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Florida’s Path Forward: Post Title IV-E Waiver and Family First Prevention Services Act (FFPSA)

Learn about Title IV-E fund categories, administration, and allowable costs for foster care maintenance under the FFPSA. Discover the basics of IV-E eligibility requirements and the implications of the waiver for child welfare in Florida.

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Florida’s Path Forward: Post Title IV-E Waiver and Family First Prevention Services Act (FFPSA)

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  1. Florida’s Path Forward: Post Title IV-E Waiver and Family First Prevention Services Act (FFPSA) July 2019

  2. Agenda • Refresher on Title IV-E • Path Forward Initiatives • FFPSA • Additional Federal Guidance • Florida Activities / Next Steps

  3. Refresher on Title IV-E

  4. The Social Security Act

  5. Title IV

  6. Foster Care Fund Categories • Maintenance Payments • “Administration” • SACWIS • Training • Demonstrations

  7. Basic Requirements of IV-E To be eligible under IV-E, expenditures must be: • On behalf of an eligible child: • Who meets certain removal and placement standards, and • Who’s family at the time of removal would have been eligible for AFDC on July 16, 1996. • Who resides in an eligible setting: • A licensed family foster home, or • A licensed child care institution.

  8. Foster Care AdministrationPenetration Rate X 50% with some exceptions • In-Placement Administration • Case Planning and Management • Eligibility Determinations* • Provider Management • Agency Management • Candidate Administration Costs

  9. Allowable Administrative Costs (1) Eligibility, fair hearings and appeals (2) The following are examples of allowable administrative costs necessary for the administration of the foster care program: (i) Referral to services; (ii) Preparation for and participation in judicial determinations; (iii) Placement of the child; (iv) Development of the case plan; (v) Case reviews; (vi) Case management and supervision; (vii) Recruitment and licensing of foster homes and institutions; (viii) Rate setting; and (ix) A proportionate share of related agency overhead. (x) Costs related to data collection and reporting.

  10. Non-Allowable Administrative Costs (3) Allowable administrative costs do not include the costs of social services provided to the child, the child's family or foster family which provide counseling or treatment to ameliorate or remedy personal problems, behaviors or home conditions.

  11. Foster Care Maintenance(Cost times FMAP for IV-E Eligible Childrenin IV-E Eligible Settings) The term “foster care maintenance payments” means payments to cover the cost of (and the cost of providing) food, clothing, shelter, daily supervision, school supplies, a child’s personal incidentals, liability insurance with respect to a child, reasonable travel to the child’s home for visitation, and reasonable travel for the child to remain in the school in which the child is enrolled at the time of placement. In the case of institutional care, such term shall include the reasonable costs of administration and operation of such institution as are necessarily required to provide the items described in the preceding sentence Separate FMAP for Maintenance paid under State-Tribal Agreements

  12. Foster Care MaintenanceFrom Child Welfare Policy Manual (CWPM), continued • (3) Reasonable costs of administration and operation in an eligible institution: Factors related to the allowability of costs therefore include:  • (a) The institution must meet the definition of a "child-care institution" in section 472 (c)(2) of the Act. Costs borne by child placing agencies are not eligible for FFP.  • (b) The costs of administration and operation must be "necessarily required to provide the items described in [paragraph 475 (4)]." Thus, the proportional cost of a bookkeeper, food workers, and supervisor of cottage parents for the institution would be allowable. The costs of providing counseling or diagnosis of illness by a social worker or nurse or costs of the staff of a parent agency not employed by the institution would not be allowable.  • (c) The costs must be "reasonable", that is, no more than the customary costs for performing similar functions in similar institutions, e.g., in size, and type of children, such as handicapped children.  • (e) The costs must be allowable under 45 CFR Part 75 (Uniform Administrative Requirements)

  13. What is this thing we call Waiver? • Requirements for an “eligible child” and an “eligible placement” were waived so that Title IV-E funds could be spent on any child / family and any child welfare purpose • In exchange, Florida agreed to a capped allocation with annual automatic increases plus “triggers” to adjust the allocation if actual levels significantly exceeded estimates • All waivers must end 9/30/2019

  14. Bottom line • Without the Title IV-E Waiver, we can only claim Title IV-E for children: • In licensed care only (i.e. family foster home, residential group care) • Who met all of the Title IV-E requirements • For room and board and related costs only (e.g. case management and related functions) We cannot claim for: • Children placed in unlicensed settings (e.g. relatives, non-relatives) • Children remaining with parents including those who have been reunified • Social services such as mental health assessments, parenting, etc.

