The Family First Act made it into the CR/budget agreement after the House inserted it in their slimmed down CR proposal. The Senate picked up the package. It is close to the version that had been considered in late 2016 with some additional behind the scenes modifications added into the final version.

It includes the reauthorization of the two Title IV-B programs: Child Welfare Services (Title IV-B part 1) and Promoting Safe and Stable Families (Title IV-B part 2). That includes associated programs such as the Court Improvement Program (CIP) and the Regional Partnership Grants (RPGs) which were modified to allow for minimum grants of $250,000 instead of $500,000 to stretch the $20 million annual grants.

The most significant parts and the struggle in the debate are the new changes to Title IV-E. It will allow states in FY 2020 to take an option to create a program that will allow the draw-down of entitlement funding to provide up to 12 months of services to children and their families if the child is a candidate for foster care. States will have to submit a plan that includes definitions, services to be covered, data and studies to be collected and conducted and additional details. HHS will have to approve the optional state plan.

Eligibility for services will not be linked to the 1996 AFDC eligibility standard as Foster Care and Kinship Care continue to be linked. Services could be provided to children at risk of removal as well as children reunified with their families or children who have been adopted and are at risk of re-entering foster care. It also allows services to parenting or expectant mothers in foster care. States will be restricted to certain programs that meet the legislation definition of promising, supported, or well-supported practices. HHS will take the first step in definition and listing these programs by October 1 of this year. Generally the services covered include in-home services as well as substance use and mental health services.

Most controversial are the new restrictions on institutional care with the new law creating a standard for Qualified Residential Treatment Program (QRTP). Institutional setting not meeting the requirements and standards will not be eligible for Title IV-E funding.

The final version differs somewhat from the bill that was adopted by the House in the summer of 2016 but generally requires trauma-informed treatment model to facilitates family participation in child’s treatment program (if in child’s best interest), includes family outreach, requires documentation of how the child’s family is integrated into the child’s treatment, includes requirements regarding post discharge services, and requires discharge planning and family-based aftercare supports for at least 6 months after release from the placement.

The QRTP must be licensed and nationally accredited by the Commission on Accreditation of Rehabilitation Facilities (CARF), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), the Council on Accreditation, or others approved by HHS.

If it is determined by an assessment of court order that a QRTP placement is not appropriate for a child, then the state has an additional 30 days from the time that determination is made to transition the child down to another placement or step the child up to a facility that can better address the child’s needs. Some critics had sought a delay to 60 for the court assessment but that was not included in the final legislation. States will be reimbursed during this 30 day period, but states will have to pay the full cost for the child beyond those 30 days if the child remains in a setting that is not appropriate for addressing the child’s needs.

If there is a determination that the QRTP placement is appropriate for a child, it needs to be documented in writing why the child’s needs cannot be met by his/her family or in a foster family with the stipulation that a shortage of foster family homes is not an acceptable reason why a QRTP will provide the most effective and appropriate level of care.

The legislation underwent modifications from the original requirement on having a registered or licensed nursing staff and other licensed clinical staff who can provide care, who are on-site during business hours, and available 24 hours and 7 days a week. The final version made some modifications in terms of the nursing not needing to be employed by the facility and there was added flexibility compared to the original bill that required the 24 hour seven days a week on site nursing. The provision take effect just as the prevention services take effect in FY 2020 but can be delayed by up to two years at state request but that would require a delay in both provisions.

The institutional definition changes are in part a strategy to reduce the reliance on “group homes” but these provisions also served as a way for the legislation to pay for itself.

The other major “pay for” is to re-link Adoption Assistance to the 1996 AFDC eligibility requirement for any child under age 2. The Adoption Assistance program had been delinked from AFDC as a result of the 2008 Foster Connection to Success Act with the delink phased in over ten years. That delink had been completed last October 1, 2017 and all special needs adoption were covered by federal funding but now as a way to help pay for the other potential expansions in the law that age group of infants are now re-linked to the defunct AFDC standards of 22 years ago. States may still provide but those payments but may not be eligible for federal funding (unless qualifying under other means such as sibling groups or SSI).

Requiring child welfare reforms to be budget neutral while being inserted into a budget bill that will likely push this year deficit beyond $1 trillion and more than doubling last year’s deficit show at least a little irony on the part of the 115th Congress.

Other items added into the bill: setting aside $5 million in Child Welfare Services (now funded at $269 million) to help states implement a web-based interstate placement information system, a one-year allocation of $8 million in funds to create competitive grants to increase foster care recruitment, lowers the maximum grants under the RPGs so they go farther—a substitute for the last Obama Administration request that sought an increase from $20 to $60 million to cover the entire nation, allowing states to use Chafee Independent Living Funds to age 23 if the state extends its foster care to age 21, modifies the use of PSSF funds for reunification services beyond the current time limit, extends Chaffee education vouchers to age 26 from current age 23, extends the current Adoption-Kinship Incentive Fund, allows the use of IV-E funds for evidence-based kinship navigator programs, and requires some GAO reports including a report whether states are reinvesting savings from the 2008 Adoption Assistance delink, and another report in 2023 on whether or not a lack of group homes is driving children into the juvenile justice system.

The legislation is seen by many in Washington as a replacement for state waivers that will expire at the end of FY 2019. CWLA will have a more detail description later this week. The text of the bill can be read on approximately page 424 of the CR here.