benefits to be denied, and another grandmother spent six months trying to enroll her grandson. Pregnant women’s applications are supposed to be processed in fifteen days, but one Mid-Missouri woman battled the system for four months before receiving help. Such lengthy delays in prenatal care coverage endanger mothers and their unborn children.

DSS offices have repeatedly lost application materials, and the call center, which is managed by a private company, had average wait times almost triple the contractual limit. Since the department is struggling to keep up with the current caseload, it would be foolish to add hundreds of thousands of able-bodied adults to the Medicaid rolls through expansion.

Unfortunately, the slow and ineffective response from DSS is indicative of the continued inefficiency and lack of responsibility we have seen in the department for years. The call center did not meet the mandatory hold time from February to September 2014, but DSS waited until August to request a corrective action plan. DSS assigned a staff team to return consumer’s calls, but its success rate is only 30%.  Officials told the committee that we would see improvements by mid-December, and we will hold them accountable for meeting this deadline.

The committee also discussed crisis intervention services with the Department of Mental Health. Too many Missourians with mental illness lack consistent services and only enter treatment after committing minor crimes. Last year the legislature funded Community Mental Health Liaisons to help people obtain services, mental health training for police officers, and ER enhancements to better handle psychiatric emergencies. While these programs are extremely beneficial, the legislature must now concentrate on helping individuals before they reach a crisis state.

Department of Health and Senior Services officials testified on the department’s plan to protect Missourians from an Ebola outbreak. Missouri’s public health lab has been designated an Ebola testing lab, and the Governor released over $3 million that the legislature had appropriated for public health. These actions may not be enough to keep Missourians safe, and I was unimpressed by the department’s lack of a comprehensive strategy.

The next legislative session will convene in January, and the committee will continue overseeing departments and requesting performance measures while drafting their fiscal year 2016 budgets. Such oversight is critical because the House plans to delve into how well programs serve Missourians when allocating the state’s limited resources.

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Day Care Received State Funds While Closed for Violations

A day care shuttered by the City of St. Louis for building code violations continued to receive subsidies from Missouri’s Department of Social Services (DSS) while it was banned from caring for children. DSS’ failure to end these payments calls into question the department’s ability to protect taxpayer funds from waste and fraud in the child care subsidy program, which is meant to help low-income families afford day care services.

Kidz in Action day care received over $56,000 in tuition subsidies from June to August 2013, despite the fact that St. Louis City had closed the center for 10 weeks during this time. The facility was not open at all in July, but it reported caring for 70 children and received over $22,000 from the state. DSS did not revoke Kidz in Action’s contract until July 2014, and as of September 21, the center was still operating pending an appeal.

It is unclear whether or not the state will ever be able to recoup all of the improper payments. Kids in Action also claimed child care subsidies for 10 days when its power was shut off and billed the state for food while the center was banned from serving meals.

DSS’ “pay and chase” system of letting waste occur and then trying to collect misused money is inefficient and rarely effective. Rather than using more state resources to recoup improper payments, state agencies should to take responsibility for preventing abuse and fraud.

At the September 29 joint Budget and Appropriations – Health, Mental Health, and Social Services oversight hearing, the committees questioned DSS and the Department of Health and Senior Services (DHSS), which inspects day cares, about the inappropriate payments to Kidz in Action. DSS told the committee that its policy had been to not revoke a child care center’s contract or end payments until it received notice from DHSS.

To avoid such long delays in the future, the two departments have agreed to increase collaboration. DSS will now be notified when DHSS suspends a provider, puts them on probation, or is in the process of revoking their license. DSS will be able to evaluate the situation and determine more quickly whether or not to end payments. The department has also asked to be notified whenever St. Louis City takes action against a day care facility. In order to help prevent future child care fraud, DSS is considering implementing an electronic time and attendance system to track how many children are actually cared for at a facility.

These policies are steps in the right direction, but DSS is still reactively solving problems instead of proactively bettering its programs. The legislature has seen too many instances in which DSS and other departments only institute solutions after being questioned about an issue by the press or a committee. In the future, departments should not wait for a scandal to break in the news or in a hearing before implementing procedures to protect taxpayer funds. State agencies are responsible for efficiently allocating their budgets, and they should constantly work to improve their operations so the state can avoid, and not just patch up, incidents of wasteful spending.

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Nixon Administration Fails to Pay Medicaid Providers Lawful Rates

Governor Nixon’s Division of Budget and Planning has refused to pay Medicaid providers of complex rehabilitation equipment at the rates approved in the fiscal year 2015 budget. Their decision to reinterpret a bill approved by the General Assembly and Governor sets a dangerous precedent of administrative overreach.

Complex rehabilitation technology is equipment that has been modified to suit a person’s unique needs, such as specialized wheelchairs. Providing individualized equipment to Medicaid patients is labor-intensive work, so the legislature increased the payment rates to properly compensate providers for their work.

