Child Welfare Conference Maximizing Funding Streams

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Child Welfare ConferenceMaximizing Funding
Streams
Elliott Robinson May 29,2008
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Child Welfare Services Funding

• Total funding 4.7 billion annually

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Breakdown of Federal Funding

• Total federal funding 1.9 billion annually

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Where does the Money Go?
1.7 million
2.7 million
0.3 million
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Major Child Welfare Allocation Funding Sources
CWS Allocation CWS Allocation
Title IV-E Case Mgt for children in FC or determined to be at imminent risk and staff development for staff administering State plan and caregivers. Prorated by proportion of caseload that is meets Federal eligibility. Federal share is 50 of case mgt and 75 for training. Open ended
Title IV-B Flexible to meet elements in State plan. Used up quickly on direct services (e.g. counseling, community contracts) and case management for non-IV-E eligible children. Can be used for prevention and after care. Capped
Title XIX Health related Medi-Cal administration Federal share is 50. If SPMP is performing specialized work not assigned to non-SPMPs then the Federal Share is 75. Open ended
TANF Emergency assistance related efforts, includes hotline, investigations before imminent risk is established and shelter. Federal Share 82. Capped
Title XX State General Fund backfill.
SGF Flexible to meet elements in State plan. State share is 70 of non-Federal costs (noting exceptions for TANF and Title XX). Capped
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Title IV-E Challenges
Claims for Federal matching funds based on
training, data collection, case management, and
other administrative costs on behalf of otherwise
eligible children who are placed in settings
ineligible for Title IV-E funding are available
in only two circumstances (1) In the case of a
child who is placed in the home of a relative who
is not a licensed foster care provider, for 12
months or as long as it takes a State to normally
license a foster family home (whichever is
shorter) and (2) In the case of a child who is
moved from an ineligible facility (e.g. juvenile
detention center) to a licensed foster family
home or an eligible child care institution, for
no longer than 30 calendar days. In the case of
a child who is at imminent risk of removal to
foster care the State may only make
administrative claims if (1) Reasonable efforts
are being made to prevent the removal of the
child from the home or (if necessary) to pursue
the removal and (2) Not less than every 6 months
the State determines that the child continues to
be at imminent risk of removal. In other words,
Title IV-E is VERY limited. Prevention work,
hotline and investigation before imminent risk is
determined are not eligible for Federal IV-E
reimbursement. Nor are efforts to manage
services for children who are in an ineligible
placement (runaway, hospital, juvenile hall) if
the child is not back in an eligible placement
within 30 days.
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Title XIX Rules
Any activity to help children who are Medi-Cal
eligible, or potentially eligible,including all
foster children, gain access to services covered
by the DHS Medicaid plan in order to attain or
maintain a favorable physical or mental health
condition. These activities will not duplicate
TCM activities provided through the DHS Medicaid
plan. Such activities include, but are not
limited to

• Assisting Medi-Cal eligible children in
  identifying and understanding their health needs
  in order to secure and utilize treatment and
  health maintenance services covered by Medi-Cal
• Facilitating the Medi-Cal eligibility
  application, by explaining the Medi-Cal
  eligibility rules and the eligibility process to
  parents/guardian of prospectively eligible
  children assisting such applicants to fill out
  the eligibility applications gathering
  information related to the application and
  eligibility determination or redetermination from
  the client, including resource information and
  third party liability information, as a prelude
  to submitting a formal Medi-Cal application to
  the county welfare department providing
  necessary forms and packaging all forms in
  preparation for the Medi-Cal eligibility
  determination.
• Development, implementation and management of
  care plans for Medi-Cal eligible children for
  their health-related needs covered by Medi-Cal
• Referrals to other agencies and programs in order
  to meet the Medi-Cal covered health care needs of
  Medi-Cal eligible clients
• Statistical reporting
• Outreach activities to Medi-Cal eligibles or
  potential eligibles to communicate about
  available Medi-Cal services and programs and
• Liaison activities with Medi-Cal providers to
  facilitate case planning.

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Title XIX SPMP Rules
The rate of 75 percent FFP is available for
skilled professional medical personnel and
directly supporting staff of the Medicaid agency
if the following criteria, as applicable, are
met

• The expenditures are for activities that are
  directly related to the administration of the
  Medicaid
• program, and as such do not include expenditures
  for medical assistance
• The skilled professional medical personnel have
  professional education and training in the field
  of
• medical care or appropriate medical practice.
  Professional education and training'' means the
• completion of a 2-year or longer program leading
  to an academic degree or certificate in a
• medically related profession. This is
  demonstrated by possession of a medical license,
  certificate,
• or other document issued by a recognized National
  or State medical licensure or certifying
• organization or a degree in a medical field
  issued by a college or university certified by a
• professional medical organization. Experience in
  the administration, direction, or implementation
• of the Medicaid program is not considered the
  equivalent of professional training in a field of
• medical care.
• The skilled professional medical personnel are in
  positions that have duties and responsibilities
• that require those professional medical knowledge
  and skills.
• A State-documented employer-employee relationship
  exists between the Medicaid agency and
• the skilled professional medical personnel and
  directly supporting staff and
• The directly supporting staff are secretarial,
  stenographic, and copying personnel and file and
• records clerks who provide clerical services that
  are directly necessary for the completion of the
• professional medical responsibilities and
  functions of the skilled professional medical
  staff. The
• skilled professional medical staff must directly
  supervise the supporting staff and the
  performance

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Revenue Maximization - 1

• Braiding Funding
• Proposition 63
• EPSDT
• Working with community partner agencies to draw
  down MAA/TCM
• Average daily attendance with education
  institutions
• Proposition 10
• WIA for ILP support
• Philanthropy ( 20 m/year) support for
  prevention, early
• intervention, post-permanency
• Differential Response
• Family-to-Family Initiative
• California Connected by 25
• Guardian Scholars

