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The Child and Family Services Agency Fy 2009 and Fy 2010 Spending Pressure
The Child and Family Services Agency Fy 2009 and Fy 2010 Spending Pressure
Testimony of
Roque R. Gerald, Psy.D.
Director
To begin, I want to provide a brief update on our progress in improving outcomes for the
children, youth, and families we serve. Strengthening the safety net remains our collective goal
and passion. With our forward momentum continuing at a fast clip, here are some updates on the
strategic goals driving our actions this summer and beyond.
Safety: Improving both the timeliness and quality of child abuse/neglect investigations continue
to be top priorities. Child Protective Services has initiated a number of new internal quality
assurance procedures. Among these are regular supervisory review of handling of hotline calls
(about eight or 10 calls per worker per month) and in-depth review of progress on the 18th day of
open investigations. Objectives of the 18-day review are to ensure thoroughness and eliminate
barriers to safe, timely completion.
Permanence: Everyone needs a family, and we’ve never been more determined that every child
and youth will leave the system for reunification, guardianship, or adoption. CFSA was on a
mission to review the cases of every youth with the goal of Alternative Planned Permanent
Living Arrangement (APPLA) by June 30—about 600 cases in all. We beat that deadline by a
couple of weeks. More important, we found potential options for permanence that we’re now
working to bring to fruition for about 40 percent of those youth. Not only are we focusing on
permanency for older youth but we are involving them in our redesign of the Office of Youth
Development (OYD). This summer, eight youth are interning in OYD, learning skills to prepare
them for the future and helping us design an OYD that is optimal for youth engagement.
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Meanwhile, CFSA has also formed an internal team of permanency specialists who assist
ongoing workers in moving children and youth on their caseloads to permanence. Finally, we
continue to target finalization of 125 adoptions by the end of 2009.
Deepening Practice: Quality practice supports quality outcomes. A major goal this year (and
beyond) is strengthening frontline clinical skills and supervision. CFSA and the Collaboratives
are jointly engaged in implementing an In-Home Practice Protocol that deepens our partnership
in serving intact families at home. In September, CFSA will roll out training for our new Out-of-
Home Practice Protocol for social workers and supervisors serving children and youth in care.
The centerpiece of both protocols is teaming between families and professionals to increase
engagement, improve decisions, enhance support, and achieve better outcomes.
Medicaid Background
As you know, the results of recent audits revealed significant challenges in terms of how the
District’s public providers claim for Medicaid reimbursable services. Later, I will address the
District’s commitment to resolving these issues through extensive cross-agency collaboration.
I think it’s important that we begin with a discussion of what Medicaid is and its importance to
supporting services to vulnerable children, youth and families. In addition to relying on Medicaid
to pay for obvious health care services like surgeries and antibiotics that foster children need,
State Child Welfare agencies also rely on two important Medicaid services that are critical to
meeting the needs of children in CFSA care: Rehabilitative Services (Rehab) and Targeted Case
Management (TCM). Here is a brief description of those programs and what services are eligible
within each one:
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functioning level. All children who come into care by virtue of maltreatment have been
injured and require rehabilitative services beyond the traditional MHRS (mental health)
counseling.
The other critical component of our approach to federal funding is Title IV-E of the Social
Security Act. By law, Title IV-E Foster Care and Adoption Assistance is available for the
care and support of eligible children. This 'care and support' includes room, board, school
supplies, supervision, and transportation. It does not include treatment of a child's medical
condition or the provision of social services. Medicaid covered services are those that treat a
recipient's medical condition, with 'medical' encompassing both physical and mental health
conditions. It does not include meeting the child's physical needs. Simply put, Title IV-E may
pay for food, clothing, and shelter, but not treatment; Medicaid may pay for treatment, but not
food, clothing, and shelter.
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Additionally, you must document the service provided to show who provided the service, when it
was provided, where it was provided, and what service was provided. While this may seem
relatively simple, there must be a robust infrastructure in place to ensure compliance with federal
and local laws and regulations, and staff must be appropriately trained to document the services
they provide.
Large Medicaid disallowances for Child Welfare services in states such as Georgia, Iowa,
Kansas, Maine, Massachusetts, Minnesota, Oklahoma, and now the District, demonstrate the
complicated nature of claiming for Medicaid services and the need for close collaboration
between child welfare and Medicaid agencies.
When CFSA became aware of the disallowances, we immediately began working with the
Department of Health Care Finance (DHCF) to develop corrective action plans which include
randomized audits of case files, remediation of case records that are found to be deficient and
training of social workers on appropriate documentation of Medicaid services. Despite these
efforts, we reached the conclusion that future disallowances would more than likely occur unless
there was a substantial change in our overall approach to claiming Medicaid. Therefore, CFSA
stopped claiming Medicaid as of January 31, 2009.
As I detailed in my June 30th correspondence to you regarding the OCFO’s estimated spending
pressure for the Agency, we continue to work closely with DHCF to prepare for claiming
Medicaid again. In particular, we are focusing on ensuring compliance with District and Federal
regulations and laws and redesigning the Rehabilitative Services option. This work is slated to
be completed in December 2009, and we anticipate re-starting claiming for these services by the
second quarter of FY 2010. Additionally, DHCF is improving oversight and technical assistance
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to CFSA. DHCF is also implementing an Administrative Services Organization in September
2009; the RFP was released on Monday July 13th.
Conclusion
In closing, Medicaid funding is a critical resource that public child welfare agencies rely upon to
provide essential services to children and families. In cooperation with DHCF, we’re working to
establish a claiming infrastructure that will allow CFSA to take full advantage of opportunities
for Federal funding. This is an important step in strengthening the local safety net for vulnerable
children and families and one in which we’re determined to succeed. I’ll now answer any
questions you may have.
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