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Understanding Claiming Under the Family First Prevention Services Act

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CDHS/CHSDA Series

August 2021

Session Four: Fiscal Analysis

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Presenters

Yumiko Dougherty, CDHS, Director of Strategic Planning & Implementation

Kelly Sawka, DCW Finance Manager

Bradly Borges, DCW Fiscal & Policy Analyst

Dennis Desparrois, DCW Provider Services Manager

Angelina Callis, DCW Family First �Project Manager

Heather Durosko, CHSDA, Senior Business Analyst

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Agenda

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  • Guided review of the fiscal impact analysis
  • Effects to the block
  • Funding opportunities
  • Previous session follow-up
  • Lunch & learn conclusion

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Context

  • February 2020, state & county workgroup
  • Development of the “Mitchell Model”
  • Guided high level decision-making and deeper understanding of how various factors impact the overall fiscal landscape
  • Where we were and where we are now
  • Remember, this is a fiscal impact MODEL with lots of assumptions and remaining unknowns

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Fiscal Impact Analysis - Before & Now

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Fiscal Analysis - Placement Assumptions

Placement assumptions made for the purpose of this analysis include:

  • Shifting bed days associated with residential child care facilities (RCCFs), group homes (GHs) and group centers (GCs) to either higher or lower levels of care as these placements types will no longer qualify for federal reimbursement
    • 74% of RCCF bed days are shifting to Qualified Residential Treatment Programs (QRTPs)
      • 230 beds available at implementation
    • 25% of bed days from GHs and GCs are shifting to foster family homes
    • The remaining 75% of bed days from GHs and GCs are shifting to therapeutic and treatment foster care with
      • 90% shifting to therapeutic foster care and
      • 10% shifting to treatment foster care
  • Incorporation of new child maintenance rate effective July 1, 2021

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Fiscal Analysis - Placement Analysis

The outcome of this analysis shows:

  • State expenditures falling by approx. $1.1 million
  • County expenditures falling by approx. $384,000
  • Federal Title IV-E revenue falling by approx. $414,000
    • Note: This reduction in federal revenue is not due to Family First, rather it’s related to shifting bed days to more cost effective levels of care.
    • Note: A portion of the remaining 26% of bed days associated with RCCF placements may shift into a PRTF placement covered by Medicaid at a later date but we do not have enough data to accurately account for moving them at this time.

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Fiscal Analysis - Prevention Service Analysis

The outcome of this analysis shows:

  • Claimable expenditures of approx. $3.1M
  • Prevention revenue totaling approx. $1.2M is expected for the first year of implementation
    • October 1, 2021-June 30, 2022
  • Prevention revenue totaling approx. $1.6M is expected for the second year following implementation
    • July 1, 2021-June 30, 2022
  • Note: Motivational Interviewing (MI) has not been included at this time. We are working on a process to capture MI through RMS. Future earnings will be added as data becomes available.

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Fiscal Analysis - Administrative Assumptions

Administrative assumptions made for the purpose of this analysis include:

  • County financial management system (CFMS) cost pool expenditures for FY 2020-21
  • Currently 3.67% of in-home services qualify for Title IV-E prevention funding
    • This is an average of 394 prevention cases per month
  • Cost pool amount of $26,371,823
    • Allocated to multiple cost pools from appendix 10 of the public assistance cost allocation plan (PACAP)
  • Family First cases will qualify for federal funding reimbursed at 50% rather than having a penetration rate applied

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Fiscal Analysis - Administrative Analysis

The outcome of this analysis shows:

  • Claimable expenditures totaling approx. $1.9 million
  • Admin revenue totaling approx. $716,000 is expected for the first year of implementation
    • October 1, 2021-June 30, 2022
  • Admin revenue totaling approx. $955,000 is expected for the second year following implementation
    • July 1, 2021-June 30, 2022

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Fiscal Analysis - Family First Revenue Summary (State Overview)

Family First Revenue Summary:

  • In year 1: Family First Title IV-E revenue for the state of Colorado totals approx. $1.5 million
    • October 1, 2021-June 30, 2022
  • In year 2: Family First Title IV-E revenue for the state of Colorado totals approx. $2.1 million
    • Increase of $257,000 over year 1
    • July 1, 2021-June 30, 2022

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Fiscal Analysis - Family First Revenue Summary (Block/Core Overview)

Family First Revenue Summary:

  • In year 1: The impact of Family First Title IV-E revenue on the child welfare services block and core services program total approx. $406,000
    • October 1, 2021 - June 30, 2022
  • In year 2: The impact of Family First Title IV-E revenue on the child welfare services block and core services program totals approx. $541,000
    • Increase of $135,000 over year 1
    • July 1, 2021-June 30, 2022

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Fiscal Analysis - Family First Revenue Summary (Prevention Trust Fund Overview)

Family First Revenue Summary:

  • In year 1: The impact of Family First Title IV-E revenue on the Colorado child abuse prevention trust fund totals approx. $1.2 million
    • October 1, 2021-June 30, 2022
  • In year 2: The impact of Family First Title IV-E revenue on the Colorado child abuse prevention trust fund totals approx. $1.6 million
    • Increase of $392,000 over year 1
    • July 1, 2021-June 30, 2022

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Funding Opportunities

  • Four more rounds of Family First Transition Funding for the expansion of the Prevention Service continuum
    • Twice yearly, through 2023, total of $500,000/year awarded
    • Sign up for the Family First Digest to get notified of RFA release
  • Children’s Trust Fund

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Funding Opportunities

  • Placement continuum
    • 2022000045 RFA for Family First SB21-278. Per SB21-278, CDHS is dedicating 15 percent of the state's Family First transition funds (a little over $1.1 Million) to supporting residential placement providers in the transition to a business model that ensures alignment with Family First, as well as Medicaid eligibility for children/youth placed with the provider. Please read the RFA and instructions below closely, as this funding will be available in multiple rounds through January 1, 2023. The first round closes on September 30, 2021.

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Funding Opportunities

  • Placement continuum
    • 2022000042 RFA for Family First Placement Continuum. The second opportunity dedicates $500,000 in Family First transition funds to building out a comprehensive placement continuum across the state. This opportunity includes efforts to serve high acuity youth in family-like settings; recruitment and retention of therapeutic and treatment foster homes; enhanced supports for foster parents and kinship families; and efforts to better understand and respond to the needs of Colorado’s children and youth in all types of care. Instructions for accessing the RFA are below. This opportunity has a closing date of September 21, 2021

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Funding Opportunities

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Wrapping-up

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Resources

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