The Governor vetoed the $500,000 increase for this program as part of the $1.1 billion he restricted from the fiscal year 2015 budget. Yet because he approved the language modifying rates for complex rehabilitation providers, this part of the bill became law.

Even though the new rates were approved by both Chambers of the General Assembly and the Governor, Budget and Planning instructed Missouri’s Medicaid system, Mo HealthNet, not to honor the increased rates. Mo HealthNet was told that the intent of the partial veto was to continue paying the fiscal year 2014 rates for complex rehabilitation technologies.

Once a bill has gone through the legislative process, the bureaucracy should not reinterpret the statute to suit its needs. The role of executive agencies is to carry out laws as they are written, not to pick and choose which sections they want to follow.

At the August 26 joint Budget and Appropriations – Health, Mental Health, and Social Services oversight hearing, the committees heard testimony from the director of Mo HealthNet and two medical equipment providers affected by the decision to ignore the increased rates. After the hearing, I met with the Mo HealthNet director and House budget staff to further discuss this issue.

While I am not sure what the outcome will be, House committees will continue to oversee the Division of Budget and Planning’s role in the budget process. Willfully ignoring a section of statute is a serious breach of public trust, and the administration ought to be held accountable for this decision.

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Feds Place Unaccompanied Minors in Missouri

The influx of undocumented immigrant minors from Mexico and Central America has created a crisis along our nation’s border that is now impacting our state as well. In July, the federal Department of Health and Human Services (HHS), without coordinating with the legislature, announced that it placed 121 unaccompanied children with sponsors in Missouri.

The Missouri Department of Social Services (DSS) and Department of Health and Senior Services (DHSS) told my office that no state funds are going toward care for these children. According to the departments, the federal government is placing children in Missouri without consulting or being held accountable to any state agency. In fact, the information DSS provided on the children in Missouri came from HHS’ public website.

If federal courts mandate that these immigrant children be placed in foster care, the state must accept them. When a House committee asked Attorney General Chris Koster’s office how they planned to address this issue, the Attorney General’s representative said he had no information to provide. This greatly concerned the committee, and we expect follow-up answers shortly.

On August 26 and 27 the Budget and Appropriations – Health, Mental Health, and Social Services committees will hold joint transparency and oversight hearings. We are requesting that DSS, DHSS, and the Attorney General’s office testify about Missouri’s role in caring for these unaccompanied children.

As the situation at the border continues to unfold, we will press departments for answers so Missourians can understand how this crisis is affecting our state. Even when a decision comes from the federal government, it is still the state’s responsibility to seek accountability and do everything possible to protect the interests of Missourians.

In an effort to minimize office expenses, I use the free version of WordPress.com to blog. Unfortunately, this means my office has no control over the content or placement of ads on this site. Thank you for understanding.

Amid Shrinking State Revenues, House Seeks Transparency

Missouri’s general revenue fund ended fiscal year (FY) 2014 down over $70 million from the previous year. With funding levels low, it is critical that the legislature diligently oversee how taxpayer resources are spent. Last week the Budget and Appropriations – Health, Mental Health, and Social Services committees met for a joint transparency hearing to hold departments accountable for efficiently using their budgets to benefit the people of our state.

Rep. Allen at the Budget/ Appropriations hearing.

The budget shortfall led Governor Nixon to withhold or veto over $1.1 billion from the fiscal year 2015 budget, but the House of Representatives discovered that funds from the Department of Social Services’ (DSS) Children’s Division were used to pay dues to the National Governor’s Association. The needs of vulnerable children in Missouri are great, and money set aside for the Children’s Division should not be diverted for organizational memberships.

House appropriations staff compiled a 27-page spreadsheet of the organizational dues in Missouri’s budget. Departments need to reveal these expenditures and explain why they are needed, especially during budget shortfalls. The Governor’s Budget Director, Linda Luebbering, agreed at the hearing that when departments submit next year’s budget requests, the larger dues will be presented as separate line items to provide transparency.

The committees also questioned Luebbering about the discrepancy between the Missouri Lottery’s profits and the money it allocates to schools. During FY 2014 the Missouri Lottery had a record year, bringing in nearly $1.16 billion. The amount going to education, however, declined to only $267 million. The Governor’s office has ordered a review of the lottery to determine what changes need to be made to ensure a steady funding stream for Missouri’s schools.  The Budget committee will discuss the results of the study at a future hearing.

During the public testimony period, citizens and organizations from across the state had an opportunity to comment on state spending. Several individuals voiced concerns about the Governor and Department of Mental Health’s (DMH) decision to close Cottonwood Treatment Center, which serves young people with severe emotional disturbances, as part of the budget restrictions. DMH officials testified that closing Cottonwood was not an easy decision, but that it was necessary because the center does not run at capacity and operates at a steep financial loss. The legislature will continue to monitor this situation because it is essential that children in Southeast Missouri receive appropriate care after Cottonwood closes.

