Child Welfare Waiver Demonstrations

Child Welfare Waiver Demonstrations

Order Code RL31964
CRS Report for Congress
Received through the CRS Web
Child Welfare Waiver Demonstrations
June 16, 2003
Matthew Shuman
Visiting Research Associate
Domestic Social Policy Division
Congressional Research Service ˜ The Library of Congress

Child Welfare Waiver Demonstrations
Summary
The federal government assists the states in providing child welfare services
through a wide array of programs and funding streams. The majority of federal
funding dedicated to child welfare programs is granted to states through Titles IV-E
and IV-B of the Social Security Act, which govern child welfare services such as
foster care, adoption assistance, independent living, and family preservation and
support. In FY2003, approximately $7.3 billion is available to states through Titles
IV-B and IV-E. In order to be eligible to receive these funds, states must comply
with numerous federal rules which may limit how the states implement their child
welfare programs.
To allow states additional flexibility in how they may use their Title IV-B and
IV-E funds, the 103rd Congress included a provision in the Social Security Act
Amendments of 1994 (P.L. 103-432) to establish child welfare demonstration
projects (commonly called waivers). Through this provision, states were able to
apply to the U.S. Department of Health and Human Services (HHS) to waive certain
provisions of Titles IV-B and IV-E to develop and implement innovative programs
that test new methods of serving children and families. Congress stipulated that
certain child protection provisions may not be waived. This waiver authority was
amended in 1997 through the Adoption and Safe Families Act (P.L. 105-89). At the
end of FY2002, the authority for establishing new waiver projects expired.
Legislation to reauthorize and amend the waiver program passed the House in
February (H.R. 4), and legislation introduced in the Senate (S. 5) would do the same.
Waiver projects must be cost neutral to the federal government; may be
conducted for no longer than 5 years (though HHS may grant an extension of up to
5 years); and must include an evaluation comparing the existing state program to the
waiver project. As of May 2003, 26 projects were being implemented or had been
completed in 17 states through 20 waiver agreements. Extensions had been
requested for ten projects in seven states. Thus far, waivers have been conducted in
eight categories: assisted guardianship/kinship permanence; managed care payment
systems; capped Title IV-E allocations and flexibility to local agencies; services to
substance-abusing caretakers; intensive service options, adoption services; Tribal
administration of Title IV-E funds; and enhanced training for child welfare staff.
Summaries of the 26 child welfare waiver demonstrations are included in this report.
This report will be updated to follow any legislative action in Congress and to
provide further information on the progress of the state waiver projects.

Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Legislative History . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Details of the Waiver Authorization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Principles and Objectives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Provisions Excluded from Waiver Authority . . . . . . . . . . . . . . . . . . . . 2
Duration of Waiver Demonstrations . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Cost Neutrality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Evaluations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Applying for a Waiver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Other Provisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Current Legislation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
State Demonstration Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Types of Waivers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
State Progress on Waiver Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Extensions for Waiver Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Outcomes of Projects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Appendix A: Summary of State Waiver Demonstrations . . . . . . . . . . . . . . . 8
Appendix B: Summary of State Waiver Project Expenditures,
FY2000-FY2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
List of Tables
Table 1. State Waiver Projects Completed or Implemented, by Type . . . . . . . . . . 6
Table A-1. Summary of State Waiver Demonstrations . . . . . . . . . . . . . . . . . . . . . 8
Table B-1. State-by-State Expenditures of Title IV-E Funds for Waiver
Projects, FY2000 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Table B-2. State-by-State Expenditures of Title IV-E Funds for Waiver
Projects, FY2001 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Table B-3. State-by-State Expenditures of Title IV-E Funds for Waiver
Projects, FY2002 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
This report was written by Matthew Shuman, a Presidential Management Intern on rotation from the
U.S. Department of Health and Human Services, under the supervision of Emilie Stoltzfus, Domestic
Social Policy Division.

