Holding Pattern in Senate
The Senate comes back mid-week for the waning days of the summer session. Plans are to depart by July 15 with no return until post-Labor Day. As a result, last week there were on-going discussions involving various organizations, foundations, and government representatives with some state and local governments and advocacy groups to develop consensus on the Family First Prevention Services Act, (HR 5456) bill without changing it.
In conversations between states and advocates and various leaders from Congress and the Administration there have been assurances that there is HHS flexibility on some of the issues that have raised concerns. There have been assurances that there would be a colloquy—an on the record conversation or dialogue in a publication of record such as the Congressional Record—between Senator Orrin Hatch (R-UT) and Senator Ron Wyden (D-OR) regarding how there is flexibility in how some of the on-sight nurse requirements are interpreted by HHS. There has also been an explanation from congressional staff on how the state required maintenance of effort (MOE) spending is calculated with an understanding the required state MOE would only apply to funds spent on the prevention of foster care placements as opposed to the larger category of child abuse prevention.
The discussions are taking place against a backdrop of concern that a change in the bill language would change the CBO calculation of the cost and any change would require a second voice vote in the House. The quickest route for the Senate would be to take up the House bill unchanged and vote on it through unanimous consent. That would require all 100 senators to at least not object. If there are objections there is not much time for other strategies. September also looks like a limited opportunity with rumors that a nervous House would have very few days in session.
Leading groups raising objection include some states and counties particularly in California where a number of parties have expressed concern about the impact on that state’s current reform initiatives. Those concerns include the bills impact on future Title IV-E foster care eligibility for some children in placements during the 12 month services period and whether they would remain eligible for IV-E foster care. They have also raised questions about the bill’s impact on how the new foster care definitions would impact current juvenile justice placements and the impact on IV-E funding for youth transitioning out of foster care at 16. Some states are also holding out hope for an extension of the current Title IV-E waiver authority, which has not been under consideration and is opposed by several congressional offices.
Bill Passes House-REVISED July 3
The House of Representatives passed the Family First Prevention Services Act, (HR 5456) by a voice vote. That happened on Tuesday, June 21 as part of the House suspension calendar which is a House method of moving bills more quickly. There was limited commentary by Republican supporters led by Congressman Vern Buchanan (R-FL), the bill sponsor who offered up positive comments. On the Democratic side the commentary was limited to Congressman Sander Levin (D-MI), Congressman Lloyd Doggett (D-TX) and Congressperson Karen Bass (D-CA).
The legislation, which has been endorsed by CWLA and by several groups will now move over to the Senate. A Senate version, S 3065, was introduced on Friday, June 17 by Senators Hatch (R-UT), Wyden (D-OR), Bennett (D-CO) and Grassley (R-IA).
The commentary by Democrats largely reflected earlier statements by some committee Democrats for its lack of funding outside of child welfare services. Congressman Levin repeated the support that he offered in Committee the week before while most of the time was used by Congressman Lloyd Doggett (D-TX). Doggett repeated his concerns about the funding offsets and the lack of immediacy in implementing the upfront intervention services.
Representative Bass used her time to offer support but also raised concerns on the need to address some of the issues that bill is raising in the nation’s biggest state. California stakeholders, in the midst of a major reform that seeks to eliminate the use of group or congregate care, have expressed concerns around the mandates regarding nurse coverage (on site during business hours), some of the screening provisions that they feel do not align with their own best-practice designs and the new definitions that limit the use of Title IV-E funds for youth 16 or older aging out of foster care or transitioning from juvenile justice placements.
The Budget Costs
Before the bill was adopted the Congressional Budget Office (CBO) score or cost calculation was released. The CBO score indicates that the cost of expansion is more than offset and actually results in $66 million in federal savings over the ten-year required budget scoring time-period. The cost is offset by the restrictions in residential/group care and the delay in the adoption assistance delink. The cost includes $1.3 billion in up-front services which start in FY 2020. The ten-year cost calculation is for the entire ten-year period but most of the federal costs is incurred between the 2020 to 2026-time period. Additional costs of the legislation are a continuation of the Court Improvement Program (CIP) at $20 million a year for five years, funding for evidence-based Kinship Navigator programs costing $3 million next year rising to the $15 to $17 million range by 2022 and a one-time grant of $8 million for grants to states to promote foster parent recruitment. Almost all savings are from the restrictions and new definitions of institutional care ($910 million) and the delay in the adoptions assistance de-link for children 3 through infancy ($720 million)
In regard to a criticism of the legislation expressed by Congressman Tom Price (R-GA) that although the legislation meets the “paid-for” over the next ten years but after the ten years it increases the deficit, CBO did weigh-in. CBO indicated that in the ten year periods beyond 2057 (i.e. between 2057-2067) it could increase the deficit by possibly more than $5 billion in the second half of the 21st century.
Hopes For New Intervention Funding
Many advocates, congressional supporters and the Administration see the legislation as offering 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.
These new provisions as well as the restrictions regarding institutional care would start in FY 2020 which starts on October 1, 2019. Programs funded would have to meet promising, supported and well-supported programs as defined in the bill. By October 1, 2018 HHS would issue guidance on the practices criteria required for services or programs to satisfy the law’s requirements. HHS would also provide a pre-approved list of services and programs that meet the requirements around promising, supported and well-supported.
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.
Many but not all of the concerns raised revolve around the new definitions the bill puts in place regarding 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). Current IV-E definitions simply define residential care as child care institutions of 25 or less. The legislation includes the requirements around screening, planning and oversight and of particular criticism is the provision that requires a licensed or registered nurse and clinical personal on site during business hours and available 24 hours 7 days a week.
Title IV-B Programs Reauthorization
The legislation reauthorizes the two Title IV-B programs which are set to expire by October 1. Child Welfare Services (CWS) is annually appropriated and is now down to $269 million a year. Promoting Safe and stable families (PSSF), which includes the CIP is set at $345 million in mandatory funds and $69 million in appropriated funds. The bill extends the two programs and makes some age changes to the Chaffee Independent Living Program. To extend the court funding requires Congress to find $20 million a year because CBO considers it “new” spending despite the fact it is a continuation of the same program. Changes include:
- Extension of the adoption-kinship incentive fund (part of IV-E) continue the same formula for awards set in 2014.
- 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,
- Increased eligibility for the Chaffee Independent Living program to age 23 (IV-E),
- Increased eligibility for Chaffee student voucher eligibility to age 26 (IV-E)
- 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 (CIP)
- A new $8 million to create competitive grants that will address foster parent recruitment