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The 2021-22 California Spending Plan

Human Services

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Child Welfare

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California’s child welfare services (CWS) system serves to strengthen families and protect the state’s children from abuse and neglect, often by providing temporary out-of-home placements for children who cannot safely remain in their home and services to safely reunify children with their families. Total CWS spending for 2021‑22 is budgeted at around $1.5 billion General Fund ($9.9 billion total funds), including the Approved Relative Caregiver program, Kinship Guardianship Assistance Payment program, Adoption Assistance Program, foster care payments, continued implementation of Continuum of Care Reform (CCR), extended foster care (EFC) programs for non-minor dependents (NMDs) and programs for former foster youth, and other special programs. Budgeted CWS spending for 2021‑22 represents a roughly 100 percent increase from 2020‑21 General Fund budgeted spending (most of which is one time or limited term). We describe the various elements driving these changes in more detail below.

Summary of One-Time and New Ongoing Child Welfare Activities

Funding for one-time and limited-term activities, as well as new ongoing spending, totals around $1.4 billion ($955 million General Fund) under the Department of Social Services (DSS) in 2021‑22 and is the primary reason for the year-over increase in total child welfare spending. The vast majority (around $1.2 billion total funds [$885 million General Fund]) of new spending is one time or limited term. Figure 1 summarizes these new activities.

FFPSA Implementation

Passed as part of the 2018 Bipartisan Budget Act, the federal Family First Prevention Services Act (FFPSA) expands allowable uses of federal Title IV-E funds to include services to help parents and families from entering (or re-entering) the foster care system. Specifically, FFPSA allows states to claim Title IV-E funds for mental health and substance abuse prevention and treatment services, in-home parent skill-based programs, and kinship navigator services once states meet certain conditions. FFPSA additionally makes other changes to policy and practice to ensure the appropriateness of all congregate care placements, reduce long-term congregate care stays, and facilitate stable transitions to home-based placements.

The law is divided into several parts; Part I (which is optional and related to prevention services) and Part IV (which is required and related to congregate care placements) have the most significant impacts for California. States are required to implement Part IV by October 1, 2021 in order to prevent the loss of federal funds for congregate care. States may not implement Part I until they come into compliance with Part IV.

The 2021‑22 spending plan includes trailer bill language (TBL) along with $31.8 million General Fund ($87 million total funds) in local assistance funding under DSS to implement required elements of Part IV of FFPSA. In addition, the 2021‑22 budget package includes TBL conveying the state’s intent to opt into Title IV-E prevention services as allowable by Part I of FFPSA, and provides $222.4 million one-time General Fund ($285.8 million total funds) for participating counties to begin implementation. We describe the major elements of TBL, and provide additional background information about those elements, below.

Part IV: Congregate Care Placements

FFPSA Part IV requires that congregate care placements meet certain standards in order to qualify for federal Title IV-E funding. If states do not comply with these standards, congregate care placements made beginning October 1, 2021 will not be eligible for Title IV-E funding. To meet FFPSA Part IV requirements, the 2021‑22 spending plan includes funding to implement new federal requirements related to qualified individuals, nursing care, aftercare, and court costs (all of which are described below), as well as funding for a pass-through to Judicial Council, necessary training, and continued evaluation of congregate care placement assessments.

Qualified Individuals (QIs)

Background. FFPSA requires that within 30 days of a Qualified Residential Treatment Program (QRTP) placement, a QI must complete an evidence-based assessment to determine if the QRTP is the most appropriate placement for the youth. A QI must be medically certified and independent from the placing agency. However, states may request waivers to allow otherwise qualified persons (for example, county social workers) to act as QIs.

Implementation Plan. TBL specifies that QIs will participate in Child and Family Team (CFT) meetings, coordinate with Interagency Placement Committees, and leverage the Child and Adolescent Needs and Strengths (CANS) assessment tool as the required evidence-based assessment tool. TBL specifies QIs are clinically licensed individuals responsible for assessing congregate care placements. The language also specifies that DSS and the Department of Health Care Services (DHCS) will seek a waiver from the federal government to allow Title IV-E agency affiliated staff (for example, county child welfare social workers) to act as QIs. DSS and DHCS will issue guidance to counties on who can perform the functions of QIs and how to apply (whether Title IV-E agency staff can apply will depend on the results of the waiver request). Forthcoming guidance from DSS and DHCS also will include details around documentation required to access Medi-Cal specialty mental health funding for QI activities.

