CHAPTER
19
Options
for Funding Reform
According
to Bear Stearns investment broker Ron White, "Investment
in child abuse prevention and treatment provides government
and society with estimated rates of return that would make
a venture capitalist envious." As we have made clear in
this report, child abuse and neglect have a tremendous impact
on society, with victims of child abuse more likely to fail
at school, engage in criminal behavior later in life, and
costing taxpayers millions of dollars in treatment for mental
illness, physical and emotional disabilities and alcohol
and drug addictions.
Massachusetts
is currently enjoying an almost unprecedented period of
economic prosperity. This is an ideal time to consider what
the public sector's role must be in supporting child abuse
prevention efforts and treatment for abuse and neglect victims.
To date,
sufficient funds have not been allocated to prevent the
abuse and neglect of our nation's children, a public health
crisis of significant proportions. While for every death
attributed to cancer, America spends $794 in prevention,
intervention, and research; for heart disease, $440; and
for AIDS, $697, for every death attributed to violence,
we spend a mere $31.[291]
Adequate
resources exist in Massachusetts to address the child abuse
crisis in our state. The following funding streams have
been identified and should be explored further as possible
sources to implement recommendations of the State Call
To Action recommendations.
Potential
Funding Sources
Crime Victim Compensation Fund
The
Victim Compensation Fund has applicability to minors who
are victims of abuse, and victim witnesses to violence.
Currently victims of crime are entitled to receive up
to $25,000 from the Victim Compensation Fund in order
to pay for their medical or psychological treatment. The
fund can be used as a last resort when insurance or Medicaid
benefits have been depleted and ongoing treatment is needed.
Children who witness violence can make a claim through
their protective parent or guardian and receive a portion
of the award. Historically, the fund has not been tapped
to support multidisciplinary assessments of abused and
neglected children, but proposed federal regulations relating
to victim compensation funds provide for this coverage.
The Massachusetts Attorney General's Office has expressed
interest in drafting legislation to amend the current
state statute and regulations in order to expand coverage
for multidisciplinary assessments.
Distinct Entitlement for Traumatized Children
Massachusetts
is currently experiencing a crisis in child psychiatric
services. Traumatized children receiving Medicaid coverage
have a need for services that far exceeds the needs
of other children receiving Temporary Assistance for
Needy Families (TANF) aide. A separate entitlement for
traumatized children through a higher capitation rate
for these children is necessary. This capitation rate
could be used to carve out services for this special
group when negotiating contracts with service providers.
This would vastly increase the funding pool for this
high-risk population.
Expanded Medicaid Coding
Medicaid
codes currently do not provide for the billing and payment
of coordination and collaboration among professionals
that are so crucial to multidisciplinary assessments.
Adding new codes to pay for these services can be done
with operational ease, and does not require time-consuming
legislation.
Private Insurance Carriers
Mental
health insurance parity legislation has recently passed
in Massachusetts. The law provides full mental health
insurance benefits for children (and adults) who have
biologically-based brain disorders, such as mental illness
and bipolar disorders. The law also provides that insurers
provide a minimum of 60 days of inpatient care and 24
outpatient visits for non-biologically based disorders,
such as adjustment disorders, which can be common among
abuse victims.
Blended Funding
Agencies
need to break down barriers so that a child can receive
what he or she needs without the constraint of internal
regulations that may prevent funding due to a technicality.
Interagency agreements to blend funding streams are
now crucial so that the impact of the money spent on
each child is maximized. For example, DSS, the Department
of Medical Assistance, and the Massachusetts Behavioral
Health Partnerships have jointly created transitional
care units at the Franciscan and MacLean Hospitals.
These supervised residences serve children and adolescents
who would otherwise have prolonged stays in the highly
restrictive environment of a hospital ward.
Community Fundraising Initiatives
Many
child abuse prevention/treatment and family support
initiatives have been successfully supported through
the creativity and commitment of community non-profit
boards. Working with concerned citizens, businesses,
churches, local foundations and other philanthropic
groups, they have complemented State and Federal funds.
The Children's Advocacy Center of Barnstable County,
for example, serves child victims of sexual and physical
abuse and is located in a lovely home donated and furnished
by local merchants and residents. Board members from
the community meet to discuss fundraising and ways to
improve the experience of children at the Center.
In
Florida, local Child Protection Teams (CPTs) raise a
significant percentage of their annual budgets through
the efforts of their local communities. This represents
the best example of how state and local partnerships
can take joint responsibility for vulnerable children
and families.
Federal Funding
The
federal government has increasingly begun to recognize
the value of comprehensive prevention initiatives that
promote healthy development and reduce a variety of
social problems. Several initiatives, through an array
of Federal government programs, have allocated funds
to the states to encourage and support programming.
In March of 2000, the Child Abuse Prevention and Enforcement
(CAPE) Act was signed into law with an appropriation
for each of the states. In addition, many states use
their Temporary Assistance to Needy Families (TANF)
funds to support and expand community-based family support
programs. Currently, research is underway to determine
how these funds could be applied in Massachusetts to
support the recommendations.
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Section
VI: Taking Action:
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