Family First at a Glance

Family First Prevention Services Act

Last week we talked about Title IV-E of the Social Security Act, which matters because it’s 57%¹ of federal child welfare spending, or $9.5 billion.²

This week, we are digging into Family First, a HUGE change to IV-E any child welfare wonk needs to know cold.

First, what is Family First? The 2018 Family First Prevention Services Act (AKA Family First AKA FFPSA, P.L. 115-123) is a bipartisan game changer for federal financing.

At its core, Family First is about three things:

1. Prevention. Well duh, Laris, it’s in the name! Yes, but this is the first permanent commitment of open-ended federal funds for it.

2. Kinship Care. The “Family First” part of the name isn’t just for keeping families together, but also to underscore the emphasis on placement with relatives.

3. Reducing and Reforming “Congregate Care”. The “Family First” name indeed has many layers, because it also refers to prioritizing family over institutions.

If you know nothing else, these are the three.

Prevention

Before Family First, a common refrain was “we have a 7 to 1 spending mismatch in child welfare”; for each $1 we spend on preventing foster care, we spend $7 on care.³

IV-E prevention pre-Family First was primarily of two limited flavors:

1. Title IV-E Waivers (Expired)

   1. 1994-2019, ~ half of states got cost-neutral waivers for flexibility/less eligibility paperwork.

2. So-Called “Traditional Candidacy” (Still Available)

   1. States and tribes can claim 50% match IV-E administrative dollars for services when an eligible child is a “candidate for foster care.”

You probably noticed both examples kept referring to eligibility, meaning we are back to discussing the Aid to Families with Dependent Children (AFDC) Lookback…

As a refresher, Title IV-E foster care maintenance payments, administrative funds, and guardianship assistance are open-ended federal funds, with a catch.

To be eligible for federal funding, a child must have been removed from a family that would meet the 1996 AFDC income requirements without adjusting for inflation.

Family First changes that:

• States and tribes get the option to establish a IV-E prevention program as of 10/1/19:

  • The Children’s Bureau maintains an ongoing list of IV-E prevention plans.

• Services are for children at imminent risk of foster care and parents/caregivers;

• Services must meet evidentiary requirements⁴ and be in one of three categories:

  • Mental health;

  • Substance use;

  • In-home parent skill-based services.

• Participating states receive 50% reimbursement until FY 2027, then Federal Medical Assistance Percentage (FMAP);⁵

• Unlike other aspects of IV-E, THERE IS NO AFDC LINK

Family First Kinship

A major challenge for kin caregivers is resources. Relative caregivers are often older, have lower incomes, and were not planning to be raising a child.

Navigator programs help kin caregivers find and access supports like health services, durable goods for children, legal assistance, or income security programs.

These programs existed before Family First, but it expanded them:

• States and tribes can use kinship navigator programs that are in the Title IV-E Clearinghouse

• Participating states receive 50% reimbursement until FY 2027, and then Federal Medical Assistance Percentage (FMAP);

• These services must be coordinated with state or local service coordination efforts and planned with input from kinship caregivers and families

• Again, THERE IS NO AFDC LINK

Congregate Care

The lead up to Family First also included a major emphasis on the harms of low quality institutional placements, and the benefits of appropriate high-quality treatment.

A 2015 Children’s Bureau report looked at congregate care data, finding nearly a third of children in congregate care were age 12 and under, and almost 30 percent didn’t have a treatment need to be there.

Family First created new standards for non-family settings:

• States could delay these rules until October 1, 2021.

• States and tribes can receive up to two weeks for any non-family placement;

• After two weeks, only “specialized settings” are eligible:

  • Programs for pregnant and parenting youth;

  • Family-based residential substance use disorder treatment;

  • Programs for youth who have been or are at-risk for sex trafficking;

  • Independent Living; and

  • Qualified Residential Treatment Programs (QRTPs).

    • The big new one, meant to ensure treatment quality and appropriateness.

You can learn more about the congregate care reforms and QRTP from this American Academy of Pediatrics report and an article in Pediatrics on it.⁶

Wonk Out and Go Deeper:

• Implementing the Family First Prevention Services Act: A Technical Guide for Agencies, Policymakers, and Other Stakeholders

1. You can see the most recent ChildTrends IV-E resource here, derived from the overall Child Welfare Financing Survey.

2. The Children’s Bureau regularly updates and disseminates spending data for 8 fiscal quarters at a time. The most recent is here.

3. See this brief from Casey Family Programs

4. See the Title IV-E Prevention Services Clearinghouse for more. It could be its own whole deep dive!

5. Technically the reimbursement level for Medicaid, but often tied to other programs too. It ranges from 50 percent to 77 percent for states and Puerto Rico, and 83 percent for the U.S. Virgin Islands, Northern Mariana Islands, Guam, and American Samoa.

6. Full disclosure, I was the PI for this report and a co-author of the Pediatrics paper.