Casey Child Welfare Financing Survey: Family Foster Care Provider Classifications and Rates. Section 3: State family foster care rate profiles

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1 Section 3: State family foster care rate profiles

2 Alabama Profile (Rates implemented in 2007) Service type/level Age ranges Per Diem % of family foster care Basic Foster Care 0 2 $ $ $ % $15.39 Therapeutic Foster Care 0 2 $ $ $ % $ $36.25 Medically Fragile All ages $ % (1) Percentages listed are statistical estimates based on the ages of the young people currently in care. State is not currently able to access reliable cohort data through their new SACWIS. State is currently working with Casey Family Programs to restore their ability to track that data set. Payment or reimbursement for incidentals (other than the daily rate): Type of payment/reimbursement Maximum $ provided Emergency clothing School clothes Allowance for children Book/school supplies Camp Diaper Family vacation Graduation expenses Holidays/birthdays School clothes Sibling visits Supplemental school fees in year round schools All of these items could be allowed as needed and are determined through Individual Planning. There are no noted caps with regard to reimbursement for incidentals as long as the reimbursement is not prohibited by State and/or Federal law. All determinations regarding spending are addressed in the Individuals Service Plans and supporting documentation and receipts are required. Any costs/purchases above $500 have to be approved by the Department s Finance Review Committee. (1) An initial clothing allowance of $200 is sometimes given. This determination is based on the specific needs of the child. If parents or guardians provide sufficient clothing at the time of removal, those funds are not expended. The clothing allowance is most often used to provide start up supplies and clothing for newborns. Many counties, however, have tremendous community support and clothing and supplies are collected and donated to the counties from community organization to support youth in foster care. The initial clothing allowance is provided on an individual needs basis. Extra ordinary expenses can be reimbursed if agreed on in advance. (2) Additional detail on clothing (excerpts from TFC Policy (See Appendix for a copy of this document.): If the parents are unable to provide an adequate initial supply of clothing or if the Department is unable to provide this through some other source, the foster parents should be authorized to purchase an initial specified amount of clothing to be paid for from local public or private funds when such is available. Workers and foster families can assist accordingly. (3) Eight percent (8%) of the board payment should be allotted each month for clothing expenses. This may not always meet the ongoing need for clothing as children outgrow or clothes need to be replaced; therefore, counties are allowed through Local Fund

3 Polices to spend up to $ per year for clothing. (Refer to Local Funds Policy) The foster care facility (foster family boarding home, therapeutic foster home) is expected to provide clothes for the child from the board payment as long as the child remains in foster care. Description of Service Types/Rate Levels Source: Excerpts below from Alabama Department of Human Resources Foster Care Board Rates. See Appendix for a copy of this document. The medically fragile rate is for children with medical conditions that require special training for the foster parents in order to care for the child. Therapeutic board rate is for children with serious mental or emotional problems that require specialized training and additional interventions to deal with. Child must have a DSM IV diagnosis. Source: Excerpts below from TFC Policy. See Appendix for a copy of this document. A link to the Therapeutic Foster Care Manual is: Therapeutic foster care (TFC) exists to serve children and youth whose special emotional needs lead to behaviors, that in the absence of such programs, they would be at risk of placement into restrictive settings, e.g. hospitals, psychiatric centers, correctional facilities, or residential treatment programs. A DSM IV Axis I diagnosis as documented by a current psychological or psychiatric evaluation within 24 months without the associated behaviors is not necessarily an entrance criterion into the TFC placements. A child may not be placed in TFC or moderate residential care with an IQ below 65. Children with IQ s below 65 should be referred to mental retardation developmentally delayed placements. TFC also aims to serve the families of the children that are placed within the program, supporting child family relationships consistent with the permanency goals outlined in the family s ISP. There are two levels of TFC services. All children who meet the criteria for TFC will enter at the Comprehensive TFC level. Children in TFC placements will be assessed semi annually by the Multi dimensional Assessment Tool (MAT) to determine their continued need for TFC services. Step down TFC is a reduced level of service need identified by the MAT. This level is identified for children who no longer need comprehensive TFC services but may require more services than offered in a traditional foster home setting. For step down procedures refer to the Therapeutic Foster Care Manual Core Services section. Out of Region TFC placements are approved by the county consultant in the Office of Child Welfare Consultation, if the assigned consultant cannot be contacted, intake in the Office of Child Welfare Consultation gives approval. The Office of Permanency must be contacted for approval for placement under the age of six (6) in TFC. Refer to Therapeutic Foster Care Manual Revised October 2005 for further information. The manual is located on the web site. Diagnostic tools used by the child welfare agency to determine a child s needs/level of care: Multi systemic Assessment Tool Information on rate setting process/frequency: Rates are driven by legislative approval. The changes in foster care rates are generally driven by an introduction of a bill by a legislator which is generally spurred by constituent concerns or advocacy groups lobbying for an increase. There has been no such successful action since Rates are not revised to reflect rates of inflation.

