Child Welfare Conference

Maximizing Funding Streams

Elliott RobinsonMay 29,2008

Child Welfare Services Funding

Federal Funds40%

State Funds34%

County Funds26%

$1.9 billion

$1.6 billion

$1.2 billion

Total funding: $4.7 billion annually

Breakdown of Federal Funding

Title IV-E80%

TANF9%

Title IV-B4%

Other7%

Total federal funding: $1.9 billion annually

Where does the Money Go?

Direct Costs7%

Out-of-Home Care57%

Casework/Support Staff

36% $1.7 million $2.7 million

$0.3 million

Major Child Welfare Allocation

Funding SourcesCWS 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-SPMP’s 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

Title IV-E ChallengesClaims 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.

Title XIX RulesAny 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.

Title XIX SPMP Rules

(i) 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; (ii) The skilled professional medical personnel have professional education and training in the

field ofmedical care or appropriate medical practice. ``Professional education and training'' means thecompletion of a 2-year or longer program leading to an academic degree or certificate in amedically 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 certifyingorganization or a degree in a medical field issued by a college or university certified by aprofessional medical organization. Experience in the administration, direction, or implementationof the Medicaid program is not considered the equivalent of professional training in a field ofmedical care. (iii) The skilled professional medical personnel are in positions that have duties and

responsibilitiesthat require those professional medical knowledge and skills. (iv) A State-documented employer-employee relationship exists between the Medicaid agency

and the skilled professional medical personnel and directly supporting staff; and (v) 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 theprofessional medical responsibilities and functions of the skilled professional medical staff. Theskilled professional medical staff must directly supervise the supporting staff and the

performanceof the supporting staff's work.

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:

Revenue Maximization - 1Braiding 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, earlyintervention, post-permanency Differential Response Family-to-Family Initiative California Connected by 25 Guardian Scholars

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

CWD Cost Allocation Plan

GENERIC OVERHEADSpace, Supplies, Consultation, Communications

GENERIC SALARIESDirector, Finance, HR

Functional Support Salaries

CalWORKs/OPA/Child Care Social Services

Line Salaries

Eligibility Employment Fraud Social Worker

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CW MC FS GA WTW FSET CW FS CWS Adop IHSS APS

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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

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

Case Management Services (Cont.)

Cost per social workerBased on 2001-02 costs per worker

Caseworker Ratios Based on outdated caseload standardSB 2030 Workload Study

recommended lower caseloads

SB 2030 Workload Study

Activity

Existing Standard

(add 1 supervisor for every 7 FTE)

Recommended Standard

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

Reunification27 15.58 11.94

Permanent Placement

54 23.69 16.42

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)

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

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

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 child’s 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

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

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

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

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 month’s rent and security deposit for

FR cases – if Title IV-B/county overmatch available

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)