The Bill Passes

On Wednesday, June 15 the House Ways and Means Committee passed the Family First Prevention Services Act, (HR 5456). The legislation was adopted by a voice vote but only after more than an hour of debate that outlined some of the challenges regarding the proposal and the process. Most members, both Republicans and Democrats, praised the legislation for its efforts to provide funding for upfront services addressing mental health and substance use. The House intends to act on the bill on Tuesday.  The bill and discussion was not without criticism about the funding strategy.

The legislation, which has been endorsed by CWLA and by several groups was criticized by some committee Democrats for its lack of funding outside of child welfare services. Most forceful on this point were Congressman Lloyd Doggett (D-TX) and Congressman Jim McDermott (D-WA).

Potential Expansion

The bill offers a potentially wide expansion and access to Title IV-E entitlement funding for tested and approved mental health, substance use and in-home services not tied to the outdated link to the 1996 AFDC program.  Instead of an income-based eligibility there would be an eligibility based on whether or not the child is at-risk of a foster care placement and considered a “candidate for foster care.”

For these candidates, the child, the parent, guardian or adoptive family would be eligible for services for up to 12 months in a spell.  Services could also be available to a foster youth who is pregnant or parenting.  Services would be limited to promising, supported and well-supported programs with an emphasis on well-supported.  There would not be a limit on the number of 12 month spells in a child or family’s lifetime. These funds could also flow to post-permanence placements including children who are reunified and adoptive families who latter are in need of counseling and other interventions.

A state would have to opt into such funding through an amendment to their five-year state plan outlining services provided, strategies and workforce standards. While 12 months may not be long enough for some program models, funding could provide a vital link or supplement to services that are already drawing on other state and federal dollars.

These new provisions as well as the restrictions regarding institutional care would start in three years.

The bill puts in place restrictions on institutional care.  It amends current definitions of foster care within Title IV-E to include a definition for family foster care homes limited to homes of six or fewer children (with state ability to waive the definition for sibling placements, children with special relationships to the foster parent, and children with disabilities).  In addition, it includes a new definition of child care institutions of 25 or less by creating a definition of qualified residential treatment program (QRTP).  The legislation includes the requirements around the need for a licensed or registered nurse or clinical personal on site during business hours and available 24 hours 7 days a week. A provision that has been criticized by some stakeholders.  It also outlines assessment requirements and treatment plans for the child in such a setting.  It does not require a time-limit in funding as proposed through some earlier proposals but does require rigorous oversight via the courts.

Other pieces of the bill since it includes a reauthorize of the Title IV-B programs:

  • Extension of the adoption-kinship incentive fund
  • Extension of the Regional Partnership Grants of $20 million with adjustments including mandated participation by state substance abuse agencies and new funding allocations
  • Continuation of the $20 million caseworker visit-workforce funds,
  • Expanded Title IV-E eligibility for evidence-based Kinship Navigator programs
  • Increased eligibility for the Chaffee Independent Living program to age 23,
  • Increased eligibility for Chaffee student voucher eligibility to age 26
  • Elimination of the 15-month time-limit on the use of PSSF funds for reunification services,
  • A set aside for a grant to spread the use of the NEICE Interstate Compact expansion initiative
  • Requirements to include evidence of being in foster care as part of the document package for youth that age out (to assist young people eligible for Medicaid to age 26 if they were in foster care)
  • Continues the Court funding which required an offset in funding
  • A new $8 million to create competitive grants that will address foster parent recruitment

The Debate

Chairman Brady praised the bill in his opening remarks by describing the bill as, 

[taking] important steps to keep more children safely at home and out of foster care…Under current law, most federal funding for child welfare is directed toward reimbursing states after they place children into foster care. This is the least desirable outcome… Chairman Buchanan’s bipartisan legislation turns this around by putting resources toward preventative services to keep children safely with their parents or relatives. Most importantly, this bill will help ensure that more children grow up in a safe home, surrounded by a stable family.”

Ranking Democrat Congressmen Sander Levin (D-MI) also offered praise of the overall legislation.  His praise was also echoed by several other members—both Republicans and Democrats.

