CRS Reports

The Pregnancy Assistance Fund: An Overview

The Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended) established the Pregnancy Assistance Fund (PAF) to assist vulnerable individuals and their families during the transition to parenthood. Specifically, the program serves expectant and parenting teens, women, fathers, and their families. This includes women of any age who are survivors of domestic violence, sexual violence, sexual assault, and stalking. The PAF program focuses on meeting the educational, social service, and health needs of eligible individuals and their children during pregnancy and the postnatal period. The research literature indicates that pregnancy has high costs for individuals eligible for the PAF program. Teenage mothers and fathers tend to have less education and are more likely to live in poverty than their peers who are not parenting. Nearly one-third of adolescent females who have dropped out of high school cite pregnancy or parenthood as a reason. Parenthood can also influence whether students pursue postsecondary education. One analysis found that single young women who had children after enrolling in community college were 65% more likely to drop out than their same-age peers who did not have children after enrolling. The research literature further indicates that approximately 3% to 9% of women experience domestic violence during pregnancy. Some studies indicate that this risk is greater among low-income women. The PAF program is administered by the Office of Adolescent Health (OAH) in the Department of Health and Human Services’ (HHS’) Office of the Assistant Secretary for Health (OASH). HHS distributes PAF funding on a competitive basis to the states, the District of Columbia, U.S. territories, and tribal entities. Through FY2018, HHS has awarded PAF funding to 30 states, the District of Columbia, and 5 tribal entities (“grantees”). These grantees can decide how to use funding under four purpose areas. Three of the purpose areas focus on providing services to the eligible expectant and parenting population through subgrants and partnerships. The fourth category focuses on public awareness about such services; however, HHS advises that grantees may not use funding solely for public awareness activities. In general, grantees have provided subgrants to school districts, community service organizations, and institutions of higher education (IHE) that directly serve the expectant and parenting population. Subgrantees have most frequently provided case management, referral services for other supports, group workshops on specific topics (e.g., pregnancy prevention), and home visiting services. The PAF statute and the program grant announcements include requirements for state grantees and subgrantees in carrying out activities under the program. The authorizing law requires each subgrantee to provide an annual report to the grantee about expenditures, fulfilling program requirements, and how it meets the needs of participants. Grantees must prepare an annual report to HHS on information provided by subgrantees, including participant data. In FY2016, grantees (17 states and 3 tribal entities) reported serving 16,053 individuals. Of these participants, 55% were expectant or parenting mothers, 37% were children, and 8% were expectant or parenting fathers. Most expectant or parenting participants were ages 16 through 19, and nearly half of all participants were white, about one-third were black, and the remaining share were another race or multiracial. About half of all participants were Hispanic. The ACA provides mandatory PAF funding of $25 million annually from FY2010 through FY2019. If Congress considers reauthorizing the program, it may look to emerging findings from a recent evaluation that may indicate the program is helping to keep pregnant and parenting students in the District of Columbia connected to their high schools. Among other topics, Congress may consider whether to establish guidelines regarding how the PAF program should interact with other, similar federal programs in the areas of education, health, and social services.

Dec 6, 2018

Defense Primer: Special Operations Forces

Dec 6, 2018

U.S. International Food Assistance: An Overview

The United States has played a leading role in global efforts to alleviate hunger and improve food security. U.S. international food assistance programs provide support through two distinct methods: (1) in-kind aid, which ships U.S. commodities to regions in need, and (2) cash-based assistance, which provides recipients with vouchers, direct cash transfers, or locally procured foods. The current suite of international food assistance programs began with the Food for Peace Act (P.L. 83-480), commonly referred to as “P.L. 480,” which established the Food for Peace program (FFP). Congress authorizes most food assistance programs in periodic farm bills. However, Congress authorized the Emergency Food Security Program (EFSP)—a newer, cash-based food assistance program—in the Global Food Security Act of 2016 (P.L. 114-195). Congress funds international food assistance programs through annual agriculture appropriations and state and foreign operations (SFOPS) appropriations bills. Since 2007, annual international food assistance outlays averaged $2.6 billion. In FY2016, FFP Title II and EFSP accounted for 87% of total international food assistance outlays. The U.S. Agency for International Development (USAID) and the U.S. Department of Agriculture (USDA) administer U.S. international food assistance programs. Historically, the United States provided international food assistance exclusively through in-kind aid. Since the mid-1980s, FFP Title II, which provides in-kind donations, has been the dominant U.S. food aid program. (The name “FFP Title II” refers to Title II of the Food for Peace Act, in which Congress first authorized the program.) In the late 2000s, U.S. international food assistance began to shift toward a combination of in-kind and cash-based assistance. This is largely due to the Obama Administration creating the cash-based EFSP in 2010 to complement FFP Title II emergency aid. EFSP is used in conditions when in-kind aid cannot arrive soon enough or could potentially disrupt local markets or when it is unsafe to operate in conflict zones. Despite the growth in cash-based assistance, U.S. international food assistance still relies predominantly on in-kind aid. Many other countries with international food assistance programs have converted primarily to cash-based assistance. U.S. reliance on in-kind aid has become controversial due to its potential to disrupt local markets and cost more than procuring food locally. At the same time, lack of reliable suppliers and poor infrastructure in recipient countries may limit the efficacy and efficiency of cash-based assistance. Also, in poorly controlled settings, cash transfers or food vouchers could be stolen or used by recipients to purchase nonfood items. Agricultural cargo preference (ACP)—the requirement that 50% of all in-kind aid be shipped on U.S.-flag ships—has also become controversial due to findings that it can lead to higher transportation costs and longer delivery times. Higher costs may be partially due to higher wages and better working conditions on U.S.-flag vessels compared to foreign-flag vessels. ACP may also contribute to maintaining a U.S.-flag merchant marine to provide sealift capacity during wartime or national emergencies. The Trump Administration and certain Members of Congress have proposed changes to the structure and intent of international food assistance programs. Some Members of Congress proposed changes in the House and Senate 2018 farm bills (H.R. 2). These proposed changes include amending requirements for some international food assistance programs and expanding flexibility to use cash-based assistance. Other proposed legislation would address ACP, expand flexibility to use cash-based assistance, and consolidate and alter funding for most international food assistance programs.