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Revenue Maximization - 2

• Prevention and reinvestment to diminish
  out-of-home care costs. Use NCC and revenues
  that otherwise would go to placement to sustain
  prevention, after care and improved case
  management
• Wrap-around
• SSI Advocacy
• Use realignment for more than the FC entitlement
  cost
• Linkages with CalWORKs and other assistance
• Share ideas and strategies with colleagues

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CWD Cost Allocation Plan
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Annual State Budget Process

• Three primary components
• Out-of Home Care Costs and Adoption Subsidies
• Case Management Services
• Ancillary Services
• State and county share non-federal costs of
  program
• Child Welfare Services 70 state/30 county
• Foster Care 40 state/60 county
• Adoption Assistance 75 state/25 county
• Kin-GAP 50 state/50 county (no federal )
• THP 100 state
• Counties generally overmatch required minimum
  spending

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Case Management Services

• Caseload-driven but capped
• Caseload-per-worker yardstick for each
  component
• Hold Harmless and augmentation
• Funds can be spent across components
• Based on cost per social worker

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Case Management Services (Cont.)

• Cost per social worker
• Based on 2001-02 costs per worker
• Caseworker Ratios
• Based on outdated caseload standard
• SB 2030 Workload Study recommended lower caseloads

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SB 2030 Workload Study
Activity Existing Standard(add 1 supervisor for every 7 FTE) Recommended Standard Recommended Standard
Activity Existing Standard(add 1 supervisor for every 7 FTE) Minimum Optimal
Hotline Staff 320 116.1 68.7
Emergency Response 15.8 13.03 9.88
Family Maintenance 35 14.18 10.15
Family Reunification 27 15.58 11.94
Permanent Placement 54 23.69 16.42
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Ancillary Services

• Mostly small, categorical funds
• Typically pass-through of federal funds or state
  General Fund appropriations targeted toward
  specific purposes
• Examples include
• Kinship Supportive Services Program (KSSP)
• Child Abuse Prevention, Intervention and
  Treatment (CAPIT)
• CWS Outcome Improvement Project
• Promoting Safe and Stable Families (PSSF)
• Services for emancipating youth (ILP, THP)

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Common Services CWS Brokers

• Substance abuse treatment
• CWS refers to county Alcohol and Drug department
• Limited entitlement through Medi-Cal
• Limited funding for services
• No statewide priority for CWS clients
• Limited range of services
• CWS also contracts directly with service
  providers

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Common Services CWS Brokers

• Domestic violence services
• No entitlement funding
• Services through local community-based
  organizations
• Funded with fees on marriage licenses, other
  minor sources
• CWS pays any fees charged to perpetrator

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Common Services CWS Brokers

• Mental health services
• Children are entitled to full-scope Medi-Cal
• Includes medically necessary EPSDT services
• Assessments and therapy for diagnosed conditions
• Prevention/early intervention also provided via
• Proposition 10 (for kids aged 0-5 and families)
• Proposition 63
• Available Title IV-B/county overmatch, for
  services not covered by Medi-Cal or not medically
  necessary
• No entitlement for parents unless they are
  otherwise Medi-Cal eligible
• Can receive indirect MC services via childs
  treatment plan
• Independent assessments - not MC reimbursed
• Other options
• Prop 63 programs and SAMHSA grants
• CalWORKs quasi-entitlement if in Welfare to Work
• CWS purchases with available Title IV-B/county
  overmatch

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Common Services CWS Brokers

• Education for children with learning disabilities
• All children
• Entitlement to education
• Entitlement to special education services
• Foster children
• Right to remain in school of origin
• Right to immediate enrollment in new school
• Transfer of records within two business days
• Many foster children need
• IEPs for special education
• Frequent transfer of records
• Tutoring
• Transportation to and from school
• Access to education services has been a major
  challenge
• Foster Youth Services is very effective model
• Recent augmentation has helped
• Not funded to fully serve every child who could
  benefit

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Common Services CWS Brokers

• Health care for the children
• For foster children
• Entitled to full-scope Medi-Cal and EPSDT
• Services through CHDP for regular exams,
  preventive care
• Public Health Nurses in child welfare and
  probation agencies
• For parents
• Not entitled to Medi-Cal when children removed
• Must continue to meet eligibility requirements on
  their own
• Finding providers, particularly specialists, is
  often a challenge

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Common Services CWS Brokers

• Regional Center services
• Entitlement for children with developmental
  disability (or at risk if aged 0-3)
• Conduct intake and assessment for services
• Services driven by individualized plan
• Regional Center purchases or secures services not
  paid for by foster care
• Children in both systems are called dual agency
• Lack of homes to serve these children
• Out-of-home care (not services) paid with foster
  care funds
• State law makes Regional Center payer of last
  resort

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Common Services CWS Brokers

• Housing
• Case plans often require parents to secure safe
  and stable housing, but only limited assistance
  is available
• HUD programs (i.e., Section 8)
• Eligibility based on income
• Long waiting lists
• No priority for CWS families
• Involvement with CWS can undermine housing
  assistance
• CWS may pay first/last months rent and security
  deposit for FR cases if Title IV-B/county
  overmatch available

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Common Services CWS Brokers

• Employment assistance for parents
• Services (not grants) to families in both
  CWS/CalWORKs
• Employment services and training
• Substance Abuse treatment
• Mental Health treatment
• Domestic Violence services
• Housing assistance (generally limited to once in
  a lifetime)
• Workforce Investment Act may be available
• Federal grant, limited funding
• Target populations (CWS families are not
  targeted)