Congressman Lloyd Doggett however was highly critical of the legislation and the effort, in large measure because of the way it is paid for and the three-year delay in implementation of the new funding.  Doggett had proposed an offset during the negotiation (a way to pay for the bill), through a change in tax filings that would better track alimony payments that sometimes go unreported.  The offset was rejected by majority Republicans on a principle that they will not reallocate such tax savings to human service programs.

Doggett’s concern over it delayed implementation of the services was reinforced by his description of current Texas circumstances.  He said that his home state was in need of critical resources now.  He also pointed to Mississippi which, like Texas, is under a new court order.  He said both are examples of states that are under-resourced.  Doggett outlined three concerns: there is an opioid crisis now and the bill does not provide immediate relief and delays it for three years; Congress’s unwillingness to use outside offsets or revenue to address the great underfunding of child welfare services but is simply reallocating dollars, and three, what he sees as the unfairness of delaying the adoption assistance de-link for two and a half years as a way to pay for the legislation.

Another child welfare champion, who was also critical of the approach but willing to support the bill, was Congressman Jim McDermott (D-WA). During his comments he asked questions of staff that more publicly revealed that the changes to residential care classifications will result in a $900 million saving over 10 years.  McDermott, said that the advocacy community and Republicans had agreed that “we don’t need any more funding for child welfare.” He said that we were “robbing from Peter to pay Paul.”

McDermott highlighted his past experience as a state legislator in saying that the cuts to congregate care would not drive state change and what would happen is that the states that are paying for congregate care would be cut and they would continue use of congregate care.  McDermott said that unless you had a very big hammer it would not drive state policy.   In part this is the case, he argued, because there were so many other priorities for state legislators like education, tuition for universities and infrastructure.

Doggett was a little kinder to advocates saying. “I understand the praise by advocates because they are starving for resources and today they get at least something in the future.” He praised Senator Wyden and his legislation (Doggett had introduced the same bill in the House) and he said he was willing to accept the Senator’s decision to reduce the coverage of that original bill but had hoped for something closer to that original bill (S 1964).

Budget Scoring and Residential Issues

Another criticism of the legislation was by Congressman Tom Price (R-GA).  He raised a budget issue. Although this legislation meets the required tests of being “paid-for” over the next five years and the next ten years, the Congressman raised an issue that could create a point of order to stop the bill if he pursues it and cannot come to an agreement on budget calculations.   He argues that it might increase the deficit beyond ten years from now.  The core argument is a somewhat arcane issue in that is usually is not raised except by members of Congress who are seeking to stop legislation.

As if on cue, the Committee, after passing the child welfare bill, passed two health care related bills, HR 3590 and HR 5452 which have a total budget cost of $50 billion.  One deals with health savings accounts while the other targets part of the ACA. The bills are not paid for but passed the Committee.  Not the first time the Committee has held tax changes to a different spending test than child welfare. The irony was a point highlighted by several committee Democrats including Ranking Member Levin.

Congressman Adrian Smith (R-NE) raised an issue that has resonated with some critics.  His specific concerns dealt with the requirement that there be a registered or licensed nurse on site during business hours. During his commentary Congressman Smith entered into a colloquy with the bill sponsor and Chairman of the Human Resources Subcommittee, Congressman Vern Buchanan (R-FL). That colloquy was an understanding to work further on the issue as the legislation moves forward.

Other members speaking in praise of the legislation included Congressman Danny Davis (D-IL) who highlighted the need for better support for kin families noting that this also provides Title IV-E funding for evidenced based kinship navigator programs. Congressman David Reichert (R-WA) also was in praise of the overall bill but raised some questions about how it will impact and some of the pediatric care centers in his district. Congresswoman Linda Sanchez (D-CA) was also in praise of the bill saying it was not perfect but it was an important bill that would help to address some of the needs for prevention services. Congressman John Larson (D-CT) and Congressmen Bill Pascrell (D-NJ) also both voiced their support of the legislation although Congressman Larson mentioned that he was moved by some of his colleague’s criticisms of the of the child welfare funding strategy that didn’t allow for funding outside sources of support.

Next Steps

The next steps are for this bill to be moved to a floor vote by the full House as early as Tuesday.  In the meantime, a Senate version, S 3065, was introduced on Friday by Senators Hatch (R-UT), Wyden (D-OR), Bennett (D-CO) and Grassley (R-IA). With a House vote accomplished it would have a much better chance in the Senate.