Dec 6, 2018

Public Health and Other Related Provisions in P.L 115-271, the SUPPORT for Patients and Communities Act

On October 24, 2018, President Donald J. Trump signed into law H.R. 6, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (P.L. 115-271; the SUPPORT for Patients and Communities Act, or the SUPPORT Act). The SUPPORT Act is a sweeping measure designed to address widespread overprescribing and abuse of opioids in the United States. The act includes provisions involving law enforcement, public health, and health care financing and coverage. Broadly, the legislation imposes tighter oversight of opioid production and distribution; imposes additional reporting and safeguards to address fraud; and limits coverage of prescription opioids, while expanding coverage of and access to opioid addiction treatment services. The law also authorizes a number of programs that seek to expand consumer education on opioid use and train additional providers to treat individuals with opioid use disorders. The SUPPORT Act builds on recent efforts by the federal government to address the opioid epidemic, including the Comprehensive Addiction and Recovery Act of 2016 (CARA; P.L. 114-198) and the 21st Century Cures Act (Cures Act; P.L. 114-255). CARA addressed substance use issues broadly, targeting the opioid crisis predominantly through public health and law enforcement strategies. The Cures Act, enacted that same year, largely focused on medical innovation, but it also authorized additional funding to combat opioid addiction and included provisions addressing various mental health and substance use activities. CRS is publishing a series of reports on the SUPPORT Act, which consists of eight titles. This report summarizes the provisions in Title VII and VIII of the SUPPORT Act. Title VII, Public Health Provisions, includes a number of provisions that seek to improve the information collected about opioid abuse and increase access to treatment by supporting treatment programs and providers, among other things. Title VIII, Miscellaneous, includes, among others, provisions related to child welfare, the Department of Justice (DOJ), and drug testing required by the Department of Transportation (DOT). It also includes several revenue-related provisions and the budget effects of this act and also describes Section 4003, an offset included in Title IV related to individuals who seek a religious exemption from the requirement to maintain health insurance coverage.

Dec 3, 2018

Overview of the ACA Medicaid Expansion

Dec 3, 2018

Managed Trade and Quantitative Restrictions: Issues for Congress

Dec 3, 2018

Defense Primer: Planning, Programming, Budgeting, and Execution (PPBE) Process

Nov 30, 2018

World Trade Organization: Overview and Future Direction

Historically, the United States’ leadership of the global trading system has ensured the United States a seat at the table to shape the international trade agenda in ways that both advance and defend U.S. interests. The evolution of U.S. leadership and the global trade agenda remain of interest to Congress, which holds constitutional authority over foreign commerce and establishes trade negotiating objectives and principles through legislation. Congress has recognized the World Trade Organization (WTO) as the “foundation of the global trading system” within trade promotion authority (TPA) and plays a direct legislative and oversight role over WTO agreements. The statutory basis for U.S. WTO membership is the Uruguay Round Agreements Act (P.L. 103-465), and U.S. priorities and objectives for the General Agreement on Tariffs and Trade (GATT)/WTO have been reflected in various TPA legislation since 1974. Congress also has oversight of the U.S. Trade Representative and other agencies that participate in WTO meetings and enforce WTO commitments. The WTO is a 164-member international organization that was created to oversee and administer multilateral trade rules, serve as a forum for trade liberalization negotiations, and resolve trade disputes. The United States was a major force behind the establishment of the WTO in 1995, and the rules and agreements resulting from multilateral trade negotiations. The WTO encompassed and succeeded the GATT, established in 1947 among the United States and 22 other countries. Through the GATT and WTO, the United States, with other countries, sought to establish a more open, rules-based trading system in the postwar era, with the goal of fostering international economic cooperation and raising economic prosperity worldwide. Today, 98% of global trade is among WTO members. The WTO is a consensus and member-driven organization. Its core principles include nondiscrimination (most favored nation treatment and national treatment), freer trade, fair competition, transparency, and encouraging development. These are enshrined in a series of WTO trade agreements covering goods, agriculture, services, intellectual property rights, and trade facilitation, among other issues. Some countries, including China, have been motivated to join the WTO not just to expand access to foreign markets but to spur domestic economic reforms, help transition to market economies, and promote the rule of law. The WTO Dispute Settlement Understanding (DSU) provides an enforceable means for members to resolve disputes over WTO commitments and obligations. The WTO has processed more than 500 disputes, and the United States has been an active user of the dispute settlement system. Supporters of the multilateral trading system consider the dispute settlement mechanism an important success of the system. At the same time, some members, including the United States, contend it has procedural shortcomings and has exceeded its mandate in deciding cases. Many observers are concerned that the effectiveness of the WTO has diminished since the collapse of the Doha Round of multilateral trade negotiations, which began in 2001, and believe the WTO needs to adopt reforms to continue its role as the foundation of the global trading system. To date, WTO members have been unable to reach consensus for a new comprehensive multilateral agreement on trade liberalization and rules. While global supply chains and technology have transformed international trade and investment, global trade rules have not kept up with the pace of change. Many countries have turned to negotiating free trade agreements (FTAs) outside the WTO as well as plurilateral agreements involving subsets of WTO members rather than all members. At the latest WTO Ministerial conference in December 2017, no major deliverables were announced. Several members committed to make progress on ongoing talks, such as fisheries subsidies and e-commerce, while other areas remain stalled. While many were disappointed by the limited progress, in the U.S. view, the outcome signaled that “the impasse at the WTO was broken,” paving the way for groups of like-minded countries to pursue new work in other key areas. Certain WTO members have begun to explore aspects of reform and future negotiations. Potential reforms concern the administration of the organization, its procedures and practices, and attempts to address the inability of WTO members to conclude new agreements. Proposed DS reforms also attempt to improve the working of the dispute settlement system, particularly the Appellate Body—the seven-member body that reviews appeals by WTO members of a panel’s findings in a dispute case. Some U.S. frustrations with the WTO are not new and many are shared by other trading partners, such as the European Union. At the same time, the Administration’s overall approach has spurred new questions regarding the future of U.S. leadership and U.S. priorities for improving the multilateral trading system. Concerns have emphasized that the Administration’s recent actions to unilaterally raise tariffs under U.S. trade laws and to possibly impede the functioning of the dispute settlement system might undermine the credibility of the WTO system. A growing question of some observers is whether the WTO would flounder for lack of U.S. leadership, or whether other WTO members like the EU and China taking on larger roles would continue to make it a meaningful actor in the global trade environment. The growing debate over the role and future direction of the WTO may be of interest to Congress. Important issues it may address include how current and future WTO agreements affect the U.S. economy, the value of U.S. membership and leadership in the WTO, whether new U.S. negotiating objectives or oversight hearings are needed to address prospects for new WTO reforms and rulemaking, and the relevant authorities and impact of potential U.S. withdrawal from the WTO on U.S. economic and foreign policy interests.

