Curbing needless foster care: Does the Obama Administration even have a clue?

INDIFFERENCE AND/OR HOSTILITY THREATEN CHILD WELFARE WAIVERS

Ok, I get that with two wars, the worst environmental disaster in our history, health care, the economy, etc. President Obama may not be paying a lot of attention to child welfare. But is it too much to ask that his administration not make things even worse?

For starters, the Administration took the terrible financial incentives that encourage foster care and discourage better alternatives and did, indeed, make them worse. I don't think they did it on purpose. Rather, my guess is they were intent on increasing state reimbursement for Medicaid and weren't paying attention to the fact that this also automatically increases reimbursement for foster care. (The House and Senate have split on whether to continue this increase, so here's a modest proposal for a compromise: Extend the increase for Medicaid, but not foster care.)

Now, according to The Columbus Dispatch, the Administration may refuse to extend a waiver that gives 18 counties in Ohio the same flexibility that has allowed Florida to vastly improve its system. (That success, already cited by The New York Times, also was a key focus of an Associated Press story Friday.)

The "ProtectOhio" waiver has been around for 12 years. It's due to expire at the end of July, and there's no word from the federal Department of Health and Human Services concerning whether they will grant another extension.

PROMISING EARLY RESULTS…

An early evaluation found that, on average, the counties did not perform as well as Florida. But that changed. And even early on there were improvements; and, in two counties, the improvements were particularly significant.

What made the difference in those counties? In a word: Leadership.

As we discuss in our report on Ohio child welfare, according to the evaluation:

The two most successful counties…share a pattern of strong leadership and careful planning of systemic reforms. Both demonstrated an early and ongoing commitment to expanding resources for child welfare activities other than foster care board and maintenance, well beyond the flexible funds generated by Waiver participation. They also sharply reduced placement utilization, instead serving children in-home or through referral to community agencies.

The evaluation found that, in Lorain County, the child welfare agency had been engaged in a comprehensive planning process, geared toward safely reducing entries into foster care, even before the waiver. So the county knew how to make the best use of flexible funds to enhance services to families. In addition to reducing needless removals of children, when a child really needed to be taken from his or her parents, the county also significantly increased placements with relatives instead of strangers.

"Overall," according to the evaluation, "the flexibility of the Title IV-E waiver seems to have reinforced the reform agenda of Lorain County Children Services."

…AND NOW, EVEN MORE SUCCESS

The other counties learned from those early experiences. According to a new report from Casey Family Programs, now:

Demonstration counties in ProtectOhio have consistently shown briefer lengths of stay in children's first placements, greater success in completing permanency plans for children in long-term foster care, higher rates of adoption, and a higher proportion of children exiting foster care to extended family caregivers without a decline in child safety measures. For the two-year period ending September 30, 2009, the ProtectOhio demonstration group generated internal savings of 329,441 placement days.

In other words, children spent a total of 329,441 fewer days in foster care than they would have had there been no waiver – with no compromise of safety. And that includes the children who had zero days in foster care because, thanks to the waiver, the services were available to keep them out of foster care in the first place.

It also probably helped that Ohio's largest county, Franklin, eased out the mediocre longtime leader of its child welfare agency. His replacement has done a better job taking advantage of the waiver. That's the whole point of reforming child welfare financing: It can't make up for mediocre leadership. But it allows good leaders to swim with the tide instead of against it.

Speaking of mediocre leadership: HHS apparently hasn't been paying attention. No surprise there. The federal leadership team on child welfare is incomplete and what there is of it is undistinguished.

HHS: THE MEDIOCRITY STARTS AT THE TOP

The problem goes all the way to the top. When the secretary of HHS, Kathleen Sibelius, was governor of Kansas, a state with one of the highest rates of removal in the nation, she turned a blind eye as her state fudged the figures it sent to HHS. She also didn't lift a finger when the head of her human services agency was caught in a bald-faced lie. (We don't know which of two flatly contradictory statements was the lie, we just know he lied. Details are in our report on Kansas child welfare.)

The one time I heard the HHS Assistant Secretary in charge of the Administration for Children and Families, Carmen Nazario, speak on the funding issue, her comments amounted to: I can't wait to give the Child Welfare League of America exactly what it wants! Since CWLA is the giant trade association for agencies, including many that live off a steady supply of foster children, that's always bad news for kids. For details, see our report on child welfare financing.