Child Welfare Waiver Demonstrations
Introduction
The federal government assists the states in providing child welfare services
through a wide array of programs and funding streams. The majority of federal
funding dedicated to child welfare programs is granted to states through Titles IV-E
and IV-B of the Social Security Act, which govern child welfare services such as
foster care, adoption assistance, independent living, and family preservation and
support.1 In FY2003, approximately $7.3 billion is be available to states through
Titles IV-B and IV-E. In order to be eligible to receive these funds, states must
comply with numerous federal rules which may limit how the states implement their
child welfare programs. A frequent criticism of federal child welfare policy is its
inflexibility regarding the use of funds by states.2
In order to provide states with additional flexibility in their use of Titles IV-B
and IV-E funds, the 103rd Congress included a provision in the Social Security Act
Amendments of 1994 (P.L. 103-432) allowing the Secretary of the U.S. Department
of Health and Human Services (HHS) to grant waivers to states to design innovative
child welfare programs using funds from Titles IV-E and IV-B. The original
legislation was amended by the 105th Congress in the Adoption and Safe Families
Act of 1997 (P.L. 105-89).3 A number of states have been granted waivers and have
used these funds to establish an assortment of waiver projects, ranging from managed
care programs to substance abuse services for parents.
This report provides background information on the child welfare waivers and
a description of the progress states have made on these demonstration projects.
1 Title IV-B consists of two subparts. Subpart 1 is the Child Welfare Services Program,
which is a discretionary program that provides grants to states for services that protect the
welfare of children. Subpart 2 is the Promoting Safe and Stable Families Program, which
provides mandatory and discretionary funds to states for family preservation, family support,
time-limited reunification, and adoption promotion and support. Title IV-E provides
funding for the foster care, adoption assistance, independent living, and related data systems.
For additional program information, see Section 11 of the House Ways and Means
Committee Green Book, WMCP: 106-14, October 6, 2000; available through the House
Ways and Means Committee Web site: [http://waysandmeans.house.gov/documents.asp].
2 See CRS Report RL31082, Child Welfare Financing: Issues and Options, by Karen Spar
and Christine Devere.
3 See CRS Report RL30759, Child Welfare: Implementation of the Adoption and Safe
Families Act, by Karen Spar.

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Legislative History
Prior to 1994, numerous bills had been introduced to establish child welfare
waiver demonstrations but had not been passed by the Congress. Child welfare
officials who desired additional flexibility had long advocated for waiver authority
in child welfare, such as had been available in other programs, including Medicaid
and Aid to Families with Dependent Children (AFDC).4 Advocates of waivers hoped
that states would then be able to use Title IV-E funds for prevention and family
preservation services. Title IV-E funds currently defray state costs that are primarily
related to the out-of-home care of children and constitute by far the largest percentage
of the total federal funds dedicated to child welfare.
The Social Security Act Amendments of 1994 included a proposal to establish
child welfare waiver demonstrations and were enacted on October 31, 1994 as P.L.
103-432. Authority for the waiver demonstrations is found in Section 1130 of the
Social Security Act. The 105th Congress extended and enacted other changes to the
child welfare waiver authority through the Adoption and Safe Families Act (ASFA)
of 1997 (P.L. 105-89). The authority to approve new child welfare waiver
demonstrations expired at the end of FY2002 and has not yet been reauthorized.
Details of the Waiver Authorization
Principles and Objectives. The Secretary of HHS was authorized to permit
states to conduct child welfare demonstration projects that promote the objectives of
Titles IV-B and IV-E and which may require the waiver of certain provisions of those
laws. Titles IV-B and IV-E are the sections of the Social Security Act that govern
child welfare services such as foster care, adoption assistance, independent living,
and family preservation and support. States conducting waiver demonstrations are
still bound to the key principles of protecting and promoting the safety, permanency,
and well-being of children. Through these demonstration projects, the federal
government seeks to test new approaches to child welfare that will help lead to
improvements in the delivery, effectiveness and efficiency of services.5
Provisions Excluded from Waiver Authority. Certain provisions of
Titles IV-B and IV-E may not be waived for the purposes of these demonstrations.
The legislation sought to assure the safety of children, protect the rights of children
and their families, and ensure permanency for children, and, therefore, excluded from
waiver are: all protections regarding the periodic reviews of the status and progress
of foster care cases; permanency hearing requirements; requirements that certain
information be contained in a child’s case plan; child protections, such as placement
setting guidelines; family protections, such as procedural safeguards to ensure that
4 Child Welfare Waivers: Promising Directions - Missed Opportunities, The Cornerstone
Consulting Group, Houston, TX, 1999, [http://www.aphsa.org/cornerstone/cwwtoc.asp].
5 Federal Register, June 15, 1995, p. 31478-31483.