4 Alaska Profile (Rates implemented in 2008) Service type/level Age ranges Per Diem % of family foster care Foster Care Base Rate: Basic Rate* 0 29 mos Min: $27.67; Max: $ mos 11 yrs Min: $24.59; Max: $ Min: $29.20; Max: $ % Fostering Independence Assistance: Basic Rate* Min: $29.20; Max: $41.46 Foster Care Base Rate: Specialized* 0 29 mos Min:$35.17; Max:$ mos 11 yrs Min:$32.09; Max:$ Min:$36.70; Max:$ % Fostering Independence Assistance: Specialized* Min:$36.70; Max:$48.96 Foster Care Base Rate: Structured* 0 29 mos Min:$42.67; Max:$ mos 11 yrs Min:$39.59; Max:$ Min:$44.20; Max:$ % Fostering Independence Assistance: Structured* Min:$44.20; Max:$56.46 Medically Fragile All ages Rate TBD based on assessment/xix waiver 0.22% Teen w/ Baby All ages Rate TBD using non custody 0.29% child s age Emergency Foster Home Care * All ages Min: $36.89; Max: $52.38 Less than 24 hrs notice/cannot exceed 30 days Emergency Foster Group Home Care* Min: $76.89; Max: $ Less than 24 hrs notice/cannot exceed 30 days (1) *Geographical difference multipliers applied. Rates in Alaskan villages across the state vary. Multipliers range from 1.00% to 1.42%. See State of Alaska Department of Health and Social Services, Orca Foster Care Rate Schedule, Effective July 1, 2008 in Appendix. (2) Percent of caseload averages are based on payments issued during the month of November 2011 Payment or reimbursement for incidentals (other than the daily rate): Type of payment/reimbursement Maximum $ provided Assessed on an as needed basis within regulation and policy. Incidentals have various spending limitations based on several criteria need, age, funding availability from other resources, placement type (in home, licensed out of home, unlicensed relative, institutional, etc.) and legislative appropriation of funds. For detailed information on incidental payments/reimbursements, see Appendix for Office of Children s Services Special Needs Spending Matrix. Description of Service Types/Rate Levels Source: Excerpts below from A. Augmented/Difficulty of Care Rates for Children in Foster Care or Fostering Independence Assistance. See Appendix for a copy of this document. Specialized Care: Children who qualify for the specialized care rate have identified special needs that require more intensive care and supervision from the foster parent.

5 Structured Care: Children who qualify for the structured care rate have identified severe problems that require specialized training by the care provider and a structured environment and their needs are more than can be provided through basic or specialized care, but residential care placements are not required to meet their needs. Diagnostic tools used by the child welfare agency to determine a child s needs/level of care: Alaska Difficulty of Care Assessment Information on rate setting process/frequency: Revisions to foster care rates vary. The most recent increase, effective July 1, 2008, increased rates 28.9% from the rates that had last been increased in All increases are subject to legislative appropriation of supplemental funds. Rates are revised to reflect rates of inflation as determined by the state legislative process. The standard rate for the foster care maintenance payment is the US Health and Human Services Federal Poverty Guideline for a household of one person for the State of Alaska, which includes a 24.8% cost of living differential as determined by the federal government. The standard daily rate may be increased by a geographical differential up to 42% over standard rate as defined by state regulation (7 AAC (b) and emergency foster care rates are calculated as 120% over standard rate in addition to a geographical differential. The standard rate is also adjusted by the child's age with ages less than 30 months decreased by 10%; ages 30 months to 11 years decreased by 20%; and ages over 12 years decreased by 5%. The emergency foster care rate is not adjusted by a child's age, however, eligibility exists only when a child is placed with less than 24 hour notice and may not exceed 30 days.

