Improve Outcomes for Children in Foster Care by Reforming Congregate Care Payment Models.
Public Consulting Group (Boston, Mass.)
Public Consulting Group
Corporate Headquarters 148 State Street
Boston, MA 02109
This report explains that while congregate care for foster children is decreasing at a greater rate than the overall foster care population, progress is not equal in every State and some States have experienced a recent surge in foster care placements, including congregate care placements. It proposes a strategy for reforming congregate care that would re-align payment models to better support congregate care as a specialized, therapeutic, stabilization service. It explains how the current fee for service payment model offers no financial incentive for programs to step children down as quickly as possible, and that the per diem rate is often not high enough to support highly therapeutic interventions. Ways the payment model can be re-aligned are then described, including developing a tiered rate structure that is highest at entry into the congregate care setting and then decreases over time, developing tiered rates based on a child’s assessed level of need, and/or developing blended or case rates for children for the duration of their time in foster care to allow them to be served flexibly, while incentivizing permanency and lower intensity of care whenever possible. Three keys to success in aligning payment structures to better support goals are identified: don’t undertake such effort solely to reduce costs, involve a broad range of stakeholders in developing the payment model, and allow sufficient time for implementation.
foster children; foster adolescents; cost effectiveness; funding; permanency; foster care drift; group homes; residential care institutions; state aid; foster care maintenance; child welfare reform