Family First Bill: CBO Projects Long-Term Savings, Does Not Expect Big Drop in Congregate Care

The Family First Prevention Services Act passed by voice vote in the House last night, and now heads back to the Senate. Nothing has been scheduled on the Senate side yet, but people close to the bill believe it could take a week or two to map out a path to a vote.

Meanwhile, the Congressional Budget Office published its official score of the legislation yesterday. Eons ago, Youth Services Insider reported that the early versions of this bill were a tough sell because the wide array of IV-E prevention services allowed would lead to a price tag that starts with “B” and ends in “illions.” In particular, the ability to spend on housing assistance seemed to be a costly proposition.

The version passed by the House yesterday – which limits IV-E prevention to substance abuse, mental health and parenting support – is expected by CBO to reduce net spending by $66 million over the period between fiscal years 2017 and 2026.

Following is how the score breaks down.

Spending Increases over 2017-2026

  • Prevention services: $1.3 billion
  • Kinship navigator: $126 million
  • Grants for state courts: $100 million
  • Technical assistance: $10 million
  • Foster home recruitment/retention: $8 million

Spending Reductions over 2017-2026

  • Restrictions on federal funds for congregate care: $910 million
  • Delay of “delink” for adoption assistance: $720 million
  • Medicaid savings: $10 milllion

Here is the most interesting aspect of the report, in YSI’s opinion: CBO does not seem to think that the federal withdrawal on most congregate care will radically change the overall use of it.

Two things in the report lead us to that conclusion. First, CBO expects big federal savings (nearly $1 billion) on the federal congregate care limits. But it actually projects a moderate decline in congregate care use that follows an already-existing trend line. From the report:

In 2015, about 14 percent of the children in foster care who received assistance under IV-E resided in nonfamily settings—either RTFs or other group settings. That share has fallen over the last decade and CBO estimates that share will continue to decrease to about 11 percent in 2026 as states find alternative placements for children living in group settings.

Another indication that CBO expects congregate care to thrive: Its projected Medicaid savings. From the report:

CBO estimates that Medicaid spending, on net, would decrease by $10 million over the 2017-2026 period, because we expect that fewer children would receive Medicaid services in RTFs (where Medicaid services are more expensive).

If any of our loyal readers know of national or regional data on Medicaid reimbursements connected to congregate care for foster youth, please send that along. But our guess is a decline of $10 million over 10 years is a fairly tiny fraction of Medicaid money going to serve foster youth in group settings.

So by 2026, CBO expects that there will be a three-percentage-point drop in the number of foster youths in group care, netting $10 million less in Medicaid spending.

The savings from adoption assistance comes from the fact that this bill delays for two-and-a-half years the delinking of federal adoption support from 1996 income standards applied to the child’s birth parent(s). Click here to read more about this.

CBO projects that this will prevent the feds from providing adoption assistance to 110,000 families across the country. This does not mean 110,000 families will be unsupported, but it does mean the states will be bearing 100 percent of the tab.

Click here to read the full CBO report.

Click here to read all of The Chronicle‘s continuing coverage of the Family First Prevention Services Act.

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John Kelly, Editor in Chief, The Chronicle of Social Change
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John Kelly is editor-in-chief of The Chronicle of Social Change. Reach him at