QRTPs

Background. Beginning October 1, 2021, only facilities accredited as QRTPs will be eligible to receive Title IV-E funding for new congregate care placements. (Supervised independent living placements and other transitional housing placements for NMDs, as well as congregate facilities providing specialized care to pregnant/parenting youth or to Commercially Sexually Exploited Children, also may continue to receive Title IV-E funding.) QRTPs must meet certain standards, including:

• Employ a trauma-informed model of care, designed to address the needs—including clinical needs—of youth with serious emotional or behavioral challenges.

• Staff includes registered/licensed nursing staff and other clinical staff, who are on-site according to the treatment model, and who are available 24 hours a day, 7 days a week (24/7).

• Facilitate outreach to a youth’s family members (including siblings), and also facilitate participation of family members in a youth’s treatment plan. In addition, document all outreach and efforts taken to involve family (including post-discharge).

• Provide discharge planning and support for at least six months post-discharge (aftercare).

• Be a licensed and accredited facility.

Implementation Plan. California’s Short-Term Residential Therapeutic Programs (STRTPs) already meet most QRTP requirements, as many of the requirements are in line with reforms that the state’s congregate care facilities already have undertaken as part of CCR. The key QRTP requirements that need to be addressed by October 1, 2021 are the requirements around nursing care and aftercare. These two requirements are addressed in subsequent paragraphs below.

Aside from implementing these two major new requirements, TBL makes other changes to STRTP requirements to ensure federal compliance:

• Updates the STRTP licensing definition to specify a facility’s care and supervision is trauma-informed, as defined in standards and regulations to be adopted by DSS.

• Updates the requirements around STRTPs’ plans of operation, adding that plans include provisions to ensure staff are providing trauma-informed services.

• Updates the requirements around STRTPs’ program statements, adding that statements include a description of how the facility will:

• Meet standards (to be established by DSS and DHCS) around providing individualized comprehensive trauma-informed treatment models and making access to nursing staff available.

• Support the individual needs of children and families, including the child-specific treatment goals identified by QIs.

• Develop aftercare support plans, in collaboration with the county, CFT, and others.

• Document how child-specific mental health goals, as identified by the QI, will be met.

• Conduct outreach to family members and integrate family participation into treatment (including aftercare).

Nursing Care

Background. As noted above, a requirement of QRTPs is that facilities have access to licensed nursing staff who are on-site according to the treatment model and otherwise available as required for a child placed in a QRTP.

Implementation Plan. TBL specifies that DSS and DHCS will contract with a statewide (and/or regional) 24/7 nursing care hotline(s), available to all STRTPs, to provide virtual access to licensed nursing care at any time. TBL specifies that if a child placed in an STRTP requires regular on-site nursing care, the placing agency (namely, the county child welfare agency or probation department) is responsible for ensuring the necessary nursing care is provided—either by the STRTP consistent with its treatment model or by the county arranging for that care to be provided utilizing county nursing resources. DSS and DHCS will issue guidance around nursing resources (both virtual access and on-site care). The legislation states that guidance will include instructions about implementation, data tracking, and claiming, as well as information about how to access existing nursing resources for the provision of medically necessary on-site care for children placed in STRTPs.

Aftercare

Background. As noted above, a requirement of QRTPs is that facilities provide discharge planning and support—referred to as aftercare—for at least six months after a child leaves a QRTP placement. Federal law does not specify the exact model that aftercare should entail.

Implementation Plan. TBL defines “family-based aftercare services” to mean an array of integrated services and supports that: (1) are provided to or on behalf of a child for at least six months after discharge from an STRTP and (2) are family-based and implemented as part of a child’s individualized transition plan in a manner that supports the child’s permanency plan and incorporates the recommendations of the QI. The language specifies that federal financial participation under Medi-Cal shall be available for aftercare only if the provided services are deemed “medically necessary.”

TBL requires DSS and DHCS to develop regulations—informed by consultations with stakeholder groups to be convened by the departments—to establish statewide minimum standards for aftercare services. These standards will include, among other components:

• Use of a California high-fidelity wraparound services model, to be approved by DSS.

• Guidance around the process through which a provider may be certified to provide aftercare.

• Workforce development and training requirements to be able to implement aftercare.

• Funding planning, including documentation to ensure federal Medi-Cal dollars are claimed only for medically necessary services.

• Data collection and outcome measures.