  15. Path Forward Initiatives

  16. Path Forward Overview/Initiatives When Florida transitions back to traditional Title IV-E claiming, we will be unable to earn $90m of our current Title IV-E Foster Care budget • 42% of waiver funds are spent on non-IV-E eligible services – 42% of $188m = $80m we can’t earn • Reduced eligibility rate since waiver began, outdated cost allocation practices results in $10m we can’t earn • Initiatives – “Expanding the IV-E Footprint” • Extended Foster Care – eliminates $7m deficit in Independent Living • Level 1 Licensing / Guardianship Assistance – about $20m* • Candidacy – about $40m* • Eligibility rate improvement – about $10m • Remaining $20m gap was funded during last session by recurring general revenue

  17. Title IV-E AdministrationAs-is - $90m gap 68% eligibility rate + 50% Federal Financial Participation

  18. Title IV-E AdministrationCandidacy – close gap by $40m 68% eligibility rate + 50% Federal Financial Participation 68% eligibility rate + 50% Federal Financial Participation

  19. Title IV-E AdministrationLevel 1 Licensing – close gap by $20m 68% eligibility rate + 50% Federal Financial Participation 68% eligibility rate + 50% Federal Financial Participation

  20. Title IV-E AdministrationEligibility Rate Improvement – close gap by $10m 72% eligibility rate + 50% Federal Financial Participation 72% eligibility rate + 50% Federal Financial Participation

  21. Path Forward Title IV-E Candidacy

  22. Administrative Costs for “Candidates” State option that allows claiming for children who are at imminent risk of removal from the home, only if— (A) reasonable efforts… are being made to prevent the need for, or if necessary to pursue, removal of the child from the home; and (B) the State agency has made, not less often than every 6 months, a determination (or redetermination) as to whether the child remains at imminent risk of removal from the home.

  23. Florida’s Approach to Candidacy Identification of candidate: When present or impending danger are identified, Florida Statute indicates 2 options – remove child or implement safety plan with caretakers to prevent removal. Therefore, any child with a safety plan receiving in-home services should meet definition (including reunifications) Documentation of candidate: Current safety plan that has been updated within prior 6 months At a minimum, all children who are being served in-home and considered unsafe (including reunifications) should meet the definition of a foster care candidate

  24. Path ForwardLevel 1 Licensing and Title IV-E Guardianship Assistance Program (GAP)

  25. Guardianship Assistance Program - Overview • The "Guardianship Assistance Program" is a program that provides benefits to a child's guardian on behalf of the child. Benefits may be in the form of a guardianship assistance payment, a guardianship nonrecurring payment, and / or Medicaid coverage. • Similar to the current Relative & Non-Relative Caregiver Program. • Available when a relative/fictive kin agrees to accept permanent guardianship of a child in foster care, as long as the caretaker has been licensed as a foster parent for 6 months. • Payments continue until the child turns 18 years old as long as the guardian has custody of the child. • Annual re-determinationrequired.

  26. Guardianship Assistance Program – Florida Implementation • Created Level 1 license option available to all relatives / fictive kin • Child specific • Non-safety requirements can be waived • Monthly payments amount to $333 per month vs current program of about $260 per month • Reduced training requirements • Process may begin immediately upon placement of child – do not have to wait for adjudication so benefits may begin sooner. • A family is still eligible for benefits if the child and caregiver live or move out of state • Available as long as relative has custody of child (i.e. until child is reunified, changes placement, or relative accepts permanent guardianship and moves to GAP program)

  27. Family First Prevention Services Act (FFPSA)

  28. FFPSA - Overview • The Family First Prevention Services Act was passed into law on February 9, 2018 as part of the Bipartisan Budget Act of 2018. • The law expands the use of federal Title IV-E child welfare entitlement dollars to prevent entry into foster care, and it restricts funds for out-of-home care that is not a foster family home.

