When Child Welfare WorksA P R O P O S A L F O R FI N A N C I N G B E S T P R A C T I C E S

Presentation for National Organization of State Associations for Children March 27, 2014

THE ANNIE E. CASEY FOUNDATION

Agenda

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• Why the urgency: The cost of doing nothing

• Likelihood of congressional action

• Overview of intent of proposal

• Summary of recommendations

• Feedback already received

• Limitations to the proposal that require creative solutions

The Cost of Doing Nothing: Decline in Federal foster care participation rates

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The Cost of Doing Nothing: Decline in Federal foster care funds

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The Cost of Doing Nothing: Decline in Federal funds for child protective services and family support

The Cost of Doing Nothing: Decline in flexible Federal funds for child and family services including prevention

Title IV-B Funding(Constant FY2012 Dollars)

19851987

19891991

19931995

19971999

20012003

20052007

20092011

1

1.2

1.4

1.6

1.8

2

2.2

2.4

2.6

2.8

3

2.8

1.7

Social Services Block Grant Appropriations

$bill

ions

P.L. 104-193 sets new ceiling of $2.38 billion

P.L. 105-178 sets new ceiling of $1.7 billion

H.R. 5652 repeals SSBG

H.Rept. 112-58 recommends

repeal of SSBG

President’s budget

included $.5 billion cut

“The Committee…has determined that the SSBG program has critical program flaws that argue for its elimination…The following key flaws in the SSBG program reflect how it clearly does not serve taxpayers well: No focus… Duplicative…No state partnership…No accountability”

Subject to sequestration

Likelihood of congressional action

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• Changes in Senate leadership

• Significant bi-partisan staff-level interest in financing reform

• End of waiver authority

• Potential for budget reconciliation in next congress

• Growing consensus on principles for reform

Intent of proposal

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• Target federal funds to support what works best for children and families

with a focus on enhancing permanency and well-being

• Protect the entitlement, ensures that all children in foster care are

included in the entitlement

• Make achieving timely permanency for children and maintaining them in

families the fiscal responsibility of states AND make the federal

investments necessary to allow states to achieve these key outcomes

• Invest to increase the quality and capacity of family foster care, support

a qualified workforce, and ensure that adequate therapeutic and family

support services are available to address children’s needs

• Maintain the current level of federal investment in child welfare

July 26, 2013 9

Children do best in families

Areas where financing can make a difference

There are four key areas in which financing changes can make a difference:

Permanence and well-being

Foster and kinship care Workforce

Therapeutic and supportive

services

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Improving permanence and well-being for children

Kids have families they can rely on to

help them become

successful adults.

VISIONTIME IN FOSTER CARE

SHELTER CARE,GROUP HOMES

RESIDENTIAL TREATMENT

INDIVIDUAL DEVELOPMENT

ACCOUNTS

NOW Reimbursement unlimited

Reimbursement unlimited

Reimbursement unlimited

No IDA Accounts

IDEAS Limit number of years of

federal reimbursement

Not reimbursable

Not reimbursable for children under 13;

Limit time in residential

treatment for older youth

IDA program for youth in

care at age 16

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Improving family foster care

Foster families have the training and support they need to help kids

grow up in families.

Relatives have resources to care for their

own.

KINSHIP CARE FOSTER PARENTS

STATE SUPPORT OF FOSTER PARENTS

TAX INCENTIVES

NOW Using unlicensed kin with TANF

grants acceptable

Only reimbursed

when child is in home

Reimbursed as administrative

costs

$1,000 tax credit for foster children

in home for six months

IDEAS All children required to be

in licensed homes, with

different standards for

kin acceptable

Allow forreimburse-

ment even if child needs

to be in residential

treatment for a limited time

Enhance reimbursement for recruitment, development

and support of foster families

Increase tax credit for teens, sibling groups and children with special

needs

VISION

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Building a more capable workforce

VISION

More experienced workers

focus on directly helping kids.

CASEWORKERLOAN

FORGIVENESSCASE

WORKERS

TRAINING OF CHILD PROTECTIVE SERVICES STAFF

ADMINISTRATION ELIGIBILITY

NOW Allowed after 10 years

Non-clinical counseling to children

and families not allowed

Not reimbursable

Overhead and direct service

costs combined

Tied to 1996 AFDC

standards

IDEAS Allowed after four years

Allow reimburse

-ment for all

activities for

primarycase-worker

Allow reimburse-ment for

competency-based training

Separate overhead from direct service (casework)

Phased-in elimination of income eligibility

requirementwith

reduced federal match

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Funding social and therapeutic services

VISION

Increased funding and flexibility for services to

prevent placement,

promote reunificationand provide therapeutic

intervention.

