FFPSA is here....

....so what's the future of this ground-breaking law?

It occurred to me that this week is the deadline for State child welfare agencies to implement the Family First Prevention Services Act (FFPSA), probably the most significant change in federal child welfare law in my lifetime. The promise of the law is that it reverses years of federal policy subsidizing the use of foster care as the primary response to child maltreatment. Instead, states will be able to use uncapped federal Title IV-E dollars for certain evidence-based services designed to keep children at home with parents or kin and out of formal state custody. One downside is that it limits the use of federal dollars for group home placements.

After the law was passed in early 2018, a number of states as well as D.C. jumped in with both feet and began implementing the law at the earliest possible date: October 1, 2019. Other states opted for either an October 2020 or an October 2021 deadline for implementation. In Georgia, we originally shot for October of last year, but the realities of Covid, the dearth of approved evidence-based services on the federal clearinghouse, and the need to ensure we were doing this “right” led DFCS to put implementation off until this year.

A number of issues have arisen for child welfare agencies during their efforts to implement the law. First, as noted above, was the requirement that to be reimbursed with federal dollars, the services needed to be “promising,” “supported,” or “well-supported.” As the list of “well-supported” programs has grown, states have adopted in their plans such qualifying services as multi-systemic therapy, motivational interviewing, functional family therapy, Healthy Families America, Parents as Teachers, Brief Strategic Family Therapy, and Nurse-Family Partnerships. But two question remain. First: whether these services, while showing evidence that they are apt for the populations for whom they were designed, can be successfully implemented to keep children safe from maltreatment in the community. And second: who will actually pay for these services?

The first question, regarding efficacy of the services, raises the issues of availability of services and fidelity to models. As their names indicate, many of these services involve “therapy” that should be conducted by qualified professionals. As the AJC recently reported, however, Georgia ranks 51st in mental health care and there are significant shortages of mental health workers in most of the state. That lack of qualified personnel is a national issue and one that may delay our ability to roll out these programs in all areas of each state.

The second dilemma comes as the result of a federal determination that Medicaid funds should be used to provide appropriate mental health and substance abuse services before states claim IV-E funding for these evidence-based programs. Combined with uncertainty about whether the federal government will consider a given child a “candidate” for foster care eligible to receive FFPSA services, this determination may cause heartburn for agency fiscal officers across the states.

A final issue to be worked out is the status of Qualified Residential Treatment Programs for children and youth in care — a vital component of the continuum of care for traumatized youth with behavioral health challenges. Washington State’s FFPSA plan, for example, specifically lists as target populations children and youth who have severe emotional health issues and those who have suffered a disrupted adoption. These are the kinds of youth who could benefit from residential treatment, but a conflict exists between the eligibility of these programs for IV-E dollars and the fact that the Centers for Medicaid and Medicare Services has suggested they may also qualify as “Institutions for Mental Disease,” the use of which results in a denial of Medicaid payments for that child. Some states have gotten around this issue — for example, by limiting such facilities to 16 beds or having the State Medicaid agency declare them “not” to be IMDs — but the conflict may continue to dampen the availability of these important programs. Fortunately, States may take advantage of certain Medicaid waivers that would allow these programs to thrive.

As we launch into the new world of FFPSA, we as the child protection and well-being community have the opportunity to take advantage of our new funding to keep children and youth in the community, with family and relations, and out of formal state custody. But the promise of this new law will not be realized overnight; rather, it will take several more years of innovation in programs, legislation, and policy to get it right.