  29. FFPSA - Impact Areas • Prevention Services Provisions • Congregate Care Provisions • Other Provisions • IV-B Changes

  30. Prevention Services – the Option • Allows states to receive open-ended entitlement (Title IV-E) funding for evidence-based prevention services • Who: Children at imminent risk of placement in foster care and their parents or kinship caregivers, and pregnant and parenting youth in foster care are eligible. • No income test for eligibility • What: Eligible prevention services are mental health, substance abuse treatment, and in-home parenting skills • How Long: Services are allowable for up to 12 months, with no limit on how many times a child and family can receive prevention services if the child continues to be at risk of entry into foster care. Services must be evidence-based and trauma informed.

  31. Prevention Services – the Funding When: Title IV-E reimbursement for eligible prevention services can begin on October 1, 2019, if state chooses option. Delinking Eligibility from AFDC: The new Title IV-E prevention services, as well as training and administrative costs associated with developing these services, has no income test. Non-Supplantation: New federal funds for prevention services are intended to augment, not supplant, state funding for prevention services. MOE: MOE will be set at FY2014 spending for these same prevention services for candidates for foster care. Federal reimbursement: 50% initially, then moves to FMAP

  32. More about Prevention Services • Must be performed under a trauma-informed framework • Must meet general practice requirements • Must meet the requirements for being a promising, supported, or well-supported practice • At least 50 percent of the expenditures for provision of prevention services and programs in each FFY must be for those that meet the “well-supported” practice criteria

  33. Candidacy Comparison

  34. Ensuring Appropriate Placements in Foster Care – the Limitation When: Effective October 1, 2019, however, a state may delay for up to 2 years but the OPTION for prevention services claiming cannot be selected until the limit on RGC is implemented Federal Reimbursement: FMAP for eligible children after 2 weeks in care only if in a specified setting

  35. Foster Family Home – per Program Instruction • The statute now limits the definition of foster family home to a “home of an individual or family,” and requires that the foster parent resides in the home with the child. This means that the term may no longer include “group homes, agency-operated boarding homes or other facilities licensed or approved for the purpose of providing foster care...” as previously permitted in the regulatory definition at 45 CFR 1355.20(a) if that facility is not the home of an individual or family.

  36. Types of “non-Foster Family Homes” Not Specified Specified Settings Prenatal Postpartum or Parenting Supports Licensed Residential Family- Based Treatment Facility Qualified Residential Treatment Program (QRTP) Victims of or At Risk of Sex Trafficking Supervised Independent Living(age 18+)

  37. Not Specified Setting Not Specified Specified Settings • Beginning with the third week of placement, no federal funds are to be made for maintenance in a setting that is not a specified setting or a licensed residential family-based treatment program for substance abuse • Federal funds for administrative costs remain available for traditionally allowable costs including case management • Costs for the administration and operation of a facility are part of the maintenance payment and not allowable, beginning with the third week

  38. Licensed Residential Family-Based Treatment Facility for Substance Abuse Not Specified Specified Settings • Child is eligible for maintenance payments without regard to AFDC eligibility • For a period of not more than 12 months • Placement and care requirements remain in effect • Recommendation for placement specified in the child’s case plan before placement • Treatment facility provides, as part of the treatment for substance abuse, parenting skills training, parent education and counseling • The facility must be licensed but the IV-E licensing and background check requirements for CCIs do not apply • The maintenance payments may not include costs of administration and operation of the facility

  39. Supervised Independent Living Not Specified Specified Settings • For youth age 18 and older • A title IV-E agency has the discretion to develop a range of supervised independent living settings which can be reasonably interpreted as consistent with the law, including whether or not such settings need to be licensed and any safety protocols that may be needed • For example, a title IV-E agency may determine that when paired with a supervising agency or supervising worker, host homes, college dormitories, shared housing, semi-supervised apartments, supervised apartments or another housing arrangement meet the supervised setting requirement” (section 472(k)(2)(C) of the Act).

  40. Prenatal, Postpartum or Parenting Supports Not Specified Specified Settings • The facility must meet the statutory definition of a Child Care Institution (private institution or public institution with not more than 25 children which is licensed by the state) • The statute does not provide additional parameters for placing a child in this setting and the Children’s Bureau is not defining it further.

  41. Victims of, or At Risk of Sex Trafficking Not Specified Specified Settings • A setting providing high-quality residential care and supportive services to children and youth who have been found to be, or are at risk of becoming, sex trafficking victims as identified by the title IV-E agency. • The facility must meet the definition of a CCI.