THERAPEUTIC SERVICES FAMILY SUPPORT SERVICES

NOW Enormous variation in states’ use of Medicaid

Title IV-B, SSBG and TANF at state discretion

IDEAS Require state plan for using Medicaid to meet

therapeutic needs of child welfare-involved families;Provide TA to implement

recent HHS guidance

Sustain and reconfigure existing funds for

child welfare;Require greater

accountability for TANF funds

Feedback Received

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Recommendations receiving widespread agreement/support

• Eliminating income test for IV-E eligibility

• Reconfiguring SSBG

• Foster parent and workforce investments

• Medicaid Plan for meeting the needs of child welfare families

Recommendations met with greatest concern

• Limiting federal funds for long-term foster care

• Limiting federal funds for non-therapeutic group and residential care

• Lack on investment in prevention and post-permanency services, support for tribes

Limiting federal funds for long-term foster care

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Rationale• Incentivize, free-up necessary resources to invest in achieving timely permanency

• Represents best practice even in challenging situations

• TPR after 15 of the last 22 months + time to achieve alternative permanency arrangement < 3 years

Potential Impact• Number of children in care for more than 3 years: 18% of children currently in care, 9.5% of entrants,

32.5% of children awaiting adoption

• Permanency: “Children 12 years or older who continued to live in foster care after 3 years were nearly certain to age out of care before finding a permanent placement alternative.” [NSCAW]

• Stability: Stability of care drops sharply after 3 years

Concerns• Reimbursement will drive

placement decisions rather than best interests (compare to deinstitutionalization)

• Slippery slope

Suggestions• Graduated decline in

reimbursement rates

• Reimbursement for children re-entering care

• Exceptions to time limit

Questions• Lifetime limit?

• What about kids already in care?

• What about youth in care after age 18?

Limiting federal funds for non-therapeutic group and residential care

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Rationale• Recognition of the need for and benefits of family, and that children should not “grow up” in group homes

• Many/most children are referred to group care because of a lack of alternative placement and not to meet their therapeutic needs

• Research findings on poor outcomes, potentially adverse impact of group care for many children

• Recognition of the developmental needs of younger children

• Feedback from residential providers on time needed to address therapeutic needs, data showing diminishing returns from residential treatment after a period of time

Potential Impact• Number of children experiencing group care

15% of foster children are currently in group care 25% of all children spend some time in group care 20% of all children initially placed in group care

• Number of teens experiencing group care 33% of foster teens currently in group care 57% of teens spend some time in group care 40% of teens initially placed in group care

• Enormous variation among and within states demonstrating significant differences in practice

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Concerns

• Where will children go for emergency placement?

• Where to find foster parents for older children?

• Residential providers often get children who have already been in several group settings

• Existing family options unable to meet needs of children with MH

• Possible unintended consequence may be short-sighted frequent replacement of children to multiple homes because the child isn’t getting the necessary level of care, increased state expenditures lead to decreased funds for other services and supports

Suggestions• Allow reimbursement for

very short-term shelter care that meets therapeutic standards

• Exceptions for both age and time limits, types of treatment facilities

• Require comprehensive MH assessment prior to group care placement

Questions• How to define non-

therapeutic?

• Why age 13?

• Why set 1 year as time limit?

Limiting federal funds for non-therapeutic group and residential care

Lack on investment in prevention and post-permanency services, support for tribes

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• AECF has a much larger agenda to support low-income families

• Caseworker support for candidates (both in-home and post-permanency)

• Medicaid access, ACA implementation could have dramatic impact

• Protection of SSBG and IV-B key

Limitations to the proposal that require creative solutions

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• Exceptions to limitations on federal funding Identify specific groups of children

Identify specific criteria for children

Allow a preset percentage of exceptions

• Services What specific services

Individual entitlement, funding entitlement, capped funding

program

Time limited

Please contact us with additional feedback:

Rgeen@AECF.org

(410) 547-3679

http://www.aecf.org/OurWork/ChildWelfareP

ermanence/WhenChildWelfareWorks.aspx21