And now, whether through indifference or hostility, HHS is threatening one of the few areas where federal child welfare policy actually has helped children – waivers from federal funding rules that provide a huge, perverse incentive to place children in foster care and keep them there.

So, if the people who occasionally pay attention to child welfare in the Obama Administration (if any) really are too distracted to do comprehensive reform of child welfare – like making the Florida waiver the way child welfare is financed nationwide, or at least making such a waiver available to any state that wants one – could they at least let the states and counties that were smart enough to get these waivers in past years keep them?

It's simple. Just sign the relevant forms. Then you can go back to the wars, the oil spill, the economy and all the rest.

Living our values makes CHILDREN safer, too

    I'll bet a lot of my fellow liberals cheered last night when President Obama got to this line in his not-quite-a-State-of-the-Union address: "Living our values doesn't make us weaker," the President said, "it makes us safer and it makes us stronger."

    I checked a transcript of the President's speech just to be sure: There is no asterisk after that line, no parentheses containing the words "except if the allegation is child abuse."

For too many of my fellow liberals in the child welfare establishment, there is a mental asterisk when it comes to civil liberties. As long as you say the magic words "child abuse" it's o.k. to hold secret trials, it's o.k. to search homes and stripsearch children without a warrant, it's o.k. to deprive the accused of legal counsel, it's o.k. to detain children indefinitely based on a standard of proof no higher than "preponderance of the evidence."

    President Obama made the comment in the context of repeating his pledge to close the prison at Guantanamo. We on the left are all for it. But when the State of Texas held hundreds of innocent children in their own private Guantanamo last year, there was silence from the big, liberal child welfare groups. The Children's Defense Fund did not defend these children. They didn't seem to matter to Every Child Matters. Voices for America's Children stood mute.

    It's time the child welfare establishment erased the mental asterisk. NCCPR believes in civil liberties without exception. We have a Due Process Agenda because living our values makes children safer, too.

Stimulating more foster care?

    There is a lot that is good in the economic stimulus bill now pending in the Senate. But there is one provision that actually would worsen the current financial incentive for states to use foster care instead of better alternatives.

    As noted in a previous post, under current law, for every eligible child (slightly fewer than half of foster children nationwide are "eligible") the federal government picks up anywhere from 50 percent to about 74 percent of the tab; it varies from state to state. (I had previously put the high end figure at 83 percent, but that no longer is the case.) Poorer states get a larger percentage of their costs covered. But there is nothing like that for safe, proven alternatives to taking children from their parents. That's the key reason why federal spending on foster care vastly outstrips federal spending on better alternatives.

    The stimulus bill actually would make this worse.

The amount that states get back for foster care is linked to the amount they get for Medicaid, the health insurance program for the poorest Americans. So, for example, if State X is reimbursed 70 cents for every dollar spent on Medicaid, it also gets 70 cents back for every dollar spent on foster care for an "eligible" child. As the Medicaid rate rises or falls, the reimbursement for foster care (and also some adoption assistance) rises or falls with it.

The stimulus bill would raise this so-called "match rate" by 4.9 percent. So that state that was getting back 70 cents on the dollar might get back nearly 73.5 cents on the dollar. Such an increase for Medicaid would be good. But the last thing Congress should be doing, even as more families are plunged into poverty, which so often is confused with "neglect," is to actually increase the incentive to tear apart these families. Odds are, when the Obama Administration proposed increasing the match rate for Medicaid they were barely aware, or not aware at all, that this automatically increased payments for foster care as well.

To stop this worsening of an already perverse incentive, Congress would have to act to apply the increase to Medicaid only.  And that's exactly what President Obama should ask Congress to do. Then the additional dollars that would have gone to foster care should be directed instead to family preservation. It would be a tragedy if one of the new president's first acts actually increased the already huge financial incentive for states to take children needlessly from their homes.

If you really want to control entitlements, Mr. President-Elect …

…I know a great place to start.

President-elect Obama says he's going to take a long, hard look at federal spending on "entitlements" – programs for which spending is automatic, and spent on every American who fits eligibility criteria. Social Security and Medicare are classic examples of entitlements.