Recognizing that convening stakeholders and developing regulations will take time, TBL states STRTPs and counties will need to meet the new standards by October 1, 2022. However, to comply with federal law, aftercare services must be provided beginning by October 1, 2021. In the intervening year, DSS and DHCS direct county agencies to leverage existing wraparound programs and other resources to comply with the six-months post-discharge aftercare requirement. Specifically:

• By October 1, 2021, counties are required to submit plans to DSS and DHCS for how they will leverage existing programs and resources to begin providing interim aftercare services.

• By October 1, 2022, counties are required to update their plans to demonstrate full compliance with the forthcoming standards for high-fidelity wraparound and other requirements of California’s family-based aftercare services. Thereafter, counties are required to inform DSS and DHCS when they modify their plans.

Facilities That May Not Qualify as QRTPs

Background. Under FFPSA, congregate facilities must meet QRTP standards in order to receive Title IV-E funding for providing care and services to eligible foster youth. As noted above, reforms that California’s congregate facilities have undergone as part of the state’s CCR process mean that STRTPs largely already comply with QRTP standards, and many STRTPs are well positioned to become accredited QRTPs. However, some STRTPs, particularly those with capacity over 16 beds, may be classified as Institutions for Mental Disease (IMDs) rather than QRTPs. The federal government is requiring California to make an IMD determination for each individual STRTP. California plans to make these determinations by December 31, 2021. Under federal law, IMDs cannot receive Medicaid funding, meaning STRTPs determined to be IMDs will lose federal financial participation via Medi-Cal. This issue is not a product of FFPSA, but is related in that it entails federal funding for congregate care facilities serving foster youth.

Aside from STRTPs, other types of congregate care facilities for foster youth may not qualify as QRTPs, and—accordingly, beginning October 1, 2021—will no longer be able to claim federal Title IV-E dollars for new foster youth placements. Specifically, Transitional Housing Placement Program for Minors for youth ages 16‑17 will not qualify and will lose federal Title IV-E funding. Regional Centers serving dual-agency youth will need to meet QRTP standards to continue receiving Title IV-E funding.

Implementation Plan. TBL acknowledges that FFPSA affects Title IV-E eligibility for certain foster youth placement settings. The language specifies that DHCS may provide guidance on where federal funding through Medi-Cal intersects with new rules under FFPSA, and seek to update the state’s Medicaid plan and/or seek relevant waivers in order to maximize federal financial participation under Medi-Cal. For STRTPs that are classified as IMDs, the 2021‑22 budget provides around $10 million General fund in temporary funding to ensure foster youth in those facilities can retain access to mental health services while facilities transition to meeting QRTP standards or remain IMD facilities (that only serve privately insured clients).

The legislation requires DSS, the Department of Developmental Services, and DHCS to coordinate to determine exactly how QRTP requirements under FFPSA may impact regional centers serving dual-agency youth, and what state and federal funding shifts may be needed to continue providing regional center placements and services to eligible foster youth. To that end, TBL specifies that departments will enter into interagency agreements that specify the proportion or amount of funds reimbursed by each state department or other responsible agency for residential placements of consumers in foster care. Departments will notify local agencies once the interagency agreements have been completed. The County Welfare Directors Association (CWDA) and the Association of Regional Center Agencies will be consulted in developing the interagency agreements.

Court Procedures

Background. Under FFPSA, specific court reporting criteria and time lines must be met for foster placements:

• Within 60 days of a QRTP placement, the court must approve or disapprove of the placement as beneficial to the youth.

• Courts must continually assess whether the QRTP placement remains the most appropriate placement setting for the youth.

• States must train judges and other court staff on child welfare policies, including federal funding limitations for out-of-home foster placements.

Implementation Plan. TBL makes statutory changes to comply with federal requirements regarding initial judicial approval or disapproval, as well as continual approval or disapproval, of STRTP placements. The legislation details specific steps and time lines that the social worker/probation officer and court must take to ensure review of STRTP placements is completed within allowable time frames and according to federal law.

Part I: Title IV-E Prevention Services

Once in compliance with Part IV, Part I of FFPSA allows states the option of using Title IV-E funding for federally approved evidence-based activities and services that have been demonstrated to reduce foster care system involvement. Eligible foster care prevention services are trauma-informed mental health, substance abuse disorder treatment, in-home parenting skills programs, or kinship navigator programs, and are rated as well-supported, supported, or promising by the Title IV-E Prevention Services Clearinghouse. Furthermore, Title IV-E funding may be used for these services only when provided to eligible “candidates.”

TBL adds a new chapter to California’s Welfare and Institutions Code to: (1) state it is the intent of the Legislature to exercise the option to receive Title IV-E funding for approved prevention services provided to eligible candidates, (2) define relevant terms, (3) define requirements and responsibilities for counties and tribes that choose to provide optional Title IV-E prevention services, and (4) establish funding responsibility.