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parental rights are respected; the requirements of collecting data on foster care and
adoption cases; and the entitlement of any child or family to benefits.6
Duration of Waiver Demonstrations. Under the ASFA amendments, the
Secretary of HHS was permitted to grant waivers for up to 10 demonstration projects
in each of FY1998 through FY2002, for a potential total of 50 demonstration projects
over the course of the 5-year authorization. All states, the District of Columbia, and
Puerto Rico were eligible to receive waivers. Under the original authorization of the
waiver demonstrations, P.L. 103-432, the Secretary had only been permitted to grant
waivers to a total of up to 10 states. The distinction between “demonstration project”
and “state” is important because each state may implement more than one
demonstration project. Each project may be conducted for up to 5 years (not
including time for start-up and final evaluation preparation), and, as allowed by the
changes made by ASFA, the Secretary of HHS may grant extensions for the
demonstration projects.
Cost Neutrality. As mandated by P.L. 103-432, the waiver demonstrations
must be cost neutral to the federal government. Therefore, the approved allocation
over the course of a demonstration project must not exceed the amount that would
have been expended by the federal government if the demonstration project were not
conducted. To achieve cost neutrality, the costs of the control group, which consists
of children being served by the existing state programs, are used as the basis for
determining the costs of the experimental group. Generally, the same average cost-
per-child is applied to the experimental group. Allocation and cost neutrality
formulas may differ among the projects and are dependent on the details of the
project. In addition, how the federal government funds the project depends on which
provision of the statute is waived in order to implement the project. If a Title IV-E
provision is waived, then the federal funds are drawn from Title IV-E. Currently, all
of the waiver requests have been for Title IV-E provisions, and, therefore, all of the
federal funding for the demonstrations are from the Title IV-E funding stream.
States are responsible for paying for demonstration project costs beyond the
agreed upon federal allocation. States may be able to receive “up-front” funding in
order to make initial investments in their projects. If, after implementation, it appears
that cost neutrality cannot be maintained throughout the duration of the project, HHS
will work with the state to modify the project or take other actions as necessary to
achieve cost neutrality. (See Appendix B for a state-by-state list of project
expenditures for each of FY2000 through FY2002; expenditure data prior to FY2000
are not available.)
Evaluations. Each state that conducts a waiver demonstration must obtain a
project evaluation from an independent contractor. This evaluation must, at a
minimum, make comparisons between the demonstration project (the experimental
group) and existing state plans (the control group) regarding the outcomes of children
and families, the service delivery methods, and the fiscal consequences. It must also
assess the cost effectiveness of the project. States must provide interim and final
6 For more information on some of the provisions mentioned, see CRS Report RL30759,
Child Welfare: Implementation of the Adoption and Safe Families Act, by Karen Spar.

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evaluation reports to HHS. The cost of this evaluation is excluded from the project’s
cost neutrality calculations.
Applying for a Waiver. States must submit an application to HHS that
includes, among other items, a description of the project, the expected benefits, an
estimate of costs or savings, a list of the Title IV-B and IV-E program requirements
for which a waiver would be required to conduct the proposed project, and a
description of the proposed evaluation design. Both the state and federal
governments are required to obtain public comments on the proposals. If necessary,
HHS and the applying state will negotiate the terms and conditions of the waiver
demonstration. The Secretary of HHS makes the final decision on the approval of
waiver projects.
During the review process for the waiver applications, HHS gave preference to
proposals that met certain criteria or addressed certain issues. HHS initially provided
guidance in the Federal Register regarding the Social Security Act Amendments of
1994 that it would grant waivers “to test the same or related policy innovations in
multiple states.” However, later policy guidance on the ASFA amendments gave
preference to states that proposed unique policy alternatives and also to states that
were not already operating a demonstration project. The Adoption and Safe Families
Act also included a requirement that certain types of proposals must be considered,
if submitted. These are proposals that: identify and address barriers that result in
delays to adoptive placements for children in foster care; identify and address
parental substance abuse problems that endanger children and result in foster care
placements; and address kinship care. Additionally, HHS provided guidance that it
would give priority to proposals that addressed certain departmental priorities. For
FY2000 and FY2001 proposals, HHS listed the following interest areas:
performance-based systems; integrated systems for behavioral health (substance
abuse and mental health); effective prevention/early intervention; adoption/post-
adoption services; service improvements for children in the placement and care
responsibility of Tribes; service improvements for adolescent youth; and
reunification services for adolescent youth.7
Other Provisions. Several additional amendments were made to the waiver
authorization under ASFA. A section was inserted into the legislation that prohibits
HHS from granting a waiver to any state that does not provide health insurance
coverage to any special needs child living in the state whose adoptive parents have
entered into an adoption assistance agreement with any other state. HHS reported
that it had received certification from all states that they provide such coverage.
Additionally, HHS is required to consider the effect that approving a state proposal
would have on the terms and conditions of a court order determining that the state’s
child welfare program has failed to comply with provisions of Titles IV-B or IV-E,
or with the Constitution of the United States.
7 HHS Information Memorandum, ACYF-CB-IM-2000-01, issued Feb. 4, 2000,
[http://www.acf.hhs.gov/programs/cb/laws/im/im0001.htm].