  42. Qualified Residential Treatment Programs Not Specified Specified Settings • A QRTP placement is a specific category of a non-foster family home setting • Must meet detailed assessment, case planning, documentation, judicial determinations and ongoing review and permanency hearing requirements for a child to be placed in and continue to receive title IV-E FCMPs for the placement • Must be licensed, criminal record and child abuse and neglect registry checks must be completed • Must be accredited by one of the independent, not-for-profit organizations specified in the statute or one approved by the Secretary (CARF, JCAHO, COA, or any other approved by the Secretary)

  43. Qualified Residential Treatment ProgramsAdditional Requirements • Assessment by a qualified individual. – Must be completed within 30 days. If not completed, no federal funds shall be made (not even for 14 days) • Qualified individual. A trained professional or licensed clinician who is not an employee of the IV-E agency or affiliated with any placement setting (may be waived) • Court Review – Court review required within 60 days of start of placement • Long-term placements. For every QRTP the child is placed in for more than 12 consecutive months or 18 nonconsecutive months (or, in the case of a child who has not attained age 13, for more than six consecutive or nonconsecutive months), the title IV-E agency must maintain documentation in the child’s case plan and make it available for federal inspection and/or review upon request, during a title IV-E eligibility review, joint planning, or a partial review

  44. Qualified Residential Treatment ProgramsAdditional Requirements • Trauma informed treatment model is required • Registered or licensed nursing staff and other clinical staff are required, on-site as consistent with the treatment model and available 24/7 • As appropriate, program must facilitate participation of family members in treatment and facilitate outreach to family members including siblings, biological family and fictive kin • Provides discharge planning and family-based aftercare support for at least 6 months post-discharge • Administrative Costs may be claimed by the IV-E agency regardless of whether QRTP requirements are met. If QRTP requirements not met, administrative costs remain but costs associated with administration and operation of the QRTP are not allowable

  45. Transitioning to the FFPSA Provisions Related to Specified Settings (sec. 472(k)) • From Program Instruction: • Title IV-E agencies may claim 14 days of title IV-E FCMPs each time a child is “placed in a child care institution” regardless of whether the child has had previous CCI placements during his or her foster care episode (section 472(k)(1) of the Act). • The setting limitations described above apply to new placements in these settings made on or after the effective date of the provisions in section 472(k) of the Act. Title IV-E agencies may claim title IV-E FCMPs for a child placed in a CCI prior to the effective date of section 472(k) of the Act for as long as the eligible child continuously remains in that setting. If the child later leaves this setting and enters a different non-foster family home setting, the title IV-E agency must apply section 472(k) of the Act.

  46. Federal Guidance

  47. Program Instruction / Other Information • July 9, 2018 – PI-18-07 “To provide instruction for: 1) changes to the title IV-E plan requirements as a result of the Family First Prevention Services Act that are effective as of January 1, 2018 and later; and 2) delayed effective dates for title IV-B/E plan requirements.” • November 30, 2018 – PI-18-09 “To instruct state title IV-E agencies on the title IV-E prevention program requirements” • Letters from Commissioner Milner

  48. PI-18-07 • Did not provide information on prevention services • Requested that states identify whether they will request delay and how long the delay will be • Florida requested the full 2 year delay

  49. PI-18-09 • Indicated that “the state is not required to provide services in all counties and geographic locations in the state, nor is the state required to provide the same type of prevention services in the elected jurisdictions.” • Outlined detailed requirements for State Plan • Service description and oversight • Evaluation strategy / waiver request • Monitoring of child safety • Consultation and coordination • Workforce support and training • Prevention caseloads

  50. PI-18-09, cont’d • Provided more detail for Prevention Plan • For candidates, the child’s prevention plan must: • identify the foster care prevention strategy for the child so that the child may remain safely at home, live temporarily with a kin caregiver until reunification can be safely achieved, or live permanently with a kin caregiver; and • list the services to be provided to or on behalf of the child to ensure the success of that prevention strategy. • For pregnant or parenting foster youth, the prevention plan must: • be included in the youth's foster care case plan; • list the services to be provided to or on behalf of the youth to ensure that the youth is prepared (in the case of a pregnant foster youth) or able (in the case of a parenting foster youth) to be a parent; and • describe the foster care prevention strategy for any child born to the youth

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