State Title IV-E Prevention Plan

Background. To opt in to Part I, states must submit a five-year Title IV-E prevention plan (state plan) to be approved by the federal Administration of Children and Families (ACF). A state plan must detail the state’s selection of evidence-based prevention services; plans for identifying populations at imminent risk of entry or reentry into foster care (who may be assessed as candidates); and the approach that will be used to comply with federal evaluation, model fidelity, activity and outcome tracking and reporting, and safety and risk monitoring requirements.

Implementation Plan. As described above, TBL states it is the intent of the Legislature to exercise the option to receive Title IV-E funding for approved prevention services provided to eligible candidates. Accordingly, TBL references that certain definitions (such as for candidacy) and specific eligible activities will be specified by the state plan and approved by the federal ACF.

DSS submitted the state’s plan to ACF in August 2021. DSS updated the initial draft of the plan, which was released in March 2021, based on feedback gathered during meetings with individual stakeholder groups and tribal consultations over the past few months. The most recent version of the plan was made publicly available in mid-June. This version includes all services currently rated as well-supported by the federal Title IV-E Clearinghouse.

TBL specifies that during the first three years of implementation, in consultation with counties, tribes, and other stakeholders, DSS shall annually review the state plan and determine whether amendments should be pursued, including (but not limited to) the candidacy population and the evidence-based programs or services included in the plan.

County and Tribal Prevention Plans and State Funding for Implementation

Background. As California’s child welfare system is state-supervised and locally administered, TBL requires individual counties and tribes to opt in if they would like to implement Title IV-E prevention services included in the state plan.

Implementation Plan. TBL specifies that counties and tribes opting in and seeking Title IV-E funding for eligible prevention services included in the state plan will be required to submit “comprehensive prevention plans”—detailing the specific activities included in the state plan that they intend to implement, as well as any other prevention services that are not currently Title IV-E eligible that the county or tribe will implement—to DSS. (TBL notes that guidance from DSS will provide instructions around developing comprehensive prevention plans.) Counties and tribes also will be required to update DSS as their prevention plans change. During the first year of FFPSA implementation, a county may elect to begin providing prevention services by providing written notice to DSS prior to fully completing its comprehensive prevention plan.

To help counties/tribes to begin implementing new prevention activities, the 2021‑22 budget includes $222.4 million one-time General Fund resources, expendable over five years. Counties and tribes may use these funds to develop internal capacity (for example, staff training or setting up reporting structures) as well as for actual service delivery for any activities included in their comprehensive prevention plans. The legislation states that funds must be used to supplement, and not supplant, any pre-existing prevention services that the county or tribe may be implementing currently. DSS is required to consult with CWDA and Chief Probation Officers of California (CPOC) to develop the funding allocation methodology for state funds. Counties will be responsible for documenting and reporting all prevention services utilizing state funds under FFPSA in accordance with forthcoming written guidance to be issued by DSS.

Beyond the provided state funds, TBL specifies that counties shall pay the nonfederal share of the cost for providing optional prevention services. In order to ensure that Title IV-E funding is the payment of last resort (as federally required), the language also requires counties opting in to establish a joint written protocol between child welfare, probation, behavioral health, and other relevant entities for determining which entities or programs are responsible for prevention services payments. DSS will provide a model protocol for this purpose.

Candidacy / Eligibility

Background. As noted above, states opting in to Part I may claim Title IV-E funds only for services included in the state’s prevention plan that are provided to eligible candidates. Candidates are individuals who are demonstrated to be at “imminent risk” of entry or reentry into foster care, and/or their parents or kin caregivers. States must assess each individual candidate to demonstrate their eligibility. Pregnant or parenting foster youth are categorically eligible for prevention services.

Implementation Plan. TBL specifies that Title IV-E funding for prevention services will be claimed only for eligible “candidates for foster care,” and TBL notes this definition is further described in the state plan as approved by the federal ACF. TBL specifies counties and tribes will be responsible for assessing each individual to determine candidacy via an in-person assessment (or an alternative method as approved by DSS) using a state-approved risk assessment tool (this tool is yet to be determined).

According to the June draft of the state plan, DSS consulted stakeholders to identify certain populations who are most likely to be at imminent risk of foster care and therefore most likely to be individually determined to be candidates for Title IV-E prevention services. As described in the June draft of the state plan, the following are categories of circumstances identified as those under which children may be eligible for services funded through FFPSA and, accordingly, should be individually assessed to determine candidacy:

• Youth and families receiving voluntary or court-ordered Family Maintenance services.