Nov 29, 2018

Budgetary Decisionmaking in Congress

Nov 29, 2018

U.S. Sanctions on Russia

Sanctions are considered by many to be a central element of U.S. policy to counter Russian malign behavior. Most Russia-related sanctions have been in response to Russia’s 2014 invasion of Ukraine. In addition, the United States has imposed sanctions on Russia in response to human rights abuses, election interference and cyberattacks, weapons proliferation, illicit trade with North Korea, support to Syria, and use of a chemical weapon. The United States also employs sanctions to deter further objectionable activities. Most Members of Congress support a robust use of sanctions amid concerns about Russia’s international behavior and geostrategic intentions. Ukraine-related sanctions are mainly based on four executive orders (EOs) the President introduced in 2014. In addition, Congress passed and the President signed into law two acts establishing sanctions in response to Russia’s invasion of Ukraine: the Support for the Sovereignty, Integrity, Democracy, and Economic Stability of Ukraine Act of 2014 (SSIDES; P.L. 113-95) and the Ukraine Freedom Support Act of 2014 (UFSA; P.L. 113-272). In 2017, Congress passed and the President signed into law the Countering Russian Influence in Europe and Eurasia Act of 2017 (CRIEEA; P.L. 115-44, Countering America’s Adversaries Through Sanctions Act [CAATSA], Title II). This legislation codifies Ukraine-related and cyber-related EOs, strengthens existing Russia-related sanctions authorities, and identifies several new targets for sanctions. It also establishes congressional review of any action the President takes to ease or lift a variety of sanctions. Additional sanctions on Russia may be forthcoming. On August 6, 2018, the United States determined that in March 2018 the Russian government used a chemical weapon in the United Kingdom in contravention of international law. In response, the United States launched an initial round of sanctions on Russia, as required by the Chemical and Biological Weapons Control and Warfare Elimination Act of 1991 (CBW Act; P.L. 102-182, Title III). The law requires a second, more severe round of sanctions in the absence of Russia’s reliable commitment to no longer use such weapons. The United States has imposed most Ukraine-related sanctions on Russia in coordination with the European Union (EU). Since 2017, the efforts of Congress and the Trump Administration to tighten U.S. sanctions on Russia have prompted some degree of concern in the EU about U.S. commitment to sanctions coordination and U.S.-EU cooperation on Russia and Ukraine more broadly. The EU, in addition, continues to consider its response to Russia’s use of a chemical weapon in the United Kingdom. Debates about the effectiveness of U.S. and other sanctions on Russia continue in Congress, in the Administration, and among other stakeholders. Russia has not reversed its occupation and annexation of Ukraine’s Crimea region, nor has it stopped fostering separatism in eastern Ukraine. With respect to other malign activities, the relationship between sanctions and Russian behavior is difficult to determine. Nonetheless, many observers argue that sanctions help to restrain Russia or that their imposition is an appropriate foreign policy response regardless of immediate effect. In the 115th Congress, several bills have been introduced to increase the use of sanctions in response to Russia’s malign activities. The 116th Congress is likely to continue to debate the role of sanctions in U.S. foreign policy toward Russia.

Nov 28, 2018

Defense Primer: The Military Departments

Nov 28, 2018

U.S. Tariff Policy: Overview

Nov 28, 2018

Federal Pell Grant Program of the Higher Education Act: Primer

The federal Pell Grant program, authorized by Title IV of the Higher Education Act of 1965, as amended (HEA; P.L. 89-329), is the single largest source of federal grant aid supporting postsecondary education students. Pell Grants, and their predecessor, Basic Education Opportunity Grants, have been awarded since 1973. The program provided approximately $29 billion in aid to approximately 7.2 million undergraduate students in FY2017. Pell Grants are need-based aid that is intended to be the foundation for all need-based federal student aid awarded to undergraduates. To be eligible for a Pell Grant, an undergraduate student must meet several requirements. One key requirement is that the student and his or her family demonstrate financial need. Financial need is determined through the calculation of an expected family contribution (EFC), which is based on applicable family financial information provided on the Free Application for Federal Student Aid (FAFSA). Although there is no absolute income threshold that determines who is eligible or ineligible for Pell Grants, an estimated 95% of Pell Grant recipients had a total family income at or below $60,000 in academic year 2015-2016. Other requirements include, but are not limited to, the student not having earned a bachelor’s degree and being enrolled in an eligible program at an HEA Title IV-participating institution of higher education for the purpose of earning a certificate or degree. The maximum annual award a student may receive during an academic year is calculated in accordance with the Pell Grant award rules. The student’s scheduled award is the least of (1) the total maximum Pell Grant minus the student’s EFC, or (2) Cost of Attendance (COA) minus EFC. For a student who enrolls on a less-than-full-time basis, the student’s maximum annual award is the scheduled award ratably reduced. For FY2019 (academic year 2019-2020), the total maximum Pell Grant is $6,195. The COA is a measure of a student’s educational expenses for the academic year. Qualified students who exhaust their scheduled award and remain enrolled beyond the academic year (e.g., enroll in a summer semester) during an award year receive a year-round or summer Pell Grant. With year-round Pell Grants, qualified students may receive up to 1½ scheduled grants in each award year. Finally, a student may receive the value of no more than 12 full-time semesters (or the equivalent) of Pell Grant awards over a lifetime. The program is funded primarily through annual discretionary appropriations, although in recent years mandatory appropriations have played an increasing role in the program. The total maximum Pell Grant is the sum of two components: the discretionary maximum award and the mandatory add-on award. The discretionary maximum award amount is funded by discretionary appropriations enacted in annual appropriations acts, and augmented by permanent and definite mandatory appropriations provided for in the HEA. For FY2019, the discretionary appropriation is $22.475 billion and the augmenting mandatory funds total $1.370 billion. The mandatory add-on award amount is funded entirely by a permanent and indefinite mandatory appropriation of such sums as necessary, as authorized in the HEA. The mandatory add-on is estimated to require $6.077 billion in FY2019. Funding provided for the Pell Grant program is exempt from sequestration. The Pell Grant program is often referred to as a quasi-entitlement because for the most part eligible students receive the Pell Grant award level calculated for them without regard to available appropriations. In a given year, the discretionary appropriation level may be smaller or larger than the actual cost to fund the discretionary maximum award, despite the augmenting mandatory appropriation. When the discretionary appropriation is too small, the program carries a shortfall into the subsequent fiscal year. When the discretionary appropriation is too large, the program carries a surplus into the following fiscal year. Since FY2012, the program has maintained a surplus. The surplus has variably been used to increase Pell Grant awards, expand eligibility, and either fund other programs or reduce the national deficit.