Entitlement spending takes up a large part of the budget, but usually such spending at least does some good. Things like Social Security and Medicare are expensive, worthwhile entitlements.

But there is at least one entitlement that actually does harm: That is the entitlement states get for throwing children into foster care. For every eligible child (slightly fewer than half of foster children nationwide are "eligible") the federal government picks up anywhere from 50 percent to 83 percent of the tab; it varies from state to state. But there is nothing like that for safe, proven alternatives to taking children from their parents. That's the key reason why federal spending on foster care vastly outstrips federal spending on better alternatives.

And there is a possibility that President-Elect Obama may inadvertently make this worse.

The amount that states get back for foster care is linked to the amount they get for Medicaid, the health insurance program for the poorest Americans. So, for example, if State X is reimbursed 70 cents for every dollar spent on Medicaid. It also gets 70 cents back for every dollar spent on foster care for an "eligible" child. As the Medicaid rate rises or falls, the reimbursement for foster care (and also some adoption assistance) rises or falls with it.

Some child welfare groups expect that a new economic stimulus package will include an increase in this "match rate." So that state that was getting back 70 cents on the dollar might get back 75 cents or 80 cents on the dollar. Such an increase for Medicaid would be good. But if Congress does this, the reimbursement for foster care also will rise by the same amount, automatically, unless Congress acts to apply the increase to Medicaid only.

And that's exactly what the new President should ask Congress should do – apply any increase to Medicaid only. Then the additional dollars that would have gone to foster care should be directed instead to family preservation. It would be a tragedy if one of the new president's first acts actually increased the already huge financial incentive for states to take children needlessly from their homes.

But President Obama should not stop there. He should end the open-ended entitlement for foster care entirely. As things stand now, safe, proven alternatives to foster care cost less in total dollars, but throwing a child in foster care sometimes can cost a state less – because the federal government picks up so much of the tab. That is insane.

The way to restore sanity to the system is to estimate the amount that states would get under this system, and then give it to them as a flat grant, indexed to inflation. But instead of limiting the funds to foster care, let states use the money for alternatives as well.

Suddenly, billions of dollars previously available to states only for foster care also would be available for better options. Of course, it couldn't all go to alternatives – some children really need to be in foster care. But the flat grant should be structured so that, as foster care is reduced, the grant does not go down – the states get to keep the savings, as long as they plow the money into more help for families. That's the carrot. The stick is that states that experience foster-care panics, huge sudden surges in needless removal of children, will have to foot the entire bill for those panics. And that's the whole idea. States might be a little more reluctant to tear apart families needlessly if they had to pick up the entire tab.

This also would be a great chance for the new President to show that he means what he says about bipartisanship. Because this particular idea came from the Bush Administration. They proposed to offer it on a purely voluntary basis. But the foster care-industrial complex, the network of child welfare agencies with a huge vested interest in keeping children in foster care, and its dutiful allies, made sure that got nowhere. Instead, the administration offered a similar plan to some states and localities in the form of a "waiver" from federal regulations.

Only one state took them up on it: Florida. And it's made a huge difference.

The waiver is one of the key reasons that Florida, once a national symbol of child welfare failure, has begun a significant turnaround. In Florida alone, more than $100 million a year formerly restricted to foster care now is available for alternatives. And that's one reason why, in 2007, Florida saw its first significant decline in entries into care in nearly a decade. Now, with Florida hit particularly hard by the collapsing economy, the progress is in danger. But while the waiver won't completely make up for state cutbacks, it will help cushion the blow.

In California, where individual counties run child welfare, Los Angeles and Alameda Counties accepted waivers.

Michigan, on the other hand, won't get that cushion. Michigan also accepted the waiver. The state Department of Human Services bragged about it publicly, and it was the subject of news accounts. Then, suddenly and mysteriously, with no public announcement, it was gone. At the very last minute, someone at DHS changed her or his mind, and the waiver was dead. It does not appear that the agency didn't even had the guts to explain who did it or why.

Michigan's fiscal cowardice leaves its children entirely at the mercy of an economy that probably is collapsing faster in the home state of the American auto industry than anywhere else.

But this is one time the federal government could offer a "bailout" that won't cost any money. All it has to do is end the foster care entitlement and require that the other 49 states do what only Florida and those two California counties had the guts to do on their own.