6 Arizona Profile (Rates implemented in 2009) Service type/level Age ranges Per Diem % of family foster care Foster Care Basic 0 11 $ $ % Foster Care Special level $ % Foster Care Special level $ % Foster Care Medically Fragile $ % (1) Rates are what the foster homes are paid directly. The rates do not include Home Recruitment Study and Supervision (HRSS) services which are paid to private providers responsible for recruitment and supervision of foster homes. (2) Rates do not include daily clothing and personal allowances. These payments are included in the table below. Payment or reimbursement for incidentals (other than the daily rate): Type of payment/reimbursement Maximum $ provided Emergency clothing/emergency clothing Emergency clothing allowance: $ per state fiscal year EXTRA Emergency clothing EXTRA: $100 per state fiscal year (e.g., Fire, Flood, Theft) Clothing Daily allowance 0 12 mos: $ yrs: $ yrs: $ yrs: $ yrs: $1.02 Personal allowance Daily allowance 0 12 mos: $2.10* 1 2 yrs: $0.95** 3 5 yrs: $ yrs: $ yrs: $0.72 *For diapers and formula **For diapers Books Education Expenses $82.50 max per school year. For books, supplies, course fees, student services and physical education. May be approved for special pre school and college level, technical and vocational classes. Diapers (Special) $62.50 per month. This allowance must be authorized monthly. Available with medical documentation for children who require additional funds for diapers. Supplemental extra school tuition and fees $165 per session. For use during summer sessions or interim sessions at year round schools. Graduation expenses $ maximum. Available for High School only for cap, gown, ring, yearbook, and other graduation related fees. Special needs $22.50 per state fiscal year. Available to assist foster parents with expenses such as holidays, birthdays, and special

7 occasions. Passport allowance Reimbursement for the actual cost of obtaining a passport book or card. Receipts are required. One time reimbursement per child. (1) Excerpts above from State of Arizona Administration for Children, Youth & Families, Family Foster Home Care Rates and Fees Schedule, Rates effective March 1, Please see Appendix for a copy of this document. Description of Service Types/Rate Levels Assignment of children to various rate levels is determined by the unique needs of each assessed case. In order for the CPS Specialist (case manager) to recommend to the CPS Unit Supervisor that a foster parent should receive a higher foster care rate than the basic rate for a specific child, the case manager must complete several assessment windows in CHILDS. The information in these windows pertains to the child's special needs, medical/dental conditions, psychological and behavioral health conditions, educational needs, and etc. This is not a diagnostic tool. It is a guide to assist case managers in their decision to recommend to their supervisor that the daily 24/7 care for a specific child merits a foster care rate over and above the basic daily rate. Any rate above the basic rate requires the approval of the CPS Unit Supervisor. Information on rate setting process/frequency: The Foster Home rate schedule adjusts when the Division of Children Youth and Families receives an increased appropriation from the legislature for Foster Care rates. Rates are not revised to reflect rates of inflation.

8 Arkansas Profile (Rates implemented in 2009) Service type/level Age ranges Per Diem % of family foster care Basic rate 0 5 $ $ $ $16.44 Special Board Rate Based on nature and extent of child s special needs; cannot exceed $460/mo above standard board rate for child s age group. If child is eligible for SSI, rate can be $460 above SSI rate. (1) Special board rates can be provided when foster parents are caring for a child with special needs and the child s needs cannot be met with the regular board payment. Although they use the PACE Exam, it is not the only thing used to determine the child s needs/level of care. They utilize the tools or medical record and psych evaluations as well as foster parent daily accommodations to determine special board per policy. Payment or reimbursement for incidentals (other than the daily rate): Type of payment/reimbursement Maximum $ provided Emergency clothing $135 initial Clothing Special payment (on an as needed basis; not a regular clothing allowance): $400 per quarter Allowance for children $35 per month Books/school supplies No maximum Camp No maximum Graduation expenses $500 per year Holidays/birthdays $30 per year Parent/sibling visits (transportation or No maximum food reimbursement) Description of Service Types/Rate Levels For Special Board Rate policy and descriptions of various rate levels, see Appendix for copies of: Instructions, Justification for Levels of Care Special Board Rate Form CFS 304 and Justification for Special Board Rate Form. Diagnostic tools used by the child welfare agency to determine a child s needs/level of care: PACE (Project for Adolescent and Child Evaluation) Exam, Special Board Rate Information on rate setting process/frequency: State reviews the board rate every 5 years which aligns with the Child and Family Services Plan development. The next review will be in However, rates might not change when they are reviewed. Rates are not revised to reflect rates of inflation.

