Colorado Children’s Caucus Out of Home Care: A Status Update Brian Brant (Vice President Child and Family Service Lutheran Family Services) representing Fostering Colorado Dr. Skip Barber from the Colorado Association of Family and Children’s Agencies (CAFCA)

Reimbursement for Out-of-Home Care Critically low reimbursement rates jeopardizing the wellbeing of Colorado foster care and juvenile justice youth Programs unable to compete for staff and unable to retain employees No rates setting methodology Rates of reimbursement arbitrarily set CDHS eliminated all rate setting methodologies in rule over a dozen years ago

Colorado Department of Human Service Placement History Total OOH FC Group/CPA Kinship Kinship FC RTC/RCCF 7068 3782 356 716 592 1483 6987 3751 360 941 512 1312 6906 3679 353 1020 515 1255 6995 3667 326 1111 564 1240 6816 3526 358 1155 548 1134 6644 3367 365 1218 459 1122 6531 3223 367 1336 433 1061 6194 3047 354 1464 358 884 5891 2900 348 1459 271 813 5423 2539 342 1439 229 783 5243 2319 350 1479 246 714 5162 2210 365 1620 271 599 5272 2084 313 1930 291 539 5433* 2093** 289 2071 330 526*** * a decline of 23.23% **a decline of 44.65% ***a decline of 64.54%

Client Acuity and Cost are higher in Out-of- Home Care today As increasing numbers of clients are served in lower levels of care (A GREAT THING!!!) the client population requiring the most intensive services (and hence the most costly to serve) are the clients today being served in out-of-home care. These youth require: greater supervision, more treatment services, greater psychiatric consultation/oversight and more medical services.

Client Acuity and Cost are higher in Out- of-Home Care today While youth are not sicker today, the youth in out-of-home care have a higher AGGREGATE acuity rate. At the same time the system has requested shorter lengths of stays, more school stability, an emphasis on keeping siblings together and greater agency accountability which have driven agency’s indirect costs. The result is that, even without considering inflation, the cost of doing out-of-home care today is much greater than it was 12 years ago.

History of Rate Adjustment for Child Welfare Services Year Adjustment CPI Lost to inflation SFY 2003-04 No adjustment 1.40% 1.40% SFY 2004-05 No adjustment 2.10% 2.10% SFY 2005-06 2.0% added 2.70% 0.70% SFY 2006-07 3.25% added 4.10% 0.85% SFY 2007-08 1.5% added 3.30% 1.80% SFY 2008-09 1.5% added 2.30% 0.80% SFY 2009-10 No adjustment 5.80% 5.80% SFY 2010-11 2.0% reduction 0% 2.00% SFY 2011-12 No adjustment 0% 0% SFY 2012-13 No adjustment 3.60% 3.60% SFY 2013-14 1.5% added 1.70% -0.20% SFY 2014-15 2.0% added 1.50% 0.50% SFY 2015-16 1.7% added 3.00% 1.30% 13 Year History 11.45% added 31.50% 18.95%

Foster Care Adjustments No community provider rate increases were regularly passed along to CPAs (Child Placement Agencies) until the last three years Whereas the legislature has passed community provider increases of 18.95% since 2004, CPAs only received 6.2%

The System is Dramatically Underfunding Service Providers SB16-201 Mandated the State, Counties and Providers come up with a rate setting methodology The State of Colorado is out of compliance with federal law which requires a methodology SB 16-201 workgroup failed to develop a methodology The JBC is now considering a new bill to address this deficiency

Current Levels of Reimbursement County negotiation of rates has resulted in CPAs base anchor rates being under funded by 6.52 million dollars (SFY 2015-2016). An investment in foster care is an investment in permanency for children where parental rights have been terminated (nationally 52% of children adopted from foster care are adopted by their foster parent). Current funding for residential treatment providers is less than 78% of audited costs This figure gets progressively worse each year In spite of salaries in the private sector being half what public employees receive

CPA Closures A decade ago there were 63 CPA and today there are only 38 Since Jan. 1st of this year 3 CPAs have closed Frontier Family Services Innovations for Children A Brighter Day

Residential Treatment Facilities Closed in last ten years Adolescent and Family Institute (20 beds) Cedar Springs Hospital Residential Unit (25 beds) Children’s Ark (Brookhurst) (60 beds) Colorado Boy’s Ranch (55 beds) Court House/Beacon Center (40 beds) Denver Family Crisis Center (50 beds) Excelsior (190 beds) Gemini/Family Tree (20 beds) Griffith Centers in Rifle, Grand Junction and Larkspur (100 beds) Flatirons Behavioral/Centennial (20 beds) Hands Up Homes (18 beds) Jefferson Hills Lakewood (closed but later reopened as another type of service) (60 beds) KidzArk (50 beds) Lost and Found (30 beds) Mountain Crest (20 beds) Mountain Star (20 beds) Namaqua (25 beds) North Range Behavioral Health- Kathleen Painter Littler Center (40 beds) Reflections for Youth (40 beds) Turning Point closed several of its locations (30 beds) Youth Emancipation Services (15 beds) Youthtrack (40 beds)

Those who care for Colorado’s children in care need your help Watch for the bill coming from the JBC regarding provider rates When allocating funds for state salary increases and expansions of program in child welfare and/or youth corrections make sure that additional funding is recommended for private providers