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Current Legislation
The authority for the child welfare waiver demonstrations expired at the end of
FY2002. In the 107th Congress, reauthorization of the waiver authority, along with
several changes to the program, were included in bills to reauthorize the Temporary
Assistance to Needy Families (TANF) program (H.R. 4737). That legislation passed
the House but did not clear the Senate before adjournment of the 107th Congress.
In the 108th Congress, the House has again passed legislation (as part of H.R. 4,
its TANF reauthorization bill) that would extend the authority of HHS to approve
child welfare demonstration projects. H.R. 4 would reauthorize the waiver program
through FY2008; allow HHS to approve an unlimited number of projects in each
fiscal year; prohibit HHS from refusing to grant a waiver to a state because of the
project’s similarity to another or from imposing limits on the number of waivers or
demonstration projects undertaken by a single state; direct HHS to develop a
streamlined process for consideration of extensions and amendments of
demonstration projects; and require HHS to make available to any other interested
party any demonstration project evaluation report provided to, or produced by, HHS.
State Demonstration Projects
As of May 2003, 26 child welfare demonstration projects were being
implemented or had been completed in 17 states through 20 Title IV-E waiver
agreements. As stated before, all of the waiver requests have been for Title IV-E
provisions.
Types of Waivers. States have broad discretion as to which types of waiver
projects they can propose and implement. The following is a list of the types of
projects that states have undertaken:
! Assisted Guardianship/Kinship Permanence: Relatives or other
caregivers may become legal guardians and be eligible for a monthly
stipend up to the amount of a foster care payment.
! Managed Care Payment Systems: States test alternative financing
mechanisms for the provision of specific services.
! Capped Title IV-E Allocations and Flexibility to Local Agencies:
Counties or other local entities have the option to use a fixed amount
of Title IV-E funds more flexibly to provide services that may
otherwise not be eligible for Title IV-E federal matching, such as
prevention and preservation services.
! Services to Substance-abusing Caretakers: States provide
services to assist caretakers with substance abuse problems.
! Intensive Service Options: States increase the nature and extent of
available services in an effort to better serve children and families.

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! Adoption Services: States test ways of improving permanency by
providing post-adoption services.
! Tribal Administration of Title IV-E Funds: States work with
Tribes to develop the administrative and financial systems necessary
for the Tribes to administer their Title IV-E foster care programs and
claim federal reimbursement directly.
! Enhanced Training for Child Welfare Staff: In order to improve
permanency outcomes, child welfare professionals, both in the
public and private sector, receive enhanced training on assessment
and decision-making.8
States may opt to propose a project that does not fall into one of the above
categories. (For a list of state projects, see Table 1.)
Table 1. State Waiver Projects
Completed or Implemented, by Type
Type of project
States
Assisted guardianship/kinship
Delaware, Illinois, Maryland, Montana,
permanence
New Mexico,a North Carolina, Oregon
Managed care payment systems
Colorado, Connecticut, Maryland,
Michigan, Washington
Capped IV-E allocations and flexibility to
Indiana, North Carolina, Ohio, Oregon
local agencies
Services to substance-abusing caretakers
Delaware, Illinois, Maryland, New
Hampshire
Intensive service options
California, Mississippi
Adoption services
Maine
Tribal administration of Title IV-E funds
New Mexico
Enhanced training for child welfare staff
Illinois
Source: Table prepared by the Congressional Research Service (CRS) based on information provided
by James Bell Associates.
a. New Mexico has two Assisted Guardianship waiver projects (a state project and a Tribal project).
State Progress on Waiver Projects. States are at various stages in
implementing their waiver projects. Of the 26 waiver projects, seven have been
completed. The completed projects include both of Delaware’s projects,
Connecticut’s project, Illinois’ assisted guardianship/kinship permanence project,
Maryland’s managed care project, and both of North Carolina’s projects. The last
project to be implemented was Illinois’ enhanced training project, which was
8 Summary of IV-E Child Welfare Waiver Demonstrations, James Bell Associates, Inc.,
Arlington, VA, Feb. 2003.

