Transcript Mental Health / Child Welfare Partnership Meeting

Child Welfare Conference
Maximizing Funding Streams
Elliott Robinson
May 29,2008
Child Welfare Services Funding
 Total funding: $4.7 billion annually
County Funds
26%
$1.2 billion
$1.9 billion
$1.6 billion
State Funds
34%
Federal Funds
40%
Breakdown of Federal Funding
 Total federal funding: $1.9 billion annually
Title IV-B
4%
Other
7%
TANF
9%
Title IV-E
80%
Where does the Money Go?
Casework/
Support Staff
36%
$1.7 million
$0.3 million
Direct Costs
7%
$2.7 million
Out-of-Home
Care
57%
Major Child Welfare Allocation Funding Sources
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-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 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.
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.
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:
(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 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.
(iii) The skilled professional medical personnel are in positions that have duties and
responsibilities
that 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 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
of the supporting staff's work.
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
Revenue Maximization - 2
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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 OVERHEAD
Space, Supplies, Consultation, Communications
GENERIC SALARIES
Director, Finance, HR
Functional Support Salaries
CalWORKs/OPA/Child Care
Social Services
Line Salaries
Eligibility
CW
MC
FS
Employment
GA
WTW FSET
Fraud
CW
FS
Social Worker
CWS
Adop IHSS APS
Annual State Budget Process
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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 worker
Based on 2001-02 costs per worker
 Caseworker
Ratios
Based on outdated caseload standard
 SB 2030 Workload Study
recommended lower caseloads

SB 2030 Workload Study
Activity
Existing
Standard
Recommended 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
Ancillary Services
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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:
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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)