• Probation youth.

• Youth whose guardianship or adoption is at risk of disruption.

• Youth with a “substantiated” or “inconclusive” disposition, but no case opened.

• Youth with a sibling in foster care.

• Homeless or runaway youth.

• Substance-exposed newborns.

• Youth who were victims of commercial sexual exploitation.

• Youth exposed to domestic violence.

• Youth whose caretakers experience substance use disorder.

Native American/tribal youth will need a candidacy assessment and determination specifically tailored to their family’s circumstances and needs. These youth will be considered candidates for Title IV-E prevention services if their tribe identifies them as at risk, and a county/tribal case worker has determined (based upon an approved assessment, which is yet to be determined) that prevention services are necessary.

Pregnant and parenting youth are categorically eligible for Title IV-E prevention services. (No individual assessment is needed.)

Monitoring and Evaluation

Background. States opting in to Part I are required to: (1) monitor implemented prevention services to ensure model fidelity and (2) evaluate implemented prevention services to demonstrate effectiveness in terms reducing a child’s likelihood of entry (or re-entry) into foster care and future referral to the child welfare system. (However, states can request evaluation waivers for activities rated as well-supported, given the strong existing evidence that these services are effective at reducing foster care system involvement.) Well-supported and supported services included in the federal Clearinghouse all have their own “essential requirements” and “quality standards” to which providers must adhere to ensure fidelity to the practice model. These requirements and standards typically include training and supervision requirements, as well as specific commitments to various model requirements. Some also include case review, consultation, specified assessment tools and protocols, as well as technical assistance activities as additional tools that work to ensure activities are delivered according to the practice model. In addition, for prevention services not yet rated by the federal Clearinghouse, states may submit evaluations to the Clearinghouse for review and potentially for rating/eligibility for future Title IV-E funding. States also must monitor the safety of youth who are/whose caregivers are receiving prevention services, to ensure that youth can remain safely at home during the intervention.

Implementation Plan. TBL specifies that counties and tribes opting in to Part I are responsible for continuously monitoring the implementation of prevention services to ensure fidelity to the program model, determine outcomes, determine how activities should be refined/improved using a continuous quality improvement framework (DSS will provide instructions about developing this framework), and ensure the safety of youth while receiving prevention services. In addition, TBL specifies that counties/tribes opting in to Part I are responsible for conducting or contracting for the well-designed and rigorous evaluation of each prevention service provided, in accordance with guidance (to be issued by DSS). The legislation requires that these evaluations must examine the effectiveness of each service in improving outcomes for children and families. For evaluations of programs that involve Medi-Cal funding, guidance will be provided by DSS and DHCS.

Importantly, TBL specifies that DSS will seek a federal waiver to the evaluation requirement for prevention services included in the state plan rated as well-supported by the federal Clearinghouse. In addition, TBL states that—subject to the availability of state funds—DSS may conduct (or contract to conduct) a statewide evaluation of certain prevention services. Participating in these state-level evaluations would fulfill counties’ and tribes’ evaluation requirements for the implicated prevention services.

Tracking and Reporting

Background. FFPSA requires states to report the following information about its Title IV-E Prevention Program:

• The specific services or programs provided to each child or family for whom Title IV-E funding for prevention is claimed and the total expenditures for each of the services or programs provided.

• The duration of the services or programs provided.

• The child’s placement status at the beginning and end of the prevention services period, and whether the child entered foster care within two years after being determined a candidate for foster care.

Implementation Plan. In order to be able to track the required individual child/family data points for federal reporting and claiming purposes, TBL requires counties to develop and implement an individual prevention plan for each child receiving Title IV-E prevention services, using a model approved by DSS. In addition, TBL specifies it is the responsibility of counties and tribes to collect the child-specific information/data necessary for federal claiming, federal reporting, or evaluation.

According to the state plan submitted to ACF in August, DSS is developing functionality in the Child Welfare Services-California Response and Engagement System for the collection and reporting of child, service, and program-level data as required. However, this functionality will not be available for the first year of implementation. At this time, how counties and tribes will bridge the gap to report the required information in the interim remains unclear.

