The Answer. With regard to HHS financing of direct health care for AIDS patients, the Federal Medicaid and Medicare programs are involved in paying for AIDS treatment where the patients qualify based on need. Nationally, about 40% of all AIDS patients have their care paid for through Medicaid. estimated $870 million in total Federal Medicaid payments in 1991, plus the approximately $870 million in State matching funds, are expected to account for nearly 25% of total national AIDS medical costs. Many private insurers and all State Medicaid programs now include coverage for some HIV treatment drugs, such as AZT. New Jersey was also the first State to apply for and be granted a Medicaid Home and Community Based Waiver to allow reimbursement for home treatment services to beneficiaries with AIDS and AIDS-related complex. Under this waiver, which became effective March 1, 1987, New Jersey is allowed to provide case management, personal care, medical day care, narcotic and drug abuse treatment, private duty nursing care, and intensive foster care to these beneficiaries. Through this waiver, New Jersey expects to be able to treat qualifying AIDS patients more humanely and at less cost than would be the case under standard Medicaid coverage for institutional services. For the longer term, two principal efforts of HHS to address the high cost of AIDS care in States such as New Jersey are through research and prevention. Ultimately, finding treatments and vaccines against AIDS, and supporting information and education activities to prevent the spread of AIDS by changing high risk behaviors, will be the best defense against the high cost of AIDS care. In total, the Public Health Service (PHS) expects to spend almost $1.7 billion on AIDS/HIV research and prevention activities in 1991, an increase of $109 million, or +7%, over expected 1990 spending, and $395 million over 1989. AIDS/HIV prevention/education and surveillance projects supported by the Centers for Disease Control (CDC) in the State of New Jersey totaled about $8.2 million in 1989. This included, as examples, an AIDS education project with the Boys' and Girls' Club of Newark, which was provided about $109,000; a study with the City of Newark on the prevalence of tuberculosis among deceased intravenous drug users who were HIV-positive compared to those without HIV infection was funded for about $213,000; an AIDS prevention project with Planned Parenthood of Essex County was provided about $175,000; and information/ education projects with the Newark school system was provided about $180,000. SUBCOMMITTEE RECESS Senator HARKIN. Thank you very much. The subcommittee will stand in recess until 1:15 p.m. At that time we will hear from the Family Support Administration, the Office of Human Development Services, the HHS Inspector General, the Health Care Financing Administration, and the Social Security Administration. [Whereupon, at 12:30 p.m., Wednesday, February 7, the subcommittee was recessed, to reconvene at 1:15 p.m., the same day.] (AFTERNOON SESSION, 1:18 P.M., WEDNESDAY, FEBRUARY 7, 1990) DEPARTMENT OF HEALTH AND HUMAN SERVICES FAMILY SUPPORT ADMINISTRATION STATEMENT OF EUNICE S. THOMAS, ACTING ASSISTANT SECRETARY ACCOMPANIED BY MICHAEL L. STURMAN, ASSOCIATE ADMINISTRATOR FOR FINANCIAL MANAGEMENT OFFICE OF HUMAN DEVELOPMENT SERVICES STATEMENT OF MARY SHEILA GALL, ASSISTANT SECRETARY ACCOMPANIED BY ROBERT STOVENOUR, DIRECTOR, OFFICE OF MANAGEMENT SERVICES OPENING REMARKS Senator HARKIN. The subcommittee will come to order. We will start where we left off and do the Family Support Administration, followed by the Office of Human Development Services and then the HHS Inspector General. We will then proceed to the Health Care Financing Administration and the Social Security Administration. We have a lot of ground to cover this afternoon. So, I hope we can all be brief and to the point. I would ask that the statements not be read but summarized and that two or three or four points be made, whatever you think is most important for us to consider. We will hear testimony first from Eunice Thomas, Acting Assistant Secretary of the Family Support Administration, and then next we will hear from Mary Gall, Assistant Secretary for Human Development Services. Welcome both. Your statements will be made a part of the record in their entirety. And I ask you to please proceed, Eunice. SUMMARY STATEMENT MS. THOMAS. Thank you, Mr. Chairman. Mr. Chairman and members of the committee, I am pleased to be here today to talk about the fiscal year 1991 Family Support Administration [FSA] budget. I would like to summarize briefly the priorities of the Family Support Administration's budget and President Bush's budget. These include continuing to maintain support for the Aid to Families with Dependent Children [AFDC] and Child Support Enforcement [CSE] Programs, and implementation of the welfare reform provisions included in the Family Support Act of 1988. We continue to emphasize the protection of those most in need as a priority. Under the AFDC program, full funding will maintain benefits to approximately 3.9 million families. At the same time, our investment of $1.2 billion in child support enforcement will lead to $6.8 billion of collections from absent parents, an increase from estimated 1990 collections of over $900 million. More than $2 billion will be collected on behalf of AFDC families, thereby providing needy families with greater economic self-sufficiency and lowering the amount of Federal and State funds needed to meet the cost of providing assistance. Implementation of the Family Support Act of 1988 continues to be one of our highest priorities. By October 1, 1990, all States are required to make the transition to the new education, employment, and training program for welfare recipients. This program includes reimbursement for child care and other work-related expenses, as well as extended child care and Medicaid benefits when an individual leaves the AFDC roles due to work; 27 States already have their programs in place. We are requesting the full $1 billion program authorization for fiscal year 1991. A key element for effective implementation of this legislation is a close working relationship with the Departments of Labor and Education. In this context, I am pleased to tell you that in November 1989 a 3-year technical assistance effort to assist States and Indian tribes was jointly announced by the three Departmental Secretaries. We will urge similar coordination at State and local levels to prevent duplication and maximize the use of available re sources. Finally, we have proposed funding levels for our programs that reflect Gramm-Rudman-Hollings objectives while pursuing our overall domestic spending priorities. PREPARED STATEMENT In closing, let me say that this budget reflects our commitment to supporting America's families through vigorous implementation of the Family Support Act, as well as aggressive enforcement of parental responsibilities for their children's economic well-being. We believe we have struck a balance between prudently managing our scare resources and identifying opportunities for reducing Federal spending. Senator HARKIN. Thank you very much, Ms. Thomas. [The statement follows:] STATEMENT OF EUNICE S. THOMAS I am pleased to be here today to talk about the fiscal year 1991 Family Support Administration (FSA) budget. I would like to summarize the FSA priorities which are presented in President Bush's budget. support for the Aid to Families with Dependent Children (AFDC) and Child Support Enforcement (CSE) programs, and implementation of the welfare reform provisions included in the Family Support Act of 1988. At Our request is designed to protect those in need. dependency, and offsets part of the cost of public assistance. То Implementation of the Family Support Act of 1988 |