Nov 28, 2018

Which Punishment Fits Which Crime?: Supreme Court to Consider Whether Portion of Supervised Release Statute is Unconstitutional

Nov 27, 2018

FY2018 and FY2019 Agriculture Appropriations: Federal Food Safety Activities

The Agriculture appropriations bill—formally known as the Agriculture, Rural Development, Food and Drug Administration, and Related Agencies Appropriations Act—funds the Food and Drug Administration (FDA) and the U.S. Department of Agriculture (USDA), excluding the U.S. Forest Service. Congress enacted the FY2018 agriculture appropriation in March 2018 as part of the Consolidated Appropriations Act, 2018 (P.L. 115-141, Division A). Both the House and the Senate Appropriations Committees have reported Agriculture appropriations bills for FY2019 (H.R. 5961, S. 2976). The Senate amended and passed its version as Division C of a four-bill minibus (H.R. 6147). Numerous federal, state, and local agencies share responsibilities for regulating the safety of the U.S. food supply. Federal responsibility for food safety rests primarily with FDA, an agency of the Department of Health and Human Services, and also the Food Safety and Inspection Service (FSIS), an agency of USDA. FDA is responsible for ensuring the safety of the majority of all domestic and imported food products—except for meat and poultry products, which are within USDA’s jurisdiction to oversee meat, poultry, and processed egg products. Appropriations for Federal Food Safety Activities, FY2009-FY2018 / Combined appropriations covering food safety activities at both FDA and USDA totaled nearly $2.1 billion in FY2018. Congressional appropriations at both FDA and USDA are augmented by existing (currently authorized) user fees. FDA user fees authorized by the FDA Food Safety Modernization Act (FSMA, P.L. 111-353) have generated between $10 million and $18 million annually in recent years. At FSIS, user fees have generated between $180 million and $250 million per year. At FDA, ongoing efforts to improve food safety include implementation of FSMA. FSMA was enacted by the 111th Congress and was the largest expansion of FDA's food safety authorities since the 1930s. Since FSMA became law in 2011, congressional appropriators have increased annual funding for the FDA Foods Program by $204.3 million—an increase of about 24% between FY2011 and FY2018—largely in an effort to support FDA’s implementation of FSMA. The enacted FY2018 appropriation for FDA’s Foods Program provided $1,041.6 million. Currently, FDA funding for its food safety oversight activities is roughly similar to those of FSIS (Figure 1). FDA's total budget for food safety programs and activities extends beyond the agency's Foods Program, encompassing other food and veterinary medicine programs at FDA. Food-safety-related activities at FSIS include continuous inspections at federal meat and poultry plants. The enacted FY2018 appropriation provided $1,056.8 million to carry out this function. Compared to FY2011—the year FSMA was enacted—annual congressional appropriations for FSIS have increased by $48.3 million (+5%). For FY2019, congressional appropriators would increase funding for federal food safety activities, whereas the Administration’s budget proposal would reduce food safety funding below FY2018 levels at both FDA and FSIS.

Nov 27, 2018

Medicaid Alternative Benefit Plan Coverage: Frequently Asked Questions

Medicaid is a federal-state program that finances the delivery of primary and acute medical services, as well as long-term services and supports, to a diverse low-income population, including children, pregnant women, adults, individuals with disabilities, and people aged 65 and older. Medicaid is financed jointly by the federal government and the states. Federal Medicaid spending is an entitlement, with total expenditures dependent on state policy decisions and use of services by enrollees. State participation in Medicaid is voluntary, although all states, the District of Columbia, and the territories choose to participate. States are responsible for administering their Medicaid programs. States must follow broad federal rules to receive federal matching funds, but they have flexibility to design their own versions of Medicaid within the federal statute’s basic framework. This flexibility results in variability across state Medicaid programs. Most Medicaid beneficiaries receive services in the form of what is sometimes called traditional Medicaid. However, states also may furnish Medicaid in the form of alternative benefit plans (ABPs). ABPs were first introduced in the Deficit Reduction Act of 2005 (DRA 2005; P.L. 109-171 P.L. 109-171) and are referred to in the Social Security Act (SSA) as benchmark or benchmark-equivalent coverage. In general, under traditional Medicaid benefit coverage, state Medicaid programs must cover specific required services listed in statute (e.g., inpatient and outpatient hospital services, physician’s services, or laboratory and x-ray services) and may elect to cover certain optional services (e.g., prescription drugs, case management, or physical therapy services). Under ABPs, by contrast, states may furnish a benefit that is defined by reference to an overall coverage benchmark that is based on one of three commercial insurance products (e.g., the commercial health maintenance organization (HMO) with the largest insured commercial, non-Medicaid enrollment in the state) or a fourth, “Secretary-approved” coverage option rather than a list of discrete items and services. The 33 states and District of Columbia that have implemented the state option to expand Medicaid to low-income adults under the Patient Protection and Affordable Care Act (ACA; P.L. 111-148, as amended) are required to cover the ACA Medicaid expansion population using ABPs, and states also may elect to require other Medicaid populations to receive care through ABPs. States cannot require certain vulnerable populations to obtain benefits through ABPs. ABPs must qualify as either benchmark, where the benefits are at least equal to one the statutorily specified benchmark plans, or benchmark-equivalent benefits, which means the benefits include certain specified services and the overall benefits are at least actuarially equivalent to one of the statutorily specified benchmark coverage packages. In addition, ABPs must include a variety of specific services, including services under Medicaid’s early and periodic screening, diagnostic, and testing (EPSDT) benefit and family planning services and supplies. Unlike traditional Medicaid benefit coverage, coverage under an ABP must include at least the essential health benefits (EHB) that most plans in the private health insurance market are required to furnish. States choose whether to furnish ABPs through managed care or a fee-for-service delivery system. The Medicaid limitations on beneficiary premiums and cost sharing apply to services furnished through ABPs. To date, states have chiefly used ABPs as the benefit package for the ACA Medicaid expansion population. However, several states have elected to use ABPs to serve other Medicaid populations (e.g., working individuals with disabilities or children and adults who do not have special health care needs). States can have more than one ABP coverage option to serve different target populations operating concurrently with traditional Medicaid benefit coverage. States have largely used the ABP design flexibility to align their benefit coverage with the traditional Medicaid benefit coverage.

