The Hidden Costs of Implementation: What State Leaders Need to Know
By Tom Rawlings
Child Welfare Director Perspectives
Our new series, Child Welfare Director Perspectives, invites insights from bipartisan former state child welfare leaders on the biggest ideas shaping the field today.
This new series surfaces how former state child welfare leaders think through high-stakes policy moments.
These aren’t endorsements; they’re strategic intelligence.
We share them because in moments like this, understanding how different leaders actually think is more useful than hearing what other people think they should do.
By looking at leadership across political and geographic contexts, you get to see the kind of thinking that shapes decisions before they’re public.
Different states, different politics, & different mental models- same stakes.
First up: the One Big Beautiful Bill Act — a sweeping proposal with major implications for child welfare systems across the country.
How would and could leaders prepare and reflect on Doug Steiger’s analysis of the current dynamics of budget reconciliation?
The Hidden Costs of Implementation: What State Leaders Need to Know
By Tom Rawlings
Former Director, Georgia State Division of Family and Children Services
Starting conversations on cost shifting
In anticipation of budget cuts from the One Big Beautiful Bill Act, state agency leaders should be discussing with legislative and gubernatorial budget staff the need for significant funding increases to cover expected federal reductions—particularly in Medicaid and SNAP.
Prepare for bottlenecks, a short runway
Increased work requirements and more frequent redeterminations will require more staffing and significant increases in payments to the handful of large national contractors who build and maintain state Medicaid and SNAP eligibility systems.
With a likely December 2026 implementation for new requirements, state leaders really don’t have much time.
Contracting for and making significant changes to complex eligibility IT systems requires a long runway.
That includes determining how to track the additional work requirements, how many additional hours will be required to make the changes, and getting those changes implemented in time.
Legislators will be looking more closely at the agency’s per-case administrative costs. Leaders will need to reduce those costs with a workforce already challenged by recruiting and retention issues.
Anticipate multi-system impact
Medicaid changes are also likely to impact child welfare services indirectly.
Nationally, around two-thirds of children whose families become involved with child welfare are on Medicaid.
Medicaid-reimbursable services for parents such as mental health and substance abuse treatment and in-home counseling services keep children out of the foster care system.
While exempting parents of younger children from the work requirements will soften the blow, families most in need of these services are most likely to be headed by the parents likely to go without coverage as a result of the Medicaid work requirements.
State dollars will have to fill the gap.
Tom Rawlings led the Georgia child welfare agency from 2018 to 2021. He served the state of Georgia for over 30 years as an attorney, family court judge, and child rights ombudsman. He is the President and CEO of Child Welfare and Justice