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approved on August 2, 2001 and began on August 19, 2002. (For summaries of state
projects, see Appendix Table A-1.)
According to HHS, in addition to the 26 waiver projects that are currently being
implemented or have been completed, six others proposals were accepted by HHS
but were eventually withdrawn by the states before implementation. These states
include California (which is currently implementing another project), Florida, New
York, Texas, West Virginia, and the District of Columbia. According to HHS, these
projects were never implemented for reasons including project cost issues, changes
in state resources or leadership, and other administrative problems.
Extensions for Waiver Projects. As previously stated, the Secretary of
HHS has the authority to grant extensions for waiver demonstrations, and although
the authority to approve new waiver projects has expired, he may still grant
extensions to projects that were approved before the end of FY2002. On May 23,
2002, HHS issued an information memorandum outlining the criteria and process for
obtaining an extension.9 To begin the application process, states must, no later than
6 months before the termination date of the demonstration project, submit a letter
requesting an extension. After receipt and review of the request letter, HHS will
grant to the state a temporary, short-term extension that is 4 months after the due date
of the final evaluation report. This “bridge” extension allows HHS time to review
the final evaluation and financial reports before granting the actual extension.
HHS will make its final decision within 4 months of receiving the final
evaluation report. Decisions will be based on the successes the project has achieved
in improving outcomes for children and families, but a state does not need to fulfill
all of its goals and objectives to obtain an extension. If a state can document the
factors that led to a project’s shortcomings and propose a detailed strategy to reach
its goals in the future, the state may still be able to obtain an extension. If a waiver
extension is approved, the original terms and conditions of the project may be
amended to reflect any agreed upon changes. As with the original waivers,
extensions may be granted for up to 5 years. If an extension is not granted, the state
will be required to phase out the project. Thus far, the following seven states have
made formal extension requests and received automatic, short-term extensions:
California, Delaware, Illinois (for its assisted guardianship project), Indiana, North
Carolina, Ohio, and Oregon. Delaware was not granted an extension by HHS;
decisions on the other projects are forthcoming. Connecticut and Maryland both
discontinued projects early. Connecticut did so in order to implement the project
statewide (using non-Title IV-E dollars) and Maryland due to budget constraints.
Outcomes of Projects. Most of the available data on the waiver projects are
preliminary. (Project summaries with preliminary or outcome data descriptions can
be found in Appendix A.) Some projects are encountering data analysis problems,
such as small sample sizes. As additional final evaluation reports are completed,
more comprehensive analyses of outcomes will be possible. Of particular interest to
Congress when making policy decisions regarding child welfare financing options
may be the results of the managed care and capped Title IV-E allocations projects.
9 See HHS information memorandum, ACYF-CB-IM-02-06, issued May 23, 2002, available
at: [http://www.acf.hhs.gov/programs/cb/laws/im/im0206.htm].

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Appendix A: Summary of State Waiver Demonstrations
Table A-1. Summary of State Waiver Demonstrations
California
Type: Intensive Services Approved: August 19, 1997
Implemented: December 1, 1998 Completed: Expected September 30, 2003
Interim Report: May 30, 2001 Final Report: Expected March 31, 2004
Summary: Seven counties are providing intensive services, including family
preservation, placement prevention, and permanency, to children and families in order
to prevent or shorten foster care placements. Eligible families are those with children in
temporary or permanent placement and children living at home who are at moderate- to
high-risk for placement. As of September 2002, 560 children had been placed in the
experimental group, and 304 children had been placed in the control group. Two counties
are using a family conferencing model, and five are using a wraparound services model.
No outcome findings are currently available.
Colorado
Type: Managed Care Approved: September 14, 1999
Implemented: October 26, 2001 Completed: Expected September 30, 2006
Interim Report: Expected March 31, 2004 Final Report: Expected March 31, 2007
Summary: The one county participating in this project (others are permitted to join)
negotiated a payment rate with a child welfare service provider to deliver needed
services, such as case coordination and residential services. The target population is
children ages 10 and older who are at high risk or already experiencing “placement drift,”
and/or are at significant risk of aging out of the foster care system. As of September 30,
2002, 86 children had been assigned to the demonstration project — 44 in the
experimental group and 42 in the control group. No outcome findings are currently
available.
Connecticut
Type: Managed Care Approved: September 29, 1998
Implemented: July 9, 1999 Completed: May 31, 2002a
Interim Report: June 2002 Final Report: Expected June 2003
Summary: The state contracted with a lead service agency to provide services, such as
case management, group care, home-based services, outpatient services, and aftercare,
for youth aged 7 to 15 with significant behavioral problems and who were already in or
authorized to be placed in residential care or a group home. This project was
implemented in two of the state’s six regions and served 159 children — 77 in the
experimental group and 82 in the control group. Connecticut discontinued this waiver
project early and opted to implement it statewide; the state no longer requests Title IV-E
funds for activities for which it had previously required a Title IV-E waiver. Preliminary
findings indicate that experimental group children receive significantly more services in
a number of areas. No significant differences were found between the experimental and
control groups for the percentage of children that experienced changes in custody,
percentages of time during the first 12 months spent in residential treatment centers and
group homes, and mental health status. Further analysis of this project is expected.