Nov 26, 2018

Maternal, Infant, and Early Childhood Home Visiting Program

Nov 20, 2018

The Emergency Food Assistance Program (TEFAP): Background and Funding

The Emergency Food Assistance Program (TEFAP) is a federal food distribution program that supports food banks, food pantries, soup kitchens, and other emergency feeding organizations serving low-income Americans. Federal assistance takes the form of federally purchased commodities—including fruits, vegetables, meats, and grains—and funding for administrative costs. Food aid and funds are distributed to states using a statutory formula that takes into account poverty and unemployment rates. TEFAP is administered by the U.S. Department of Agriculture’s Food and Nutrition Service (USDA-FNS). TEFAP was established as the Temporary Emergency Food Assistance Program by the Emergency Food Assistance Act of 1983. The Emergency Food Assistance Act continues to govern program operations, while the Food and Nutrition Act provides mandatory funding authority for TEFAP commodities. Based on levels set in statute, appropriations provided $289.5 million in mandatory funding for TEFAP’s “entitlement” commodities in FY2018. TEFAP also incorporates “bonus” commodities, which are distributed at USDA’s discretion throughout the year to support different crops using separate budget authority. USDA purchased $268.6 million worth of bonus commodities for TEFAP in FY2017. A smaller amount of cash assistance ($64.4 million in FY2018) is appropriated to cover administrative and distribution costs under Emergency Food Assistance Act authority. These administrative funds are discretionary. USDA-FNS coordinates the purchasing of commodities and the allocation of commodities and administrative funds to states, and provides general program oversight. State agencies—often state departments of health and human services, agriculture, or education—determine program eligibility rules and allocations of aid to feeding organizations (called “recipient agencies”). States often task food banks, which operate regional warehouses, with distributing foods to other recipient agencies. TEFAP aid makes up a modest proportion of the food and funds available to emergency feeding organizations, which are reliant on private donations as well. TEFAP is the largest source of federal support for emergency feeding organizations. Other related food distribution programs focus on specific subpopulations; for example, the Federal Emergency Management Agency’s (FEMA’s) Emergency Food and Shelter Program distributes food to homeless individuals and USDA’s Commodity Supplemental Food Program distributes food to low-income elderly individuals. TEFAP is typically amended and reauthorized through farm bills. Most recently, the 2014 farm bill (P.L. 113-79) extended and provided additional funding for TEFAP’s entitlement commodities. Current 2018 farm bill proposals (two versions of H.R. 2) would reauthorize and continue additional funding for entitlement commodities (as of the date of this report). They also include different approaches to incorporating non-federally donated foods and reducing food waste. Recent program developments include TEFAP’s use in disaster response and receipt of commodities from the 2018 trade aid package.

Nov 19, 2018

Defense Primer: Navigating the NDAA

Nov 16, 2018

Defense Primer: Defense Appropriations Process

Nov 16, 2018

Defense Primer: Department of the Army and Army Command Structure

Nov 16, 2018

Defense Primer: Organization of U.S. Ground Forces

Nov 16, 2018

FY2018 and FY2019 Appropriations for Agricultural Conservation

The Agriculture appropriations bill funds the U.S. Department of Agriculture (USDA) except for the Forest Service. The FY2018 Consolidated Appropriations Act (P.L. 115-141, Division A), and both of the FY2019 agriculture bills reported by the House and Senate Appropriations Committees (H.R. 5961, S. 2976) include funding for conservation programs and activities at USDA. Congress passed the FY2018 Consolidated Appropriations Act on March 23, 2018, which included agriculture appropriations under Division A. For FY2019, the House and Senate Appropriations Committees reported agriculture bills in May 2018. The Senate amended and passed its version as Division C of a four-bill minibus on August 1, 2018 (H.R. 6147). In the absence of a final appropriation, Congress enacted a continuing resolution through December 7, 2018 (P.L. 115-245, Division C). Agricultural conservation programs include both mandatory and discretionary spending. Most conservation program funding is mandatory and is authorized in omnibus farm bills. Other conservation programs—mostly technical assistance—are discretionary and are funded through annual appropriations. The largest discretionary program is the Conservation Operations (CO) account, which funds conservation planning and implementation assistance on private agricultural lands across the country. The enacted FY2018 appropriation provided $874 million for CO, an increase from the FY2017 enacted amount ($864 million). The FY2019 House-reported and Senate-passed bills would further increase funding for CO above FY2018 levels to $890 million and $879 million, respectively. Other discretionary spending is primarily for watershed programs. The largest—Watershed and Flood Prevention Operations (WFPO)—was funded at $150 million in FY2018. Both the House-reported and Senate-passed bills would fund WFPO at the $150 million level in FY2019. Most mandatory conservation programs are authorized in omnibus farm bills and do not require an annual appropriation. However, Congress has reduced mandatory conservation programs through changes in mandatory program spending (CHIMPS) in the annual agricultural appropriations law every year since FY2003. The enacted FY2018 omnibus marks the first appropriation since FY2002 that does not include CHIMPS to mandatory conservation programs. For FY2019, both the House and Senate appropriation bills do not include reductions to mandatory conservation programs, because most programs’ authorizations expired on September 30, 2018, making these programs ineligible for reduction. While this is infrequent, the Agriculture appropriations bill may also serve as a vehicle for amendments to authorized programs that permanently alter or create programs. The FY2018 enacted appropriation included two such amendments—one to WFPO and one to farm bill conservation program reporting requirements. The WFPO amendment increased the size threshold required for congressional approval. Under the amended language, the Senate and House Agriculture Committees must approve WFPO projects that include an estimated federal contribution of more than $25 million for construction, an increase from the previous $5 million threshold. Additionally, the FY2018 appropriation exempted farm bill conservation programs from select federal reporting requirements, including obtaining a Data Universal Numbering System (DUNS) number and System for Award Management (SAM) registration. Agriculture appropriations bills may also include policy-related provisions that direct how the executive branch should carry out the appropriation. The FY2018 enacted appropriation and both the FY2019 House-reported and Senate-passed bills include policy provisions for conservation programs that range from reports to Congress to suggested natural resource priorities.

