Fiscal Considerations and Family First Don Winstead, Consultant to Casey Family Programs Madison, WI November 8, 2018

Key Points Always start with your vision and goals. What are your key lessons learned on practices or interventions that you want to build on for the future? What is your fiscal pathway from now to October 1, 2019? How will Family First impact your IV-E funding? What changes can you make now to improve your readiness for Family First?

FFPSA Impact Areas Prevention Services Provisions Congregate Care Provisions New Opportunities Prior to 10/1/2019 Some Key Decisions Some Important Questions

Congregate Care and Foster Family Care In-Home Imminent Risk Institutional Care Foster Family Homes Relatives & Fictive Kin Licensed Unrelated Intensive Residential Treatment “FamilyLike” Considerations Placement & Care? Therapeutic?

Prevention Services Candidacy Mental Health and Substance Abuse Prevention and Treatment Services In-Home Parent Skill-Based Programs Parenting skills training Parent Education, and Individual and Family Counseling For not more than 12 months For Candidates or children in foster care who are pregnant or parenting Trauma-Informed Provided in Accordance with Promising, Supported or Well-Supported Practices.

Outcome Assessment and Reporting For each child for whom prevention services are provided, the State shall report: The specific services or programs provided and the total expenditures for each of the services or programs. The duration of the services or programs provided. In the case of a candidate, the child’s placement status at the beginning, and of the end, of the 1- year period and whether the child entered foster care within 2 years after being determined a candidate for foster care.

Prevention Services Measures Beginning with FFY 2021 and annually thereafter, the Secretary shall establish the following prevention service measures: Percentage of candidates for foster care who do not enter foster care, including those placed with a kin caregiver outside of foster care, during the 12-month period in which the services are provided and through the end of the succeeding 12-month period. Per child spending for prevention services for or on behalf of each child. The Secretary shall establish and annually update the measures based on the median values for the most recent three years taking into account regional price parities and publish the prevention services measures for each state.

Past Candidacy Claiming Based on 2016 (non-waiver) or 2012 (waiver)

Candidacy Comparison Current Law FFPSA Imminent risk of removal Imminent risk of entering foster care Identified in defined case plan, IV-E eligibility form or court order Identified in prevention plan Absent preventive services, foster care is the planned arrangement for the child Service needs directly related to the child’s safety, permanence, or well-being or to prevent entry Renewed every 6 months Not more than 12 months No services – Administration 50% match subject to penetration rate Specified services 50% match (with some restrictions) - Administration 50% match not subject to 1996 AFDC eligibility

POP QUIZ Question: How much federal reimbursement will you receive? Prevention Service Claims (50% Federal Reimbursement) Total Claim Promising Practices $10 million Supported Practices $10 million Well Supported Practices $10 million Question: How much federal reimbursement will you receive? A: $5 million B: $10 million C: $15 million D: $20 million

Maintenance of Effort (MOE) Any Other State Program (but not IV-E) TANF IV-B SSBG State Foster Care Expenditures For Prevention Services and Activities Does NOT Include: IV-E Expenditures IV-E Waiver Expenditures FFY 2014 (most states)

Federal IV-E Payments to States Sec. 474, as amended by FFPSA Foster Care Maintenance Payments (FMAP) Adoption Assistance Payments (FMAP) Administrative Expenditures Training (75%) Automated Systems (50%) Remaining expenditures for the proper and efficient administration of the State Plan (50%) Chafee and ETV Expenditures (80% capped) Kinship Guardianship Assistance (FMAP) Prevention Expenditures Prevention Services Expenditures (50%) Prevention Services Administration and Training (50%) Kinship Navigator Expenditures (50%)

Congregate Care and Foster Family Care In-Home Imminent Risk Institutional Care Foster Family Homes Relatives & Fictive Kin Licensed Unrelated Intensive Residential Treatment “FamilyLike” Considerations Placement & Care? Therapeutic?

Percentage of Children in Group Home or Institution FY 2016 (Kids Count)

Types of “Institutional Care” Not Specified Specified Settings Licensed residential family-based treatment facility Supervised Independent Living (age 18+) Prenatal Postpartum or Parenting Supports Victims Of or At Risk of Sex Trafficking QRTP

Licensed Residential Family-Based Treatment Facility for Substance Abuse Specified Settings Not Specified Child is eligible for maintenance payments without regard to AFDC eligibility. For a period of not more than 12 months. Placement and care requirements remain in effect. Recommendation for placement specified in the child’s case plan before placement. Treatment facility provides, as part of the treatment for substance abuse, parenting skills training, parent education and counseling. The facility must be licensed but the IV-E licensing and background check requirements for CCIs do not apply. The maintenance payments may not include costs of administration and operation of the facility.

Supervised Independent Living Specified Settings Not Specified For children age 18 and older. A title IV-E agency has the discretion to develop a range of supervised independent living settings which can be reasonably interpreted as consistent with the law, including whether or not such settings need to be licensed and any safety protocols that may be needed. For example, a title IV-E agency may determine that when paired with a supervising agency or supervising worker, host homes, college dormitories, shared housing, semi-supervised apartments, supervised apartments or another housing arrangement meet the supervised setting requirement” (section 472(k)(2)(C) of the Act).

Prenatal, Postpartum or Parenting Supports Specified Settings Not Specified The facility must meet the statutory definition of a Child Care Institution (private institution or public institution with not more than 25 children which is licensed by the state), but the statute does not provide additional parameters for placing a child in this setting and the Children’s Bureau is not defining it further.