The Spending Oversight Council, a group of citizens dedicated to reviewing government spending, cited instances of improper expenditures by state and federal programs and suggested linking future funding to measureable outcomes. The Appropriations – Health, Mental Health, and Social Services committee that I chair consistently requests performance data to determine whether or not programs are producing a return on the state’s investment.

The Budget and Appropriations – Health, Mental Health, and Social Services committees will have their next oversight and transparency hearings in late August. By holding departments accountable and requiring government programs to prove their value to the state, the House will have the information needed to responsibly allocate Missouri’s revenue during next year’s budget cycle.

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Committee Evaluates Departments’ Performances

The 2014 legislative session came to a close last month, but the Appropriations – Health, Mental Health and Social Services committee will continue overseeing departments’ spending to determine whether or not they are delivering measurable, positive outcomes for Missourians.

Our June 9 hearing opened with a period of public testimony. These hearings are excellent opportunities for individuals and organizations to share their concerns about state programs.

The public testimony centered on the dental services that the legislature reinstated for adult Medicaid recipients in the 2015 budget. Poor oral health is linked to a variety of serious health conditions, and when individuals lack preventative care they often seek relief in the emergency department, which is both expensive and ineffective. Offering adults access to basic oral healthcare will improve wellness while saving the state money by averting ER visits.

It appears likely that Governor Nixon will withhold funds from the budget passed by the General Assembly. These dental benefits, however, are too essential to scale back. I encouraged everyone at the hearing to convey to the Governor that he needs to protect funding for dental coverage since this program will produce a significant return on the state’s investment. In fact, a portion of the budget for adult dental care came from the savings that this reform will generate

Recent audits have demonstrated a pattern of inefficiency in the Department of Social Services (DSS), and the committee has been continually concerned by the department’s lack of performance measures to indicate how successfully its programs operate.

Temporary Assistance for Needy Families (TANF) and the Child Care Development Fund, which subsidizes child care, are the two largest federal block grants administered by DSS. Both have been plagued by poor performance and a lack of compliance with federal regulations.

Many TANF recipients are supposed to take part in work activities in order to receive benefits. DSS failed to meet the federal government’s work participation standards in 2011, so our state could face an $8.5 million penalty. DSS fell short of these standards in 2008 and 2009, and department officials told the committee that our state can expect another penalty when the 2012 data is assessed.

From 2008 to 2012 Missouri’s food stamp error rate was higher than the national average, reaching 7.18% in 2012. During oversight hearings last summer, my interim committee expected DSS to define the steps it would take to rectify this pattern of inaccuracy. Thankfully, the Family Support Division (FSD) in DSS has managed to improve the error rate to the point that Missouri may be eligible for a high performance bonus. Expecting transparency and accountability from departments encourages improvement, and the appropriations committee will follow up on this issue to ensure that Missouri’s food stamp program remains on track.

During the hearing, it became clear that departments often renew federal grants and waivers without any real input from the General Assembly. In the future, legislators need to be made aware of programs that are set to expire so we can have a frank discussion about their value before deciding whether or not our state should continue to participate. Missourians do not want their money blindly thrown after initiatives simply because the federal government makes them available.

Departmental oversight must be a year-round process to promote transparency and gain real insights into how well departments are operating. My appropriations committee will have monthly meetings to continue delving into departments’ performances and spending. Our hearings will begin with an opportunity for public testimony, and if you are interested in speaking, please email me at sue.allen@house.mo.gov.

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Promoting the Health of Missouri Families

Families are our state’s most precious resource and the fundamental building blocks of our communities, state, and nation. The Missouri House recently considered several pieces of legislation to strengthen families and protect the health of all their members, from parents to unborn children.

To provide women in our state with adequate information on their risk for breast cancer, I sponsored House Bill 1510, which was voted out of the House by an overwhelming vote of 146 to 6. In the United States, one woman is diagnosed with breast cancer every three minutes, and a woman dies from this disease every thirteen minutes. Unfortunately, mammograms, which are meant to detect breast cancer, may not be a sufficient screening tool for the 40% of women in the US with dense breast tissue.

HB 1510 requires mammography facilities to provide patients with a notice stating that if they have dense breast tissue and other risk factors for breast cancer, they may benefit from supplemental screenings. The bill does not mandate additional tests but ensures that women have the information they need to make the best possible decisions about their health.

Women should not be pressured into making ill-informed or hasty decisions about any procedure, especially not one as life-altering as an abortion. Representatives Kevin Elmer (R-Nixa) and Keith Frederick (R-Rolla) sponsored HBs 1307 & 1313 to extend the waiting period for an abortion from 24 hours to 72 hours. This bill is designed to give women adequate time to consider the consequences of an abortion and the other options available to them and their child. HBs 1307 & 1313 needs one more favorable vote in the House before moving to the Senate for consideration.