Nov 16, 2018

Defense Primer: Under Secretary of Defense for Research and Engineering

Nov 14, 2018

The Charitable Deduction for Individuals

Nov 13, 2018

Defense Primer: Congress’s Constitutional Authority with Regard to the Armed Forces

Nov 13, 2018

Defense Primer: Research, Development, Test, and Evaluation

Nov 13, 2018

Defense Primer: Legal Authorities for the Use of Military Forces

Nov 13, 2018

Labor Enforcement Issues in U.S. FTAs

Nov 13, 2018

Federal District Court Enjoins the Department of Homeland Security from Terminating Temporary Protected Status

Nov 9, 2018

Defense Primer: The NDAA Process

Nov 9, 2018

Military Medical Care: Frequently Asked Questions

Military medical care is a congressionally authorized entitlement that has expanded in size and scope since the late 19th century. Chapter 55 of Title 10 U.S. Code, entitles certain health benefits to military personnel, retirees, and their families. These health benefits are administered by a Military Health System (MHS). The primary objectives of the MHS, which includes the Defense Department’s hospitals, clinics, and medical personnel, are (1) to maintain the health of military personnel so they can carry out their military missions and (2) to be prepared to deliver health care during wartime. Health care services are delivered through either Department of Defense (DOD) medical facilities, known as military treatment facilities (MTFs) as space is available, or through civilian health care providers. As of 2017, the MHS operates 681 MTFs, employs nearly 63,000 civilians and 84,000 military personnel, and serves 9.4 million beneficiaries across the United States and in overseas locations. Since 1966, civilian care for millions of retirees, as well as dependents of active duty military personnel and retirees, has been provided through a program still known in law as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), more commonly known as TRICARE. TRICARE has three main benefit plans: a health maintenance organization option (TRICARE Prime), a preferred provider option (TRICARE Select), and a Medicare supplement option (TRICARE for Life) for Medicare-eligible retirees. Other TRICARE plans include TRICARE Young Adult, TRICARE Reserve Select, and TRICARE Retired Reserve. TRICARE also includes a pharmacy program and optional dental and vision plans. Options available to beneficiaries vary by the sponsor’s duty status and geographic location. This report answers selected frequently asked questions about military health care, including How is the Military Health System structured? What is TRICARE? What are the different TRICARE plans and who is eligible? What are the costs of military health care to beneficiaries? What is the relationship of TRICARE to Medicare? How does the Affordable Care Act affect TRICARE? When can beneficiaries change their TRICARE plan? What is the Medicare Eligible Retiree Health Care fund, which funds TRICARE for Life? This report does not address issues specific to battlefield medicine, veterans, or the Veterans Health Administration. Veterans’ health issues are addressed in CRS Report R42747, Health Care for Veterans: Answers to Frequently Asked Questions, by Sidath Viranga Panangala.

Nov 8, 2018

Defense Primer: Department of the Navy

Nov 8, 2018

Defense Primer: Geography, Strategy, and U.S. Force Design

Nov 8, 2018

Defense Primer: Naval Forces

Nov 8, 2018

Defense Primer: The United States Air Force

Nov 7, 2018

Defense Primer: Military Officers

Nov 7, 2018

Defense Primer: Military Enlisted Personnel

Nov 7, 2018

Defense Primer: United States Airpower

Nov 7, 2018

Child Care Entitlement to States: An Overview

Nov 6, 2018

National and International Educational Assessments

Nov 2, 2018

National and International Educational Assessments: Overview, Results, and Issues