9 California Profile (Basic rates implemented in 2012; specialized care rates implemented in 2008) Service type/level Age ranges Per Diem % of family foster care Basic 0 4 $ $ $ $ $26.27 Specialized Care Varies by county (1) There are 54 participating counties responsible for maintaining and administering county specific specialized care systems. Each county has its own rate system, criteria and methodology. Caseload unknown. Not all counties have a specialized care system. (2) All of California s licensed foster family homes receive the minimum of the rates reflected above. The California Department of Social Services sets the rates that counties pay their foster family homes across the state. California pays providers monthly set rates rather than per diem rates as reflected; however, for consistency purposes for this report, California s monthly rates have been converted to per diem rates. Description of Service Types/Rate Levels See for each county s specific rates and assessment tools/methodology. Source: Excerpts below from Specialized Care 1. What is specialized care? Specialized care provides a supplemental payment to the family home provider, in addition to the family home basic rate, for the cost of supervision (and the cost of providing that supervision) to meet the additional daily care needs of an Aid to Families with Dependent Children Foster Care (AFDC FC) child who has a health and/or behavior problem. Placement of children who need specialized care in family homes complies with the intent of State and federal requirements that a child is entitled to placement in a family environment, in close proximity to the parent's home, and consistent with the best interest and special needs of the child. California's specialized care rate setting system promotes these concepts. 2. Can any AFDC FC child with a health and/or behavior problem receive a specialized care increment? Children who are placed under the authority of a court order, either as a dependent or ward of the Juvenile Court, relinquishment, voluntary placement agreement or guardianship may be eligible to receive a specialized care rate if the county has a specialized care system. Not all counties in California have a specialized care system. 3. Are there any restrictions on the type of facility in which the child must be placed to receive a specialized care rate? Children placed in a licensed or approved family home, licensed small family home, the certified home of a Foster Family Agency non treatment program or the home of a relative or nonrelated legal guardian may be eligible to receive a specialized care rate.

10 4. Who is responsible for the development, maintenance, and administration of the specialized care rate setting system in California? California's county welfare departments are responsible for developing, maintaining, and administering county specific specialized care systems. The State provides technical assistance to counties to modify or adopt a system. Currently 54 counties have specialized care systems. Diagnostic tools used by the child welfare agency to determine a child s needs/level of care: State agency does not use a tool, but county agencies might. Each county has its own criteria for determining the increment. Information on rate setting process/frequency: Basic rates are increased annually, and revised to reflect rates of inflation (adjusted according to the California Necessities Index). The last time specialized care rates were changed was in The specialized care rates are increased when the legislature grants an increase to the specialized care rates. A county may choose to apply a cost of living adjustment to its specialized care increment during the or fiscal years. To the extent that a county chooses to apply a cost ofliving adjustment during that time, the state shall not participate in the costs of that adjustment.

11 Colorado Profile (Rates implemented in 2009) Service type/level Age ranges Per Diem % of family foster care Basic 0 10 $ $ $14.12 Specialized County specific (1) Colorado is a county based state, so the 64 counties each negotiate their own rates with providers. The rates listed above are the base anchor rates that the state agency sets (based on the cost to raise a child per day). However, counties can go above or below these rates in terms of what they pay providers. (2) The specialized rates and classifications are county specific. Counties use their own needs based care tools to classify children into different rates. Payment or reimbursement for incidentals (other than the daily rate): Type of payment/reimbursement Maximum $ provided School clothes $86 per time child is placed in care Respite $20 per month, given to foster care provider (e.g., babysitting) Description of Service Types/Rate Levels The specialized rates and classifications are county specific. Counties use their own needs based care tools to classify children into different rates. Diagnostic tools used by the child welfare agency to determine a child s needs/level of care: State agency does not use a tool, but county agencies do. Each county has its own needs based care tool. Information on rate setting process/frequency: Rates are changed based on legislative decision making. No set timeframe upon which rates are reviewed/changed. Last change was actually a decrease. Rates are not revised to reflect rates of inflation.

