Less than a year after landmark federal legislation quietly transformed the child welfare field, tensions about the future of federal support for foster care emerged again in California.
At a meeting of the state’s influential County Welfare Directors Association, Jerry Milner— one of the the nation’s top child welfare officials— laid out his vision for overhauling the country’s foster care system in the wake of the passage of the Family First Prevention Services Act.
Passed in February as part of a last-minute spending bill, Family First is a bold step toward financing reform. The legislation grants child welfare agencies new flexibility to spend federal foster care dollars on some prevention services in an effort to help families avoid entering the foster care system. Under Family First, agencies can use the Title IV-E entitlement on parental supports, which before now had been limited to only children living in out-of-home care.
The opposition to the bill was most fierce in California, where advocates have raised concerns about how the new plan will mesh with the state’s own ongoing reforms encapsulated in the Continuum of Care Reform. There are also longstanding concerns from advocates in the state about a potential end to the open entitlement for children who enter foster care system as a result of abuse or neglect. States can begin to opt in to the new arrangement under the Family First Act as soon as next month, with a final deadline of October 2019.
States can begin to opt in to the new arrangement as soon as next month, with a final deadline of October 2019.
Another front has opened up over discussions about the potential end of the child welfare entitlement, a hot-button issue for the field. An idea floated by the Trump administration in its 2019 budget proposal would offer states the ability to give up the constraints of the entitlement in exchange for a flexible, but capped, allocation.
It was no surprise that the clash continued again in California, where Milner and a pair of California child welfare leaders renewed a debate around the future of the child welfare entitlement, flexible funding for prevention efforts and implementation of the Family First Act.
The federal government is just starting to implement Family First, but Milner sees new-found flexibility to deliver some preventative services to parents as a prelude to an even greater emphasis on prevention.
“I’m not talking about tweaking a dysfunctional system around the edges; I’m talking about dramatically re-envisioning a system that is prevention-based, and having the fortitude to move forward with the vision is part of the responsibility,” Milner said.
Milner said that the nation’s child welfare system continues to cling to the current child welfare financing structure despite offering few benefits to families involved with the system. Many agencies have a “kneejerk reaction” to accepting a capped allocation, or block grant, because of the threat of losing money, he said.
“I’m not wedded to the entitlement for the very simple reason that the only thing that Title IV-E right now entitles anybody to is a foster care payment,” said Milner, the associate commissioner at the Children’s Bureau, which is housed in the U.S. Department of Health and Human Services. “Parents aren’t entitled to a darn thing. Families are not entitled under Title IV-E to get the services they need to live together safely under the same roof as a family unit.”
CWDA Executive Director Frank Mecca is among those who are uneasy with the call to circumscribe the entitlement. The opposition is rooted not in a cultural addiction to business as usual, he said, but in a potential diminishment of resources available to children placed in foster care.
“This idea that you have to fund prevention out of the entitlement services … is not a natural law, and it doesn’t exist in other program areas,” Mecca said. “Kids who are entitled to Medicaid—we deliver prevention services to those children. We try to avoid childhood obesity. But if children do become obese and develop diseases related to obesity, we don’t say, we’re sorry, you used your prevention money, were not going to treat you.”
For Bobby Cagle, director of the Los Angeles County Department of Children and Family Services, there are larger considerations for getting rid of the child welfare entitlement.
“There’s also real concern that any kind of removal of an entitlement will give [Republicans] entré to further cuts with Medicaid and SNAP,” said Cagle, who took over the Los Angeles system after three years leading the Georgia Division of Family and Children Services.
That anxiety is more than a theoretical issue. Last week, Senate Majority Leader Mitch McConnell (R-Ky.) blamed increasing federal debt and deficits on the cost of entitlements like Medicare, Medicaid and Social Security in comments to Bloomberg News.
“It’s kind of better to have the devil you know than the devil you don’t,” Cagle said of narrow entitlements and flexible block grants.
During his short time in office, Milner has described the current financing structure as a contributing factor in poor outcomes associated with foster care, including the increasing number of children entering care.
“I don’t believe that foster care is a bad thing, when it’s necessary,” Milner said. “What I do believe is that we have a hell of a lot of kids in foster care right now who do not need to be there and who would not be there if we had offered their families the kinds of support that they needed, early enough, flexibly enough, accessible enough before they got to the point where foster care was really the only option that we have.”
That sentiment was roundly rejected by Mecca, who wants to see an entirely new funding source for prevention services.
“I think we should have an entitlement for primary prevention. That should be robust, our first option,” Mecca said.
“The idea that somehow out-of-home care is bad, to me, is a lark, a justification for having to get rid of the entitlement in order to get the flexibility to do prevention. Any child that is abused or neglected should be entitled to both.”
Barring the sudden availability of a new funding source earmarked for prevention, Mecca and Cagle are lobbying to save the Title IV-E waiver system, which for decades has allowed dozens of states and counties, including Los Angeles, to spend the foster care entitlement on other services for families and children. The waivers are set to expire in October of 2019, when Family First takes effect.
Cagle said L.A. County hopes to band together with other jurisdictions receiving waivers in an effort to lead discussions around possibly extending the waiver program. Losing waivers will be costly to L.A. County’s child welfare system, he said.
“It’s going to cost us $200 million annually if we don’t get the [waiver] extension and when we start looking at our budget, although it’s a relatively large budget, $200 million means we’re going to have to cut back on staff and that means unsafe children in my book,” Cagle said.
Milner said that he has paid close attention to waiver-funded programs in California – eight other counties in the state aside from Los Angeles are also under the waiver– he is confident about the future of prevention services under Family First.
“I spend my days going from coast to coast to look at these programs and talking directly to children and families that are getting the services,” Milner said. “They give me the evidence that we have a fighting chance to support children and families by keeping them out of the child welfare system by taking this approach.”
In the weeks ahead, the Children’s Bureau will start drawing up plans for implementing Family First. Part of the challenge will be to calibrate child welfare systems for a new mandate to support parents, who are now eligible for 12 months of support for parental skill-building, substance abuse and mental health programs.
There are many questions about how states will implement the new category of services, and Milner indicated that ACYF will be issuing guidance on those three areas, including substance abuse programs. According to Milner, many agencies have asked if it would be possible to extend the strict 12-month limit of treatment.
“We believe that there may be some flexibility in the number of episodes of service delivery that might be funded,” Milner said. “That doesn’t change the funding scenario, but there may be some possibility that perhaps another 12 months might be available. We haven’t worked out the details on that, but that is what we’re looking at.”
The deadline for states to opt into the new Family First programs is coming up next month. Milner hopes that child welfare agencies will be willing to take a shot on a different approach.
“If you’re happy with the outcomes that we’ve got right now, there’s not a need for you to do a single thing, you don’t have to worry with the flexible funding option, you don’t have to worry about a transitional waiver,” Milner said. “But if you’re not satisfied with it, we have to do something different. It has to start with a vision, it has to start with a commitment, it has to start with leadership and then the financing has to follow that.”
This article was updated to note Jerry Milner’s affiliation with the Children’s Bureau and to clarify the nature of California’s objections to the Family First Act.