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Delaware
Type: Substance Abuse Services Approved: June 17, 1996
Implemented: July 1, 1996 Completed: December 31, 2002b
Interim Report: June 30, 1999 Final Report: March 27, 2002
Summary: Substance abuse counselors worked with child protective services (CPS) staff
to identify eligible families and arrange for services. The target population was families
throughout the state with children who were in or were likely to enter foster care due to
parental substance abuse. As of February 2002, the control and experimental groups were
each comprised of 530 families. Outcome findings indicate a 31% reduction of days in
foster care for experimental group children (204 days compared to 294 days in the control
group). No statistically significant differences were found in length of time to achieve
permanency or the percentage of cases closed due to case plan completion. Delaware
requested an extension for this project. The state received the automatic short-term
extension to December 31, 2002, but HHS denied the actual extension.
Type: Assisted Guardianship Approved: June 17, 1996
Implemented: July 1, 1996 Completed: December 31, 2002b
Interim Report: June 30, 1999 Final Report: March 27, 2002
Summary: Assisted guardianship was offered for Title IV-E eligible children who had
been living in a foster placement for at least 1 year and had a strong attachment to the
potential guardian. The state provided guardians with a payment equal to its foster care
payment. This project was implemented statewide. As of September 2001, 36 families
were approved for guardianship and 18 were pending approval. Outcome findings for
this project were limited; the state received a minimal response to mail surveys and
interview requests. Delaware requested an extension for this project. The state received
the automatic short-term extension to December 31, 2002, but HHS denied the actual
extension.
Illinois
Type: Assisted Guardianship Approved: September 18, 1996
Implemented: May 1, 1997 Completed: March 31, 2003b
Interim Report: February 2000 Final Report: February 2003
Summary: The state offered guardians throughout the state a subsidy payment equal to
that of an adoption assistance payment along with a variety of services. Eligible children
must have been in the custody of the state and have resided with the prospective guardian
for at least 1 year. Between May 1, 1997 and March 31, 2002, local courts transferred
6,822 children from state custody to private guardianship. (The courts also reunified
3,877 children and finalized adoptions for 14,468 children.) Children assigned to the
guardianship-eligible group were significantly more likely than children in the control
group to achieve permanency (77.9% v. 71.8%). The withdrawal of regular
administrative oversight and casework services for the experimental group did not result
in higher rates of child abuse and neglect reports. Illinois requested an extension from
HHS and is now operating under a short-term extension; the final decision is
forthcoming.

CRS-10
Type: Substance Abuse Services Approved: September 19, 1999
Implemented: April 28, 2000 Completed: Expected June 30, 2005
Interim Report: Expected February 28, 2003 Final Report: Expected December 31, 2005
Summary: Parents are assigned a Recovery Coach, who assists the family during and
after treatment to prevent relapse and facilitate reunification, along with typical child
welfare and substance abuse treatment services. This project is being implemented in one
county. The target population is custodial parents with a substance abuse problem and
may include custodial parents who deliver drug-exposed infants. As of September 2002,
528 parents were in the experimental group, and 211 were in the control group. No
outcome findings are yet available.
Type: Enhanced Training Approved: August 2, 2001
Implemented: August 19, 2002 Completed: Expected July 31, 2007
Interim Report: Expected February 28, 2005 Final Report: Expected February 28, 2008
Summary: The state will provide enhanced training to newly hired public and private
sector child welfare professionals in order to enhance staff competency in assessing child
and family needs, providing appropriate services, and decision-making. This project is
being implemented in eight counties in and around Chicago. No outcome findings are
currently available.
Indiana
Type: Capped IV-E Approved: July 18, 1997
Implemented: January 1, 1998 Completed: Expected August 31, 2003b
Interim Report: February 22, 2001 Final Report: Expected September 30, 2003
Summary: The state allows the counties to use up to $9,000 annually per child
(additional costs are borne by the county) to provide intensive services to children in
order to improve child well-being and develop home- or community-based alternatives
to institutional placements. The target population is children who are at risk of placement
or have already been placed and who have substantiated reports of child abuse and/or
neglect. As of December 31, 2001, 3,916 children (1,820 Title IV-E eligible and 2,096
non-IV-E eligible) had been assigned to the project. From data available from December
2001, children in the experimental group remained in care for a significantly shorter
period when compared to the control group (366 days v. 491 days). Also, reunifications
were more likely among the experimental group (66%) than the control group (59%), and
placement recidivism was less likely in the experimental group (15% had at least one new
out-of-home placement) as compared to the control group (20%). Indiana has requested
an extension for this project. HHS has granted the state the short-term extension, but has
not made a final decision on the actual extension.

