On Tuesday, April 17 the Los Angeles County Board of Supervisors sponsored a briefing on Capitol Hill. The briefing, “The Path Forward on the Affordable Care Act, Child Welfare and Title IV-E Waivers, included remarks by Democratic Leader Nancy Pelosi (D-CA), Congressman Tony Cárdenas (D-CA) and Congresswoman Judy Chu (D-CA). The event was moderated by Wendell Primus, Senior Policy Advisor to Leader Pelosi.
The initial comments and discussion focused on preserving the Affordable Care Act with the Democratic speakers all highlighting their opposition to past efforts to repeal the ACA in this Congress. After some initial comments by Pelosi, Mr. Primus offered comments on what is needed in health care, particularly the growing need to address the future increased demands for long term care linked to the aging baby-boom population. He then turned his remarks to the Family First Act (PL 1115-123). Many Californians, both state and county officials as well as advocacy groups, had serious reservations about the legislation and Primus was one of the key staffers to get the legislation inserted into the budget agreement in February. He defended the effort and listed several changes that were made to the earlier drafts based on California concerns. In his later remarks he responded to comments by several of the five county supervisors regarding the need to preserve the Title IV-E foster care waivers. The supervisors argued for an extension and made the case that Los Angeles County has made progress since its 2006 waiver in serving families better. Mr. Primus indicated that waivers are unlikely to happen or get renewed when they expire next year.
LA County and a few other California counties have waivers dating back to 2006. California along with the state of Florida received a waiver in 2006 before the authority expired that year. They essentially amount to a block-granting of Title IV-E foster care funding based on what at that time was the projected cost of foster care for a five-year period.
The waiver authority was renewed again in 2011 with the provision that up to 30 states being allowed to apply for the waivers. At the time in 2011, key legislative staff argued it would not be extended when that authority expired. The waivers are supposed to be conducted along with a rigorous evaluation although results are not clear. According to the last Child Trends Survey of state spending:
“Ten percent of Title IV-E waiver funds spent by states in SFY 2014 (roughly $100 million) were used to support services/activities that are not traditionally funded via Title IV-E (e.g., prevention services, parenting services, and kinship supports). The remaining 90 percent were spent on activities (e.g., maintenance payments and case worker activities on behalf of children in care) that would be permitted without a waiver. However, states did use almost one third of the waiver funds (32 percent) on activities for children who, without the waiver, would not have been eligible for traditional Title IV-E support due to income, placement type, or how they came into foster care.”
The states that received waivers have generally received what are call capitated payments or block grants spread out over the period of the waiver. States that have them have been advocating for a continuation arguing that they’ve made progress in terms of child welfare services. States like Florida have have argued that the reduction in their foster care numbers is due to the flexibility of funding they received but many of those states are now experiencing increased caseloads despite the continued waivers.
Authors and supporters of the Family First Act argue that the new services available through Title IV-E should be enough flexibility to meet current state waiver needs. A bigger hurdle for states looking for an extension is that it is expected that the CBO will project a significant cost to any renewal. Congress is very reluctant to pass any child welfare legislation unless it is paid for by cuts in other human services and more recently within other parts of child welfare. A waiver extension that costs several hundred million dollars over five years will be very difficult to extend. There may be an additional challenge, the Family First Act allows states that have a waiver in effect, to supersede requirements under Family First.