Pediatricians Group Lines Up Against Federal Bill to Extend Child Welfare Waivers

Sens. Dianne Feinstein (D-Calif.) and Marco Rubio (R-Florida) introduced a bill that allows states with child welfare waivers to keep them an extra two years. Photo courtesy of the White House.

The American Academy of Pediatrics (AAP) announced last week that it opposes federal legislation that would temporarily preserve child welfare waivers and delay implementation of the landmark Family First Prevention Services Act.

The advocacy organization representing pediatricians played a big role in pushing for passage of the Family First Act, which President Trump signed into law in 2018. The law opens up the federal child welfare entitlement, Title IV-E, to enable child welfare agencies to serve more families without the use of foster care. It also includes limits on federal funding for placements in congregate facilities that don’t have a strong clinical design.

In a letter dated April 18, AAP announced its opposition to the State Flexibility for Family First Transitions Act of 2019 (S. 107), a bill introduced earlier this year by Sens. Dianne Feinstein (D-Calif.) and Marco Rubio (R-Fla.). The legislation would allow states and counties that have a waiver in place — currently jurisdictions in 27 states, according to a recent Child Trends survey — to keep those arrangements in place until 2021.

According to AAP, that could muck up the ability of states to implement the Family First Act, which will start to take effect in October of this year.

“S. 107 would undermine the success of Family First by continuing costly waivers that benefit a limited number of states at the expense of enacting a comprehensive policy to provide all states needed resources and supports to make Family First succeed,” said the AAP letter, which was sent to Rubio and Feinstein.

Begun in 1994, child welfare waivers are a demonstration project designed to allow child welfare agencies to use federal funds to test innovative approaches by granting flexibility in the way they can use Title IV-E funds. Prior to the Family First Act, waivers represented the only way agencies could use Title IV-E dollars outside of costs related to foster care payments and adoption subsidies.

The AAP letter calls Family First “an intentional shift forward from individual demonstration projects to a universal policy that will fundamentally improve the child welfare system for all children, regardless of where they live.”

The Feinstein-Rubio bill is not the only current federal bill addressing Family First Act implementation. Legislation is in the works from a pair of Democrats that would remove an income test long associated with states’ ability to access IV-E entitlement money and would offer states more assistance to make the transition to Family First easier and faster.

Update: Los Angeles County Department of Children and Family Services Director Bobby Cagle, who has been helping lead a coalition of waiver jurisdictions in support of the Feinstein and Rubio bill, disagreed with the AAP’s letter on social media.

“This completely ignores the fact very few jurisdictions across US will actually opt in to Family First for first 2 years,” Cagle wrote on Twitter. “This denies funding to millions of children in waiver jurisdictions but adds very few in nonwaiver states. Outcome: fewer children nationally get served.”

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Jeremy Loudenback, Senior Editor, The Chronicle of Social Change
About Jeremy Loudenback, Senior Editor, The Chronicle of Social Change 352 Articles
Jeremy is a West Coast-based senior editor for The Chronicle of Social Change. Reach him at