CRS-11
Maine
Type: Adoption Services Approved: September 17, 1998
Implemented: April 1, 1999 Completed: Expected March 31, 2004
Interim Report: December 31, 2001 Final Report: Expected December 31, 2004
Summary: This project consists of two parts: (1) training for public and private sector
professionals about special needs adoptions and (2) the provision of an array of post-
adoption services to families who adopt children with special needs. This project is being
implemented statewide. As of December 2002, 222 professionals had been trained, and
115 families and 196 children were receiving services. Outcome findings are not yet
available.
Maryland
Type: Assisted Guardianship Approved: April 17, 1997
Implemented: March 1, 1998 Completed: Expected December 31, 2003b
Interim Report: December 13, 2000 Final Report: Expected August 30, 2003
Summary: The state offers assisted guardianship for children who have been living with
a relative or kinship caregiver for a minimum of 6 months. The caregiver would then
become a legal guardian of the child and receive $300 per month, an amount between the
foster care subsidy ($600) and the TANF child-only payment for kinship caregivers
($211). This project is being implemented in Baltimore City and six counties. As of
November 1999, 1,021 children were in the experimental group, and 737 children were
in the control group. As of November 2002, 267 guardianships had been completed.
Outcome findings revealed statistically significant differences between the control and
experimental groups regarding case closure. As of January 2000, 29% of children in the
experimental group had exited care, as compared to 23% of children in the control group.
Maryland has requested an extension for this project. The state received a short-term
extension, but the actual extension is still pending HHS approval.
Type: Managed Care Approved: September 16, 1999
Implemented: January 1, 2000 Completed: December 31, 2002c
Interim Report: October 31, 2002 Final Report: Expected June 2005
Summary: The state contracted with one child placement agency to provide case
management, placement, permanency planning, and support services to all referred
children. The agency received a fixed sum to provide services and was responsible for
costs above the fixed sum. A second agency withdrew from the project prior to signing
an agreement with the state. Due to state budget constraints, Maryland opted to end this
project early and transitioned the experimental group children back to the public child
welfare system. Five hundred children had been in the experimental group, and 250 were
in the control group. As of November 2000, exit rates were not significantly different for
the two groups, but the experimental group had a higher rate of adoptions than the control
group.

CRS-12
Type: Substance Abuse Services Approved: September 16, 1999
Implemented: October 1, 2001 Completed: Expected December 31, 2004d
Interim Report: Expected March 31, 2004 Final Report: Expected June 30, 2005
Summary: Female primary caregivers with a child in foster care or at risk of having a
child placed in foster care receive a variety of services from Family Support Services
Teams (FSST), which are comprised of Chemical Addiction Counselors, local child
welfare agency staff, treatment providers, parent aides, and mentors. After referral and
assessment, the caregivers are assigned to one of three treatment options: inpatient
treatment for parents and children, 28-day residential care, or intensive outpatient
treatment. The project is being implemented in Baltimore City and two counties. As of
September 2002, the experimental and control groups each had nine women. No outcome
findings are currently available.
Michigan
Type: Managed Care Approved: December 19, 1997
Implemented: October 1, 1999 Completed: Expected September 30, 2003
Interim Report: May 31, 2003 Final Report: Expected June 30, 2004
Summary: The state has contracted with providers in six counties to provide
comprehensive services to children (ages 0 to 18) who meet any of the following criteria:
previously in out-of-home-care; currently in out-of-home care and case suitable for
reunification; at risk of placement; or in residential care but could be returned to
community. Before October 2001, providers received a monthly payment of $1,500 per
child, but now receive a single case rate per child ($14,272) regardless of length of the
case. As of January 2002, 149 children had been assigned to the experimental group and
94 to the control group. No statistically significant differences have been found between
the groups regarding number of placements, re-entry into care, or safety outcomes.
Mississippi
Type: Intensive Services Approved: September 17, 1998
Implemented: April 1, 2001 Completed: Expected March 31, 2006
Interim Report: Expected March 31, 2004 Final Report: Expected December 31, 2006
Summary: The state provides intensive services, both currently existing and newly
developed, to children involved in the child welfare system as well as their parents,
potential and current foster or adoptive parents, custodial relatives, and siblings.
Provided services may include: respite care, temporary financial or in-kind assistance,
job training, medical care, transportation, educational services, child care, counseling,
support services for foster parents, parenting training, and homemaker services. Eight
counties have participated in the project. As of September 30, 2002, 77 children were
served in the experimental group, and 72 were served in the control group. No outcome
findings are currently available.

