Child welfare system settling into public-private partnership

2013-06-30T03:50:00Z Child welfare system settling into public-private partnershipBy JoANNE YOUNG / Lincoln Journal Star JournalStar.com

A newly amended contract between the Nebraska Department of Health and Human Services and Omaha's Nebraska Families Collaborative has been approved by both organizations.

The contract should allow Nebraska Families Collaborative, a private contractor, to break even financially as it provides child welfare services to 40 percent of families in the state system, said Kerry Winterer, CEO of the department.

That has been an issue in past contracts with private contractors, all of whom, with the exception of Nebraska Families Collaborative, pulled out of providing services in other parts of the state because of financial losses.

That leaves Nebraska Families Collaborative as the only private contractor, and its participation continues as a pilot project allowed by the state and the Legislature.

The number of state wards in the system continues to go down; the latest number is 5,350, said Vicki Maca, deputy director of the division of children and family services. That's a reduction of about 700 children from a year ago, she said.

Nebraska Families Collaborative has about 40 percent of Nebraska children in the system, with 2,629 children who come through the courts or who are placed voluntarily. That's 232 fewer than a year ago. 

The contract is essentially the same as the current one from a financial standpoint, said Dave Newell, Nebraska Families Collaborative president and CEO. The department did agree to a $350,000 increase in the base payment to the agency.

The variable case rate remained the same.

The contractor's in-home rate is $17.02 per family per day, and the out-of-home per-child rate is $58.98.

The contract also includes more financial reporting requirements.

Two challenges face both the department and his agency, Newell said.

Nebraska Medicaid eligibility was changed for kids living at home. Up until May, kids who became wards of the state automatically qualified for Medicaid regardless of their parents' income. Now family income is being used to determine eligibility for those children.

"We haven't seen a huge impact on that yet, but we're worried that there could be one over time," he said.

In the fall, changes that will occur in the Medicaid behavioral health contract have potential for cost shifting from the Medicaid budget to the child welfare budget, Newell said. That needs to be monitored closely, he said.

Also, beginning in October, juvenile offenders will begin a transition from the department's Office of Juvenile Services to supervision by the Office of Probation Administration, under the Nebraska Supreme Court. 

While there are unknowns about the number of those juveniles that will remain in state care, there are opportunities for families, Maca said. Moving forward, families will not have to relinquish decision-making authority for their kids in order to access services.

"For Nebraska families this could be a major win," she said.

Both Winterer and Newell said indicators are, generally speaking, going in a positive direction.

Maca said the implementation of structured decision-making is working in deciding safety when kids come into the system, before they are reunited with parents and before cases are closed. Some type of assessment occurs about every 90 days, she said. 

There is verification the decision-making process is being used correctly, that kids are safe, she said.

"That's really positive for the state of Nebraska and for the families in Nebraska," she said.

The state also is monitoring how often case workers have visits with families, both in and out of the home. 

"Historically we've struggled with that measure in the area of documentation," she said.

The latest numbers show that 94 percent of kids have a face-to-face visit with a case manager every month, and the visit is documented.

"That's a huge increase from where we were a couple of years ago," she said. "And that … is one of the best things a system can do to ensure that kids are safe."

Newell said his hope for the state is to let the system settle in. With major changes, people are so busy trying to figure out what their jobs are the system loses two years of progress.

Other states have mixed public and private systems, he said. When a state has urban and rural populations like Nebraska has, it makes sense to have different systems in different parts of the state.

Newell said the system is coming together well in the Omaha area, but there are still challenges, such as disproportionate numbers of minority kids in the system.

"In Omaha, I would say we still have too many kids coming into the system, and of the kids who are coming in, too many are of color," he said. "So we've got to find other ways of serving those kids so they don't necessarily have to come into the child welfare system."

Poverty is the biggest driver that impacts the system in many different ways, he said.

Reach JoAnne Young at 402-473-7228 or jyoung@journalstar.com -- You can follow JoAnne's tweets at twitter.com/ljslegislature.

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