Currently, before a minor can undergo an abortion, both the girl and one of her parents or guardians must provide their written consent. Representative Rocky Miller’s (R-Tuscumbia) HB 1192 would require the consenting adult to inform any other custodial parents or guardians at least five days prior to the abortion being performed. Input from both parents could help minors make better-informed decisions, and all parents ought to be aware if their child is undergoing such a traumatic procedure.

The Missouri Department of Social Services (DSS) is also charged with protecting families, and its most important function is protecting and finding a safe residence for children that must be removed from their homes. Caseworkers are currently required to complete investigations within 30 days, but DSS staff members have raised concerns that they need additional time to finish them.

The House passed HB 1092, sponsored by Representative Bill Lant (R-Pineville), which would change the timeframe to 30 business days, by a vote of 151 to 1. This legislation would only apply to actions that occur after the child is removed from their home, so emergency removals would not be delayed. By giving caseworkers adequate time to perform thorough and effective investigations, they will be able to produce the best outcomes for children in need. Our Appropriations – Health, Mental Health, and Social Services Committee also recommended allocating additional resources to the Children’s Division to better serve foster children.

Your Republican-led legislature will continue crafting legislation to improve the health and wellbeing of Missouri families, not through intrusive government mandates, but through smart policies that emphasize transparency, quality services, and personal choice.

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Funding Improvements to Missouri’s Children’s Division

The Appropriations – Health, Mental Health, and Social Services Committee held two hearings this week to hear funding requests from the Department of Health and Senior Services (DHSS) and the Department of Social Services (DSS).

DSS’s Children’s Division, which is responsible for investigating claims of child abuse and caring for foster children, is plagued by a high staff turnover rate, which inhibits the division’s ability to protect Missouri’s children.

To recruit and maintain high-quality workers, DSS requested funding for computer and software updates to allow staff to access files on the go, a loan forgiveness program to encourage college graduates to remain at DSS, and advanced training to better prepare staff. This would include Forensic Training for all staff involved in investigations and Secondary Trauma training for all Children’s Division workers to help them cope with the difficult situations they encounter on the job.

The division’s Career Ladder initiative would allow for more internal promotion within the Children’s Division based on skill and tenure. Hopefully, the opportunity for advancement and recognition will encourage the most experienced and talented workers to remain with the department.

There is sufficient support in the Appropriations Committee to work with DSS to secure the funding for these changes. Children in Missouri deserve to be protected and cared for by qualified and experienced staff able to accurately assess their safety and make difficult decisions when necessary.

The committee also delved into departments’ core budgets and their new decision items from previous years to determine how well the money was used. If these programs have not served their purposes, improved wellness, or encouraged positive behavioral changes, the legislature should not continue spending taxpayer money on these initiatives.

Appropriations Committees have two more weeks to examine departments’ budget proposals and present their recommendations to the House Budget Committee.  Our committee will continue to set aside time for public testimony to hear citizens’ views on the budget process. Since time is limited, messages should be no longer than five minutes, but additional written materials are encouraged. Please email me at sue.allen@house.mo.gov if you are interested in speaking.

In an effort to minimize office expenses, I use the free version of WordPress.com to blog. Unfortunately, this means my office has no control over the content or placement of ads on this site. Thank you for understanding.

Improving Missouri’s Child Welfare Services

As part of his fiscal year 2015 budget proposal, Governor Jay Nixon is seeking a $6 million increase for the Department of Social Service’s (DSS) Children’s Division.

With this request for resources and with the Children’s Division under the leadership of Tim Decker, the new division director, I am hopeful and expecting to see evidence of positive changes for our state’s children in foster care.

The department should be held responsible for explaining where this money will come from and what the funding is meant to accomplish. If the funds are appropriated, DSS will need to prove to the legislature and the people of Missouri that it has put the money to good use.

Throughout the summer and fall, the Interim Committee on Improving Government Responsiveness and Efficiency heard testimony on several unfortunate incidents where children were harmed after their families were investigated by the Children’s Division.

Lucas Webb, a four year old from Holt, Missouri, died of blunt force trauma to his abdomen in 2012 only five days after Children’s Division workers declared him safe in his home, and a grandfather spoke to the committee about his struggle to have his grandchildren removed from an unsafe home.

The Children’s Division is responsible for protecting some of Missouri’s most vulnerable children, those in foster care or being removed from their homes, and must be held responsible for effectively implementing the procedures needed to keep them safe.

In an effort to minimize office expenses, I use the free version of WordPress.com to blog. Unfortunately, this means my office has no control over the content or placement of ads on this site. Thank you for understanding.