Building Capacity to Serve Youth With Complex Care Needs in State

Some foster youth have particularly complex or acute behavioral health, developmental, physical health, and/or socio-emotional needs, which may make finding a suitable foster placement option challenging. In some cases, these youth may be placed in congregate care facilities in states other than California. In the past, several dozen youths or more were in these out-of-state congregate care placements at any time. DSS certified the individual out-of-state facilities, rendering them eligible to provide care to any number of California youth. In December 2020, DSS decertified all out-of-state facilities where California youth were placed at the time and began the process of returning all youth to California. This decertification and repatriation resulted from DSS’s review of all incident reports from those facilities—prompted by the death of a foster youth at a Michigan facility where California youth had been placed. While all out-of-state facilities where foster youth had been placed were decertified, no accompanying moratorium on the use of out-of-state placements moving forward was established at that time.

The 2021‑22 budget includes $139.2 million one-time General Fund and accompanying TBL to: (1) reduce California’s reliance on out-of-state placements beginning July 1, 2021 by instating new rules around out-of-state placements and developing and expanding in-state treatment options, (2) prohibit any new out-of-state congregate care placements beginning July 1, 2022 (with limited exceptions), and (3) stipulate that all out-of-state placements will be decertified January 1, 2023 and all out-of-state youth will be returned to California. We describe components of the trailer bill language in more detail below.

Legislation Changes Criteria for Placing Youth Out of State. Legislation accompanying the budget package changes the process for certifying out-of-state placements beginning July 1, 2021. As of this date, DSS may certify an out-of-state facility only on a case-by-case, child-specific basis, and only after the placing county has: (1) exhausted in-state placement and services options that meet the needs of the child, and (2) participated in the department’s technical assistance program. Once a child-specific placement is certified by DSS, the placement also must be approved by the juvenile court. Beginning July 1, 2022, the budget TBL stipulates that no new out-of-state congregate care placements may be made for foster youth. These statutory changes do not apply to children who are placed in congregate care facilities in other states for the purposes of special education as per their Individualized Education Program in accordance with the federal Individuals with Disabilities Education Act, or to Native American children who are placed out-of-state in accordance with the federal Indian Child Welfare Act.

New and Expanded Programs, Services, Supports, and Practices. The spending plan includes funds for assistance to counties and tribes and contracts to community-based providers to “support new or expanded programs, services, practices, and training that builds system capacity and ensures the provision of a high-quality continuum of care designed to support foster children in the least restrictive setting.” Pursuant to forthcoming guidance that will be established by DSS and DHCS, in consultation with CWDA, CPOC, and the County Behavioral Health Directors Association, funds may be used to supplement or build new capacity for:

• Specialized models of professional foster care.

• Intensive child-specific recruitment, family finding, engagement, and support for youth with complex needs.

• Specialized models of integrated care and support for family-based services, including high-fidelity wraparound, and community-based treatment models that are alternatives to out-of-home placement.

• Children’s Crisis Continuum Pilot Program (described in more detail below).

• Specialized STRTPs designed to serve youth with co-occurring intellectual or developmental disabilities and behavioral health needs.

Funding will be conditioned on qualitative and outcome standards established by DSS, in consultation with DHCS, counties, tribes, and other stakeholders.

Children’s Crisis Continuum Pilot Program. Legislation directs DSS and DHCS to establish guidance for a five-year pilot program to provide technical assistance and funding for counties to develop strategies and procedures to: (1) support youth in family settings and prevent the need for more restrictive placement settings, and (2) connect youth in more restrictive settings to a continuum of care and services that facilitate a transition to family-based placement settings. TBL specifies that DSS and DHCS will determine if any federal Medi-Cal approvals are needed and seek those approvals by June 1, 2022. Language further instructs DSS and DHCS to develop and administer a request for proposal process and selection criteria to determine which counties will participate in the pilot. Selected counties will agree to:

• Collaborate with a workgroup to develop a highly integrated continuum of care for foster youth served by the pilot program. The continuum will include:

  • A crisis stabilization unit, providing emergency assessment and stabilization for urgent cases for up to 24 hours. The unit will be licensed as a 24-hour health care facility or hospital-based outpatient program or provider site, and must be within 30 miles of (or co-located at) a psychiatric health facility or other secure hospital alternative.

  • A crisis residential program, providing stabilization services to youth not requiring inpatient treatment.

  • A psychiatric health facility, as licensed by DHCS.

  • Intensive services foster care homes with integrated specialty mental health services.

  • Community-based supportive services, providing transition planning and aftercare services.

• Commit to including a number of approaches throughout their continuums of care, including:

  • Individualized and trauma-informed services.

  • Culturally and linguistically responsive treatments.