12 Connecticut Profile (Rates implemented in 2007) Service type/level Age ranges Per Diem % of family foster care Foster/Relative Care 0 5 $ $ % $28.24 Medically Complex $ % Therapeutic FC $ % Therapeutic FC Wrap $ % Therapeutic FC Medically Fragile $ % (1) Percentage of caseload data: Total does not equal 100%, due to some providers being paid child specific rates, not the standard per diem. Payment or reimbursement for incidentals (other than the daily rate): Type of payment/reimbursement Maximum $ provided Emergency clothing $300 per initial removal Camp Not defined Graduation expenses $500 per child Sibling visits $100 per visit Wrap Services $5,000 per request. Wrap funds are used for expenditures that go beyond what is normally paid for. Wrap funds are to be used to preserve the child in the home or placement. These expenditures are very individualized and would be difficult to subject to a bidding process. Description of Service Types/Rate Levels A child with complex medical needs is one who has one or more of the following: a diagnosable, enduring, life threatening condition a medical condition that has resulted in substantial physical impairments medically caused impediments to the performance of daily, age appropriate activities at home, school or community a need for medically prescribed services as identified on the Certification of Child s Complex Medical Needs form, DCF Those children with behavioral disorders, mental health needs, or intellectual disability who do not have one or more of the conditions listed above are not included in the category of children with complex medical needs. Therapeutic Foster Care (TFC) is an intensive, structured, clinical level of care provided to children with serious emotional disturbance (SED) within a safe and nurturing family environment. Children in TFC receive daily care, guidance, and modeling from specialized, highly trained, and skilled foster parents. TFC families receive

13 support and supervision from private foster care agencies with the purpose of stabilizing and/or ameliorating a child's mental/behavioral health issues, and achieving individualized goals and outcomes based upon a comprehensive, multifocal care plan, and facilitating children's timely and successful transition into permanent placements (e.g., reunification, adoption, or independent living). Diagnostic tools used by the child welfare agency to determine a child s needs/level of care: Child and Adolescent Needs and Strengths, Mental Health (CANS MH) Ohio Youth Problems, Functioning and Satisfaction Scales (Ohio Scales) Information on rate setting process/frequency: Increases in rates are requested with the biennial budget request. Due to the financial crisis of the past few years, the state hasn t had an increase since the SFY 08 fiscal year. Rates are revised to reflect rates of inflation; requested every 2 years.

14 Delaware Profile (Basic rates implemented in 2000; Governor s Task Force (GTF) rates implemented in 2003) Level of Care (LOC) Rate Table Service type/level Age ranges Per Diem % of family foster care Child Level of Care: $ $ & up $16.79 Child Level of Care: $ $ & up $18.79 Child Level of Care: $ $ & up $19.79 Child Level of Care: $ $ & up $20.79 Baby Rate $13.04 Governor s Task Force (GTF) Rate Table CHILD Level PROVIDER Level Per Diem % of family care caseload in this category GTF 1 or 2 Paid according to the child s Level of Care and Age (per table above) GTF Level 3 GTF Level 3 $35.00 GTF Level 4 GTF Level 3 $35.00 GTF Level 5 GTF Level 3 $35.00 GFT Level 3 GTF Level 4 $35.00 GTF Level 4 GTF Level 4 $45.00 GTF Level 5 GTF Level 4 $45.00 GFT Level 3 GTF Level 5 $35.00 GTF Level 4 GTF Level 5 $45.00 GTF Level 5 GTF Level 5 $55.00 All Levels of Care and GTF Emergency $55 Levels $13.04 (baby) (1) Governor s Task Force (GTF) rates: these levels are associated to the 2001 task force report. The GTF made recommendations for a variety of settings, and because of budget and workforce barriers the state was only able to implement GTF Levels 3 5. (GTF Level I (Basic) and Level 2 (Moderate) have not been implemented). Due to this, state operates off two different payment tables currently: Level of Care Rates: which assign children by level of care (0 3) and age group, and are paid to foster parents with GTF levels of 0 2.

