I’m as sick of Children’s Rights, Inc., and its approach to “reforming” child welfare as Richard Wexler is (see “Attn. CR: If you REALLY want to curb abuse in Georgia foster care, stop trying to shovel so many children into it” at the NCCPR Blog), but for some reasons other than just that the states keep shoveling children into care.
My first inkling that something had seriously gone awry at Children’s Rights was when it was announced that Richard Gelles – proud architect of the Adoption and Safe Families Act – had joined their ranks. Thank you very much, Mr. Gelles, for swelling the ranks of foster care with a new category of “legal orphans.” (See my July 15 posting for a discussion of this phenomenon, complete with references and a possible solution).
I wrote about revenue maximization in an article published in 1999, and when I was interviewed in Massachusetts News, many family advocates found themselves outraged by the despicable practice as the article made the rounds in various discussion groups.
Today, most family advocates understand what the “penetration rate” in foster care is, just as they understand how financial gimmicks such as “Targeted Case Management” are used to draw down federal revenue for foster care and juvenile justice from the Medicaid program. In short, they understand that their children have not been removed from their homes for “protection,” rather they have been removed so that their particular state can enrich its coffers at the trough of federal funding.
What sickens me the most about CR’s approach is its continued reliance on the despicable practice of revenue maximization. Indeed, they go so far as to compel the “dysfunctional” (Lowry’s term) agencies that they strive to reform to draw down even more federal dollars so that their bureaucracies can grow even larger than they already are. And, while it is laudable that they are bringing the thorny issue of abuse in foster care to the public’s attention, they pay scant attention to the unnecessary removal of children from their homes, and to revenue maximization’s role in promoting just that.
As the recently-released Kenny A. v. Perdue Period VII Monitoring Report explains: “A child’s IV-E eligibility is based on several different variables and the percentage of children in foster care who are IV-E eligible can fluctuate. The higher the percentage, the more federal reimbursement is available to the state for the administrative costs it incurs to provide safe and stable placements and work to achieve permanency for children in its custody. Consultants hired by the Department in 2007 suggested that the State should strive to increase the penetration rate from its 28 percent level at that time to 45 percent, and suggested some strategies for doing so …”
The Report goes on to explain: “The Consent Decree contains requirements for DHR/DFCS to 1) maximize available federal funding through Titles IV-B and IV-E of the Social Security Act, and 2) not supplant state dollars for foster care services with any federal increase that results from the maximization efforts.”
Georgia’s effort at maximizing federal revenue is nothing new. According to the job description provided by Georgia’s State Personnel Administration, the Revenue Maximization Specialist: “Provides and coordinates the provision of Medicaid and Title IV-E eligibility determinations for children in custody of the State of Georgia, Department of Human Resources, Division of Family and Children Services and/or the Department of Juvenile Justice.”
The Specialist also: “Works closely with county staff and participates as a team with Revenue Maximization Center staff to assure appropriate State/federal financial resources are available for children in State custody.”
The above job description, by the way, was last updated in 2001.
According to the Department of Family and Children Services Administrative Policies and Procedures Manual: “The Division of Family and Children Services (DFCS) is a major participant in Georgia’s Revenue Maximization Initiative. This is a broad, statewide initiative involving agencies within state government and public and private partners.”
“The purpose of the initiative is to implement more effective ways to maximize federal funding sources,” the Manual explains. Within the broader state initiative, known as RevMax, the agency seeks to increase federal Medicaid and Title IV-E funds to support services DFCS provides and purchases by:
Increasing the number of children receiving Medicaid and Title IV-E foster care funds.
Expanding the Medicaid billable treatment services for children and families served by DFCS.
“The state has dedicated significant time and financial resources to planning, establishing, and implementing the RevMax Initiative and Centers, which tell us just how important maximizing federal dollars are to our programs,” the Manual explains.
The Manual continues on to discuss Targeted Case Management Services, which are defined as “services which will assist individuals in gaining access to and managing needed medical, nutritional, social, educational, housing, and other services.”
There’s even more: “Each county is given a TCM goal based in caseload size and the percentage of cases that are eligible for Medicaid.” The Manual also explains that: “If we don’t bill for all eligible services, less money is available to the State and for positions.”
According to the Division of Family and Children Services’ 2007 Program Improvement Plan, some of the problems identified during its 2006 Title IV-E Eligibility Review included:
Judicial determination of Reasonable Efforts to Finalize a Permanency Plan
Valid removal of child from home during most recent foster care episode
Inconsistencies in the dates of the court order; court orders lacked attention to details
What is Georgia’s solution to these problems? “RevMax will be the gatekeeper for court orders. Social Services staff will be required to forward a copy of all court orders and referenced attachments on active children in foster care as of June 30, 2007, to RevMax,” the Plan explains.
“Training will cover not only the judicial finding requirements but also the child specific determinations that are required. The purpose of this training is to serve as a refresher course for veteran staff in order to have a more comprehensive knowledge regarding those determinations that must be made in the court orders,” the Plan further explains.
That’s right – let’s have the revenue maximization department be the gatekeeper to the courts. So much for independent judicial determinations.
Professor of social work Leroy Pelton explains that the current structure of the child welfare system is dysfunctional, and that: “A fundamental restructuring of the system will be necessary before it can accommodate any large-scale expansion of family preservation and prevention programs and services.” Lacking such a restructuring, “any incremental approach or tinkering with the system in its present form will not change its focus from placement to prevention.”
The incessant piecemeal tinkering with the system serves only to strengthen it, even as it provides an intellectual trap for would-be reformers. “Just by calling for more workers, more training, better academic credentials, advocates serve to maintain the status quo,” Pelton explains, adding that: “Even radical critics have succumbed to the delusion that more of the same, albeit of higher quality, is what we need.”
If anything, the state of Georgia has been doing a fine job of maximizing federal revenue at the expense of families and children. Now, along comes Children’s Rights, Inc., demanding more of the same and writing that into its Consent Decree. It’s a phoney solution that this advocacy group continues to promote time and again.
To the extent that Lowry and those among the ranks of Children’s Rights, Inc., can be considered “radical critics,” they have indeed succumbed to the delusion that more of the same, albeit of higher quality, is what is needed.