  • Inclusion of youth and families in decision-making.

  • Coordination around level of care determinations, allowing youth to transition between levels as needed.

Finally, TBL related to the pilot program requires DSS and DHCS to submit an interim report to the Legislature by April 1, 2025, including information about the program’s impacts and outcomes as well as best practice recommendations for providing services to foster youth with high acuity mental health needs.

Exceptional Support for Individual Foster Youth. Further funding will be allocated as assistance to counties and tribes and contracts to community-based providers to provide child-specific supports as necessary to meet the complex care needs of foster youth in state, within the least restrictive setting . These child-specific supports will be based on individual assessments and evaluations and could include enhanced care planning, ongoing technical assistance, and other exceptional supports. Funds can be requested by counties for individual youth based on a process which will be established by DSS.

Legislation Requires Joint Interagency Resolution Team to Issue New Findings. Chapter 815 of 2018 (AB 2083, Cooley) seeks to develop a more integrated overall system of care for foster youth who have experienced severe trauma. Toward this end, some key measures included in the legislation are: (1) requiring counties to develop and implement memorandums of understanding specifying the roles and responsibilities of the various local entities serving foster youth who have experienced severe trauma; (2) requiring the California Health and Human Services (CHHS) Agency and Superintendent of Public Instruction to establish the Joint Interagency Resolution Team (JIRT), comprising representatives from a number of state departments, to provide technical assistance to counties; and (3) requires the JIRT to analyze gaps in existing services in terms of serving youth who have experienced severe trauma and to make recommendations to the Legislature for building system capacity. The 2021‑22 budget’s accompanying TBL specifies that the JIRT will update its trauma-informed care review and provide additional recommendations to the Legislature by December 31, 2022 that take into account the specific needs and characteristics of youth with unplanned STRTP discharges and youth for whom counties have difficulty finding suitable placements to meet their needs. This could include youth who have been commercially sexually exploited, youth with acute behavioral health needs, youth with intellectual and developmental disabilities, and others with complex care needs. TBL further specifies that, beginning July 1, 2022 and annually thereafter, the JIRT will provide data and information published on the CHHS Agency website about youth who have received assistance under the new statutory provisions to expand or preserve in-state placements.

Legislation Includes Other Reporting Requirements. TBL also includes a number of reporting provisions to ensure the Legislature can track the progress of ending out-of-state foster placements and building in-state capacity to serve youth with complex care needs. Specifically, beginning September 1, 2021 and monthly thereafter, DSS will report the number of youth placed out of state. Beginning January 1, 2022 and every six months thereafter until all facilities have been decertified and all youth returned to California, DSS (in consultation with counties) will report on the state’s capacity for serving all child welfare and probation youth within California (or in home-based settings outside California). Reports will include: (1) the number of children served by out-of-state residential facilities; (2) data measures related to ongoing transition planning efforts, including CFT meetings, child-specific recruitment and family finding activities, and multiagency care coordination efforts; (3) length of stay out of state for each child; and (4) information about all serious incident reports received regarding out-of-state residential facilities—and specifically reports involving California youth.

Pandemic Response

Within weeks of Governor Newsom’s declared state of emergency in response to the coronavirus disease 2019 pandemic in March 2020, the state began funding emergency response activities and supports for youth and families involved with the child welfare and foster care systems. The 2021‑22 spending plan includes funding to continue some of these supports—and provide a few new supports—in 2021‑22. Figure 2 summarizes the state’s pandemic response within child welfare in 2019‑20, 2020‑21, and 2021‑22.

Continued CCR Implementation

Since 2012, California has been implementing a series of reforms known as CCR that institute fundamental changes to the way the state cares for youth in the foster care system. CCR aims to achieve a number of complementary goals including: (1) ending long-term congregate care placements; (2) increasing reliance on home-based family placements; (3) improving access to supportive services regardless of the kind of foster care placement a child is in; and (4) utilizing universal child and family assessments to improve placement, service, and payment rate decisions. Figure 3 summarizes funding for CCR included in the 2021‑22 spending plan.

Foster Care Rates Receive Statutory COLA. Pursuant to current law, monthly foster care payments for county-approved resource families, Foster Family Agency (FFA) families, and STRTPs increase by 3.72 percent in 2021‑22. This increase represents the annual cost-of-living adjustment (COLA).