15 GTF Rates: which assigns both children and foster parents GTF levels (parents GTF levels based on experience, training, etc) and rate is determined accordingly, per table above. (2) Percentage of caseload receiving various rates: Approximately 57% of foster families receive what is considered the basic rate for children in their home and 43% of foster families receive a higher rate for children in their home. Payment or reimbursement for incidentals (other than the daily rate): Type of payment/reimbursement Maximum $ provided Emergency clothing A 1 time, separate payment. Maximum by child's age: 0 9 yrs: $ yrs: $ yrs: $ Maximum by GTF: GTF Level 3, 4, or 5: $ Clothing & Incidentals $ per request. As requested by the provider and approved by the client's case worker School supplies All foster care clients are provided $150 per year with additional funds as approved by caseworker/supervisor. Travel/camp As approved by caseworker, supervisor and regional administrator. Cost varies per request. No maximum amount memorialized. Graduation expenses $300 per request. As requested by the provider and approved by the client's caseworker. Description of Service Types/Rate Levels Information entered by a caseworker from an element table in the SACWIS system calculates a score based on the child s needs and a caregiver s effort caring for a particular child to determine the level of care. Caregivers are rated on skills, experience and training to calculate a payment schedule. GTF Tables with further detail on characteristics of children, assessment, child s needs, services required of the foster family, training, supports, and systems needs are found in Appendix, Division of Family Services, Foster Care Model. **NOTE: GTF Basic Level I and Moderate Level 2 have not been implemented. However, state notes that the information under the characteristics of children and child s needs columns for these two tables utilize related domains to how the Levels of Care are determined. Diagnostic tools used by the child welfare agency to determine a child s needs/level of care: DSCYF Self Developed Assessment Information on rate setting process/frequency: The last basic foster care rate increase was The Governor's Task Force rates for Levels 3, 4, and 5 were established in Rates are not revised to reflect rates of inflation.

16 District of Columbia Profile (Rates implemented in 2010) Service type/level Age ranges Per Diem % of foster family care Regular 0 11 $ & up $32.97 Special 0 11 $ & up $34.17 Handicapped 0 11 $ & up $36.52 Multi Handicapped 0 11 $ & up $43.04 (1) Many of DC s foster homes are contracted through private agencies. The rates above are guidelines for private agencies payments to foster parents, though some may actually pay different rates. Payment or reimbursement for incidentals (other than the daily rate): Type of payment/reimbursement Maximum $ provided Emergency clothing Available on request for special circumstances Graduation expenses Other things a child may need could be provided on a case by case basis Description of Service Types/Rate Levels Placement classification is determined by: the placement unit; individual social workers; and availability. CFSA policy for determining the Level of Care and establishing the appropriate board rate. In determining the level of care that a child requires, CFSA uses four levels to determine the maintenance amount that a child will receive. Based upon the needs of the child, a level is awarded. The awarded level translated to a per diem amount which is a calculation of the amount of money that it may cost to provide care on a daily basis for that child. These levels and rates are established agency policy. The following is a discussion of determinants used to establish a level. Level I Normal The normal board rate is paid for the basic and routine care required by a child who comes from a neglecting or abusing family. It is expected that basic care will include bringing the child into the regular, daily life of the family and providing 24 hour/day adult supervision. Level II Special The special board rate is paid for the child who has a regular, recurring special need that requires extraordinary time or expense on the part of a foster parent. A special need would be a recurring or on going, professionally diagnosed medical, psychiatric, education or social need. Level III Handicapped

17 The handicapped rate is paid for a child who needs foster parent intervention because he cannot accomplish normal age appropriate life processes (e.g. eating, bathing, toileting, dressing, ambulating, emotional and/or social control) without adult intervention. Children who are classified as handicapped require parents who are specially trained to provide daily care and participate in the child s treatment plan. Level IV Multi Handicapped The multi handicapped board rate is paid for a child who requires adult intervention in more than one ageappropriate daily living process (e.g. eating, bathing, toileting, dressing, ambulating, emotional and/or social control). This rate is reserved for the most severely handicapped children. Extensive training may be needed for parent to provide an adequate level of care for the multi handicapped child. Information on rate setting process/frequency: Currently no set schedule for how often rates are revised. Rates are revised to reflect rates of inflation, on a variable frequency.