U.S. students participate in many assessments to track their educational achievement. Perhaps the most widely discussed of these are statewide assessments required by the Elementary and Secondary Education Act (ESEA), which was most recently comprehensively amended by the Every Student Succeeds Act (ESSA; P.L. 114-95). However, U.S. students also participate in large-scale national assessments, authorized by the National Assessment of Educational Progress Assessment Act (NAEPAA; Title III, Section 303 of P.L. 107-279), and international assessments, authorized by the Education Sciences Reform Act (ESRA; Title I, Section 153(a)(6) of P.L. 107-279). At the national level, students participate in the National Assessment of Educational Progress (NAEP). At the international level, U.S. students participate in the Trends in International Mathematics and Science Study (TIMSS), Progress in International Reading Literacy Study (PIRLS), and Program for International Student Assessment (PISA). Although there are some similarities between statewide, national, and international assessments, they differ in purpose and level of reporting. For example, the purpose of statewide assessments is primarily to inform statewide accountability systems and provide information on individual achievement. By contrast, the purpose of large-scale assessments is to highlight achievement gaps, track national progress over time, compare achievement within the United States, and compare U.S. achievement to that of other countries. Results of these assessments are not reported for individuals. National Assessments: The NAEP is a series of assessments measuring achievement in various content areas. The long-term trends NAEP (LTT NAEP) has tracked achievement since the 1970s and has remained relatively unchanged. The main NAEP assessment has tracked achievement since the 1990s and changes periodically to reflect changes in school curricula. The main NAEP has three levels: national, state, and Trial Urban District Assessment (TUDA). States that receive Title I-A funding under the ESEA are required to participate in biennial state NAEP assessments in reading and mathematics for 4th and 8th grade. Results from the 2017 main NAEP show a small but significant increase in 8th grade reading since 2015. There were no significant changes in 4th grade reading, 4th grade mathematics, or 8th grade mathematics since 2015. Longer term, however, average reading and mathematics scores have increased significantly since the initial administrations in the 1990s. International Assessments: The United States participates in three international assessments: TIMSS, PIRLS, and PISA. TIMSS is an assessment of mathematics and science for 8th grade students. PIRLS is an assessment of reading literacy for 4th grade students. PISA is an assessment of reading literacy, mathematics literacy, and science literacy for 15 year old students. In general, U.S. students have made statistically significant gains since the initial administrations of international assessments; however, achievement did not consistently increase in the most recent administrations of international assessments. Issues of Interpretation of National and International Assessments: Results of national and international assessments are difficult to interpret. One challenge is processing the large amount of data. Another is understanding the difference between statistical significance and educational significance. Reporting statistical significance is standard practice in research, but it does not convey the magnitude of a difference and its associated educational significance. Another issue is the tendency to focus narrowly on one assessment at one point in time. A narrow focus may not provide the appropriate context to interpret results accurately. International assessment results may also be affected by socioeconomic considerations within and across countries. Comparing Results Across Assessments: Comparing results across national and international assessments can be challenging. Each assessment was created for a unique purpose by different groups of stakeholders, which makes direct comparisons difficult. There are a number of issues to consider when evaluating U.S. students’ performance across assessments. For example, consideration must be given to the differences in (1) the degree of alignment of content standards and assessments, (2) the target population being assessed, (3) the voluntary nature of student participation, (4) the participating education systems, (5) the scale of the assessment, and (6) the precision of measurement for each assessment.

Nov 2, 2018

VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (VA MISSION Act; P.L.115-182)

On June 6, 2018, the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018, or the VA MISSION Act of 2018 (S. 2372; P.L. 115-182; H.Rept. 115-671), was signed into law. The Department of Veterans Affairs Expiring Authorities Act of 2018 (S. 3479; P.L. 115-251), enacted on September 29, 2018, made some changes and technical amendments to the VA MISSION Act. This act, as amended, broadly addresses four major areas. First, it establishes a new permanent Veterans Community Care Program (VCCP), replacing the current Veterans Choice Program (VCP). The VA MISSION Act stipulates that the new program must be operational when regulations are published by the Department of Veterans Affairs (VA) no later than one year after the date of enactment (June 6, 2018), or when the VA determines that 75% of the amounts deposited in the Veterans Choice Fund (VCF) have been exhausted. Second, it expands the current Program of Comprehensive Assistance for Family Caregivers, in two phases, to all eligible veterans who served prior to September 11, 2001. Third, it establishes an asset and infrastructure review process by establishing an Asset and Infrastructure Review Commission. The purpose of the commission is to examine the VA’s assets and to make recommendations for modernizing and realigning medical facilities. Fourth, it provides various statutory authorities to the Veterans Health Administration (VHA) of the VA to recruit and retain health care providers. Veterans Community Care Program (VCCP) The VA MISSION Act establishes a new permanent discretionary community care program known as VCCP. The act provides conditions under which the VA is required to provide care in the community once the program is established. Generally, all veterans enrolled in the VA health care system would be able to qualify when (1) the VA does not offer the care or service required by the veteran; or (2) the veteran resides in a state without a full-service VA medical facility; or (3) the veteran previously qualified under the 40-mile criterion of the VCP; or (4) the VA cannot provide the veteran with care and services that comply with designated access and quality standards; or (5) the veteran and the veteran’s primary care provider agree that it is in the best interest of the veteran to receive care in the community. In addition, the VA is required to enter into contracts to build a network of private community providers. Expansion of Comprehensive Assistance for Family Caregivers The VA MISSION Act expands the Program of Comprehensive Assistance for Family Caregivers to pre-9/11 veterans in two phases. Under the first phase, veterans with serious service-connected injuries incurred on or before May 7, 1975, would qualify for benefits over a two-year period beginning on the date when the VA certifies to Congress that it has fully implemented the information technology system required for this program. Under the second phase, those with serious service-connected injuries incurred between May 7, 1975, and September 11, 2001, would qualify for the Comprehensive Assistance for Family Caregivers program two years after implementation of the first phase. Capital Asset Review The VA MISSION Act establishes a process for realigning and modernizing facilities of the VHA. Under this process, the VA will develop criteria for selecting VHA facilities to dispose of, modernize, or acquire, so as to better meet the health care needs of veterans. VA must then create a list of recommendations based on those criteria and submit it to a newly created Asset Infrastructure Review (AIR) Commission. The AIR Commission shall review the VA’s recommendations but may not alter them, unless it determines that one or more recommendations are inconsistent with the criteria. The commission shall submit the list of recommendations to the President, who shall either approve the list in its entirety or send it back to the AIR Commission. The AIR Commission may change the recommendations and resubmit a revised list to the President for reconsideration. The President may approve or disapprove of the revised list. If the President approves of the original or revised list, then VA must begin implementation of the recommendations within three years, unless Congress passes a joint resolution of disapproval, in which case the asset review process terminates. Recruiting and Retaining Health Care Providers in the VHA The VA MISSION Act authorizes or expands several programs, with the intention of recruiting and retaining health care providers in the VHA. Among other things, the act increases the maximum amount of student loan debt that may be reduced under VA’s Education Debt Reduction Program (EDRP); authorizes designated scholarships for physicians and dentists under the VA Health Professional Scholarship Program (HPSP); establishes the VA specialty education loan repayment program to incentivize VHA employees to pursue education and training in medical specialties for which VA determines there is a shortage; establishes a pilot Veterans Healing Veterans Medical Access and Scholarship Program; and extends eligibility for VA’s EDRP to clinical staff working at Vet Centers. The act also requires the VHA to establish a program to deploy mobile health teams to serve in underserved VA medical facilities. Lastly, the VA MISSION Act authorizes and appropriates $5.2 billion in mandatory funding for the VCP until the VCCP is operational.