Resource Family Approval (RFA) Preapproval Funding for Emergency Caregivers Continued. Counties provide grant payments to emergency placement foster caregivers with a pending RFA application in an amount equal to the basic rate paid to approved resource families. In 2020‑21, recipients were eligible for this funding for up to 120 days (or up to 365 days for caregivers requiring an extension for good cause). Statute dictated that the maximum duration for preapproval funding would shorten to 90 days without the option for an extension beginning in 2021‑22. However, the 2021‑22 spending plan includes budget-related legislation that retains the prior-year funding provisions for one additional year, delaying the reduction to 90 days until 2022‑23.

Funding for All Level of Care (LOC) Protocol Tool Rates Included in Budget. The 2021‑22 spending plan includes funding for LOCs 1‑4 for all eligible home-based placement types (foster family homes, relative/kin placements, and FFA homes) as well as for Adoption Assistance Program placements. This is the first full fiscal year that the LOC Protocol Tool is fully rolled out to placement types other than FFA homes—DSS provided instructions to counties in February 2021 about rolling out the tool and corresponding rate levels 2‑4.

FFA Social Worker COLA Continued on Ongoing Basis. A 4.15 percent increase for FFA social workers was included in the 2019‑20 budget, but the increase was subject to suspension in 2020 and 2021. The January Governor’s budget proposal included new suspensions, which would have put the FFA social worker increase on the list to be suspended at the end of 2022. However, the 2021‑22 spending plan does not include any new suspension language and funding for the 4.15 percent increase is budgeted on an ongoing basis.

New FFA Social Worker Increase. The 2021‑22 spending plan includes $5.4 million General Fund ongoing to provide FFA social workers with an additional $50 per child per month.

Ongoing Augmentation for CANS Implementation. As proposed by the administration in May, the 2021‑22 spending plan includes $3.4 million General Fund as an ongoing workload adjustment for the time that county child welfare social workers spend completing and recording CANS assessments.

Reconciliation for Past Year’s CCR Costs. As per current law, the Department of Finance and CWDA have agreed to a methodology for determining the net costs of agreed-upon activities (primarily CFTs) under CCR based on counties’ actual expenditures. The spending plan includes $7.1 million General Fund to fully fund counties’ final expenditures in the 2018‑19 fiscal year as per this annual reconciliation process.

Additional Funds for Counties. The 2021‑22 spending plan also includes an additional $85 million General Fund one time for county costs of child welfare services. CWDA requested these funds as a true-up for county RFA costs. Notably, the administration has not agreed to provide additional state funds for RFA on an ongoing basis. The administration has expressed that responsibility for RFA was transferred to counties as part of 2011 realignment, meaning counties are responsible for funding it using their realignment dollars. Counties, however, have asserted that RFA was not fully implemented at the time of 2011 realignment and accordingly the state should provide additional funds to counties to implement this required activity, according to the rules of Proposition 30 (2012).

Other Augmentations

Continuation of California Work Opportunity and Responsibility to Kids (CalWORKs) Aid for Child Welfare Families. The 2021‑22 spending plan includes around $9 million General Fund ongoing to provide up to six months of continued CalWORKs cash assistance to recipients when a child is removed from the home and the family is participating in family reunification services. Accompanying TBL implements this policy change. Prior to this change, when a family receiving CalWORKs aid experienced the removal of a child, that family did not receive CalWORKs cash assistance during the months when the child was out of the home. Previous statutory changes allowed CalWORKs recipients to continue benefitting from CalWORKs services while a child was in foster care, but did not allow for continued cash assistance under those circumstances.

Guaranteed Income Pilots Could Target Assistance to Former Foster Youth. Similar to universal basic income pilot projects that have been implemented by some local governments, the spending plan dedicates $35 million General Fund for cities and counties to undertake guaranteed income pilot projects. Participation is optional and local governments will need to apply for funding. While forthcoming guidance from DSS will specify project criteria and application instructions, budget language indicates that funding priority will be given to projects supporting youth who age out of EFC, pregnant or parenting foster youth, and low-income Californians.

Approved Relative Caregiver (ARC) Payments for Youth Placed Outside California. TBL implements a policy change within the ARC program—which is the program that provides equivalent payments to relative caregivers who are not eligible to receive federal foster care maintenance payments. This policy change extends ARC eligibility to youth placed with ARCs out of state. Previously, California residence was an eligibility criterion for ARC payments. Other ARC eligibility criteria will still apply to these out-of-state homes, including requirements that the relative’s home be licensed/approved in line with the state’s standards, and that the youth is not federally eligible for foster care maintenance payments. TBL specifies that this policy change will take effect once DSS has issued comprehensive guidance and claiming instructions, and has established a new aid code if needed.

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