18 Florida Profile (Rates implemented in 2006) Service type/level Age ranges Per Diem % of family foster care Basic 0 5 $ $ & up $16.93 Medical $16.57 Emergency: Family Shelter 0 11 $ & up $14.86 (1) Rates are guidelines, not absolute limits or requirements. In line with the policy memos, the CBC (community based care) lead agencies are supposed to pay their providers at least the minimum, but actual payment levels depend on local negotiation within their allocated total budget for the purpose. The amount should be the floor, but it is not audited. (2) Medical per diem is a stand alone paid for room/board/basic essentials to the foster parent, but for homes designated Medical Foster Homes it is supplemented for eligible children in these placements according to an assessed level of reimbursement in the Medicaid Handbook. If a foster home gets certified as a Medical Foster Home under a program in the Department of Health, they can claim additional reimbursements at different levels for children in their homes from another department's budget (Medicaid). The amount that they can claim depends on the needs of the child. There are three levels of reimbursement: Level I ($38.80 per day); Level II ($48.50 per day); Level III ($67.90 per day). This would be additional reimbursement available for the people caring for those children, but like many other services it is not considered part of the child welfare budget. Medical foster care is administered by the Department of Health/Children's Medical Services, but the Agency for Health Care Administration is the Medicaid agency and actually pays for the services. Payment or reimbursement for incidentals (other than the daily rate): Type of payment/reimbursement Maximum $ provided These may be paid by local community based care lead agencies but there is no statewide rate structure. What is paid depends on CBC (community based care) lead agency negotiation with foster parent providers. Description of Service Types/Rate Levels Medical foster care: The use of medical foster care is determined by a multidisciplinary assessment team under the management of the Department of Health/Children s Medical Services and levels of Medicaid reimbursement determined according to a State Plan and Medicaid Handbook (AHCA). The Dept. of Children and Families is heavily engaged in the process, but does not unilaterally make the determination. A child welfare caseworker identifies a child potentially eligible for, and refers for assessment, to medical foster care services according to the interagency (Dept. of Health/Children s Medical Services, Department of Children and Families, Agency for Health Care Administration) Statewide Operational Plan. The assessment is done by a multidisciplinary team, using criteria in the Plan. Services are delivered under Department of Health management, and paid for using Medicaid funds from AHCA. The child welfare agency does not include the funds for these services in its budget. For more information, see Florida Medicaid, Medical Foster Care Services Coverage and Limitations Handbook (http://portal.flmmis.com/flpublic/portals/0/staticcontent/public/handbooks/cl_07_070201_mfc_ver1_1. pdf).

19 Information on rate setting process/frequency: Rates are only increased across the board when specific legislative appropriation for this purpose is received. Rates are not revised to reflect rates of inflation.

20 Georgia Profile (Rates implemented in 2007) Service type/level Age ranges Per Diem % of family foster care Standard 0 5 $ $ % 13 & up $18.80 Waiver higher rate No fixed maximum; based on the needs of the child Payment or reimbursement for incidentals (other than the daily rate): Type of payment/reimbursement Maximum $ provided Initial clothing Will reimburse a foster parent for some initial clothing purchases, especially if the child has no clothes to speak of. Only allowed based on the foster parent providing receipts. Maximums vary by age: 0 12 yrs: $ : $300 Clothing After a year, the foster parent can go for another clothing allowance (flat $300 across all age groups) but receipts are needed; it is not automatic. The clothing reimbursement is not intended to fully cover the clothing costs of the child more an incentive to the foster parents. Description of Service Types/Rate Levels Staff can request a waiver for a higher rate for an individual child based on special or unique needs of the child. The waiver of the normal rate needs to be approved by staff in the central state office. There is no set scale for what the waiver can be (e.g., a CAFAS score of x leads to a per diem increase of $y per day). It is really incumbent on the assigned case manager to make a compelling argument that special and unique needs of the child require a waiver. Information on rate setting process/frequency: There is no specific frequency with which rates change. Rates are not revised to reflect rates of inflation. 22%

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