Nov 1, 2018

U.S. Trade Policy Functions: Who Does What?

Nov 1, 2018

California Dreamin’ of Privacy Regulation: The California Consumer Privacy Act and Congress

Nov 1, 2018

Medicaid Financing for the Territories

Oct 29, 2018

The Public Service Loan Forgiveness Program: Selected Issues

The Public Service Loan Forgiveness (PSLF) program provides Direct Loan borrowers who, on or after October 1, 2007, are employed full-time in certain public service jobs for 10 years while making 120 separate qualifying monthly payments on their Direct Loans with the opportunity to have any remaining balance of principal and interest on their loans forgiven. The program was enacted under the College Cost Reduction and Access Act of 2007 (P.L. 110-84) to encourage individuals to enter into and remain employed in public service and to alleviate the potential financial burdens associated with federal student loans of borrowers in public service occupations who were presumed generally to earn less than their counterparts in other occupations. With the opportunity to apply for program benefits first being made available on October 1, 2017, based on service completed and payments made prior to that date, many issues that span several aspects of the program have been raised and have garnered congressional interest. This report addresses numerous issues, which are highlighted below. Program implementation issues that have surfaced relate to how the PSLF program’s statutory requirements have been operationalized, difficulties experienced by borrowers in participating in the program, and difficulties in administering the program. Some of these issues include: Operationally defining what constitutes a “public service job.” This includes whether the definition in use is sufficiently targeted to meet congressional intent for the program and whether it has created inequities among types of borrowers. There have also been administrative difficulties associated with identifying and certifying qualifying employment. Determining what constitutes a “qualifying payment.” Multiple criteria related to on-time payments, time periods over which payments must be made, and specific payment amounts must be met for a payment to be considered qualifying, which may cause confusion among borrowers and create administrative difficulties. Difficulties borrowers may face when determining which repayment plan to enroll in to maximize PSLF benefits. Payments made according to an income-driven repayment (IDR) plan may decrease the monthly dollar amount of payments made, which may ultimately lead to greater amounts of PSLF forgiveness benefits. Payments made under other plans may also qualify for PSLF but may not be as valuable to borrowers in terms of eventual PSLF forgiveness benefits. The effects of loan consolidation on a borrower’s progress toward receiving PSLF benefits. Of particular importance, PSLF qualifying payments made prior to consolidation do not count toward forgiveness of the resulting Direct Consolidation Loan. The complexities and challenges that administering the program may present for the Department of Education, loan servicers, and borrowers. These include issues of communication among the parties regarding program requirements and processes, lack of coordination among loan servicers, loans servicers making errors or not completing tasks associated with the program in a timely manner, and the lack of automation of some administrative functions. Issues pertaining to PSLF program interactions with other programs and benefits relate to whether borrowers understand the interactions well enough to make rational choices and maximize available benefits and, from the federal government’s perspective, questions have arisen regarding whether the desired targeting of benefits is being achieved and about the potential costs associated with such interactions. Some of these issues include: There is no limit to the amount of loan forgiveness benefits an individual may realize under the PSLF program. While it is possible that many borrowers may receive limited benefits, some Direct Loan borrowers may realize large forgiveness benefits under the program. This outcome may be more likely to occur for borrowers of Direct PLUS Loans for graduate and professional students, which have no aggregate borrowing limits, and which were newly authorized to be made just prior to the enactment of PSLF. Also, the variety of IDR plans has expanded greatly since the PSLF program’s inception, with several of the new IDR plans providing for lower monthly payments than under the Income-Based Repayment plan—the primary IDR plan available when the PSLF program was enacted. This expansion may allow borrowers to lower monthly payments and potentially realize larger forgiveness benefits under the program. The current borrowing limits and variety of IDR plans, coupled with PSLF program benefits, have raised questions about whether certain types of students are not incentivized to limit borrowing and whether they may be less sensitive to the price of postsecondary education. Borrowers may receive benefits under a number of federal student loan repayment programs. Borrowers may also be able to avail themselves of certain income tax provisions to maximize PSLF program benefits. For borrowers, understanding whether the same service that qualifies for PSLF may also qualify for other loan repayment benefits is important, as is their understanding of how other benefits and tax provisions may interact with PSLF. From the perspective of the federal government, a key consideration may relate to what constitutes a “double benefit” for service performed by borrowers and the extent to which overlapping benefits might be provided. Broad program-related issues relate to (1) how the program fits into the overall suite of federal student aid benefits and (2) the difficulty of estimating the potential participation in and costs of the program. The enactment of the PSLF program is reflective of a broadening of the federal approach to student aid, providing more widely available assistance to individuals after a postsecondary education’s costs have been incurred. This approach may place greater emphasis on providing aid on the basis of economic circumstances after enrollment, rather than at the time of enrollment. It also makes some aid available on a targeted basis—providing relief to individuals who pursue certain types of service or occupations, rather than providing aid more broadly to individuals who enroll in postsecondary education. The granting of loan forgiveness benefits results in costs to the federal government, and there has been some speculation that the cost of PSLF could be much higher than anticipated. Limited information is available on the actual and future costs to the government of the PSLF program. It has just recently become possible to claim program benefits; thus, little is known about what the costs associated with the program will be based on the experiences of actual cohorts of borrowers. In addition, estimating potential costs may prove difficult as borrowers are not required to submit information on their intent to participate in the program until they seek forgiveness benefits after 10 years of service and qualifying payments.

Oct 29, 2018

Medicaid Coverage for Former Foster Youth Up to Age 26

Oct 26, 2018

U.S. Global Family Planning and Reproductive Health Programs: Funding Trends and Issues for Congress

Oct 26, 2018

What Legal Obligations do Internet Companies Have to Prevent and Respond to a Data Breach?

Oct 25, 2018