Victims Of or At Risk of Sex Trafficking Specified Settings Not Specified A setting providing high-quality residential care and supportive services to children and youth who have been found to be, or are at risk of becoming, sex trafficking victims as identified by the title IV-E agency. The facility must meet the definition of a CCI. The statute does not define “a setting that provides high quality residential care and supportive services to children and youth who have been or found to be or are at risk of being, sex trafficking victims” and ACF is not defining it further. This means title IV-E agencies have flexibility in determining what “high quality residential care” consists of, what “supportive services” are provided by the setting, and which children are “found to be or are at at-risk of becoming” victims of sex trafficking (consistent with the definition of “victim of sex trafficking” noted in section 475(9) of the Act).

Qualified Residential Treatment Program Specified Settings Not Specified A QRTP placement is a specific category of a non-foster family home setting, for which title IV-E agencies must meet detailed assessment, case planning, documentation, judicial determinations and ongoing review and permanency hearing requirements for a child to be placed in and continue to receive title IV-E FCMPs for the placement. It must be licensed, criminal record and child abuse and neglect registry checks must be completed. Further, it must be accredited by one of the independent, not-for-profit organizations specified in the statute or one approved by the Secretary (CARF, JCAHO, COA, or any other approved by the Secretary).

Qualified Residential Treatment Program Additional Requirements Specified Settings Not Specified Assessment by a qualified individual. – Must be completed within 30 days. If not completed, no federal funds shall be made (not even for 14 days). Qualified individual. A trained professional or licensed clinician who is not an employee of the IV-E agency or affiliated with any placement setting (may be waived). Court Review – Court review required within 60 days of start of placement. Long-term placements. For every QRTP the child is placed in for more than 12 consecutive months or 18 nonconsecutive months (or, in the case of a child who has not attained age 13, for more than six consecutive or nonconsecutive months), the title IV-E agency must maintain documentation in the child’s case plan and make it available for federal inspection and/or review upon request, during a title IV-E eligibility review, joint planning, or a partial review.

Qualified Residential Treatment Program Additional Provisions Specified Settings Not Specified Trauma informed treatment model is required. Registered or licensed nursing staff and other clinical staff are required, on-site as consistent with the treatment model and available 24/7. As appropriate, program must facilitate participation of family members in treatment and facilitate outreach to family members including siblings, biological family and fictive kin. Provides discharge planning and family-based aftercare support for at least 6 months post-discharge. Administrative Costs may be claimed by the IV-E agency regardless of whether QRTP requirements are met. If QRTP requirements not met, administrative costs remain but costs associated with administration and operation of the QRTP are not allowable.

Transitioning to the FFPSA Provisions Related to Specified Settings (sec. 472(k)) Not Specified Specified Settings The setting limitations of FFPSA apply to new placements in these settings made on or after the effective date of the provisions in section 472(k) of the Act. Title IV-E agencies may claim title IV-E FCMPs for a child placed in a CCI prior to the effective date of section 472(k) of the Act for as long as the eligible child continuously remains in that setting. If the child later leaves this setting and enters a different non-foster family home setting, the agency must apply section 472(k) of the Act.

Not Specified Setting Specified Settings Not Specified Beginning with the third week of placement, no federal funds are to be made for maintenance in a setting that is not a specified setting or a licensed residential family-based treatment program for substance abuse. Federal funds for administrative costs remain available for traditionally allowable costs including case management. Costs for the administration and operation of a facility are part of the maintenance payment and not allowable, beginning with the third week.

Key Decisions Biggest decision – implement congregate care restrictions October 1, 2019 (and therefore be able to implement prevention services provisions) or delay for up to two years. What opportunities are there to reposition child welfare funds to best align with your vision and goals within Family First context. And many other decisions…

Opportunities Prior to 10/1/2019 Kinship Navigator Programs Children Placed with a Parent in a Licensed Residential Family-Based Facility for Substance Abuse Improvements to the John H. Chafee Foster Care Program for Successful Transitions to Adulthood Other changes…

Section 427 of the Social Security Act describes the Kinship Navigator Requirements. FFPSA requires evidence-based Kinship Navigator Services. The draft revised CB- 496 form includes a line for Kinship Navigator administration.

Chafee Foster Care Program for Successful Transition to Adulthood Specifies minimum age at 14. For States that have extended foster care to age 21 (or are providing comparable services and assistance), the age for eligibility is extended to age 23. Limits room and board for age 18 – 21 (or 23) to not more than 30% of Chafee funds. Provides an option for States to allow youth to remain eligible for ETV vouchers until age 26 as long as they do not participate for more than 5 years. Provides for redistribution of unexpended funds among States.

Title IV-B Changes FFPSA includes a number of changes to title IV-B including continued funding for programs, modifications to Regional Partnership Grants, etc. Changes to IV-B, subpart 2, Promoting Safe and Stable Families include: Revision of the definition of “family support services” to include community-based services “to support and retain foster families so they can provide quality family-based settings for children in foster care.” Revision and renaming “family reunification services” The change in definition removes the previous time limit for providing reunification services to the family of a child in foster care, and allows reunification services to be provided for a period of up to 15 months once the child is returned home.

Some Important Questions There are many areas where clarification from the Children’s Bureau may be forthcoming or where States, Counties and Tribes will need to make their best assessment of how to proceed. Areas (among many others) include: Candidacy Licensure Standards Kinship Placements QRTP Requirements Prevention Services Maintenance of Effort If you wait for definitive answers – you will likely be too late…

The Stages of FFPSA Delight that something finally passed, Anxiety about all the requirements and the work that will be required, Terror that prevention will be too limited and that use of group care will be impossible Cautious optimism that change is possible, and finally Recognition that success requires building a system that truly maximizes prevention and family-based care (which is what we wanted all along).