CRS-13
Montana
Type: Assisted Guardianship Approved: September 29, 1998
Implemented: June 21, 2001 Completed: Expected March 31, 2006
Interim Report: Expected June 30, 2004 Final Report: Expected March 31, 2007
Summary: Caretakers can become legal guardians of foster children who have been in
their care for at least 6 months and have been designated as having special needs. The
monthly subsidy amount can not exceed the amount of a foster care subsidy. This project
may be implemented statewide and in as many as seven reservations (four Tribes were
participating as of September 2002). As of July 2002, guardianships had been established
for 17 of the 69 children in the experimental group. No outcome findings are yet
available.
New Hampshire
Type: Substance Abuse Services Approved: September 24, 1998
Implemented: November 15, 1999 Completed: Expected December 31, 2004
Interim Report: Expected July 31, 2002 Final Report: Expected July 31, 2005
Summary: Substance abuse specialists work with child welfare staff to provide
screening, assessment, referrals and services for substance abuse issues. Families are
eligible for this project if caretaker substance abuse was a major factor in their child
abuse and/or neglect case. This project is being implemented in two district offices. As
of May 2002, 449 families were participating in the project — 227 in the experimental
group and 222 in the control group. As of January 2003, only preliminary results were
available; none of these results were statistically significant.
New Mexico
Type: Tribal Administration Approved: June 14, 1999
Implemented: July 1, 2000 Completed: Expected June 30, 2005
Interim Report: Expected February 2003 Final Report: Expected December 31, 2005
Summary: Up to five eligible Tribes may enter into an agreement with the state to be
allowed to administer their own Title IV-E programs, including foster care, adoption
assistance, independent living, and staff and parent training. Tribes are eligible to
participate in this project if they do not already have a Joint Powers Agreement with the
state. As of March 2002, only the Pueblo of Zuni opted to participate in the experimental
group; seven other Tribes and Pueblos with Joint Powers Agreements are in the control
group. As of December 2002, there were 14 children in the experimental group and 25
in the control group. Outcome data on this project are limited.
Type: Tribal Assisted Guardianship Approved: June 14, 1999
Implemented: July 1, 2000 Completed: Expected June 30, 2005
Interim Report: Expected February 2003 Final Report: Expected December 31, 2005
Summary: Children in Tribal custody (under a Joint Powers Agreement or the Tribal
Administration of Title IV-E Funds waiver project) may be placed in assisted
guardianships, and the guardians may receive subsidy payments that do not exceed those
for adoption assistance. As of December 2002, three children in Tribal custody had been
placed in a guardianship. Insufficient data are available for outcome analysis.

CRS-14
Type: State Assisted Guardianship Approved: June 14, 1999
Implemented: April 2001 Completed: Expected June 30, 2005
Interim Report: Expected February 2003 Final Report: Expected December 31, 2005
Summary: Children in state custody may be placed in assisted guardianships, and the
guardians may receive subsidy payments that do not exceed those for adoption assistance.
Both Native American and non-Native American children in state custody and who are
Title IV-E eligible may be served through this project. As of December 2002, 54 children
in state custody had been placed in a guardianship. Insufficient data are available for
outcome analysis.
North Carolina
Type: Capped IV-E Approved: November 14, 1996
Implemented: July 1, 1997 Completed: April 30, 2003b
Interim Report: June 30, 2002 Final Report: November 2002
Summary: The state granted individual counties the opportunity to receive a capped
amount of Title IV-E funds that may be used to serve children and families. Each county
is able to develop its own set of initiatives under the project, such as, but not limited to,
assisted guardianship, court reforms, new services, and organizational changes. The
counties participating in the assisted guardianship initiatives are also included in North
Carolina’s Assisted Guardianship waiver project. Counties were able to undertake
multiple initiatives. The state and county will share any excess costs. Nineteen of the
state’s 100 counties participated in the project; nineteen other counties formed a control
group. The probability of placement in out-of-home care declined at a greater rate in the
experimental counties than in the control counties. Additionally, children in both the
experimental and control counties showed similar rates of decline in length of stay, even
though the risk factors for children entering into the experimental group became more
severe as the project continued. The state requested an extension for this project. The
short-term extension was granted, but a final decision has not yet been made.
Type: Assisted Guardianship Approved: November 14, 1996
Implemented: July 1, 1997 Completed: April 30, 2003b
Interim Report: June 30, 2002 Final Report: November 2002
Summary: The eight counties choosing to implement an assisted guardianship initiative
in North Carolina’s Capped Title IV-E Allocations waiver project are also considered
part of this waiver project. All children in foster care were eligible for assisted
guardianship. The assisted guardianship payment was equal to the foster care
maintenance payment. Thirty-eight assisted guardianships were established (17 of them
were in one county). Outcome findings for this initiative were not reported separately
from the other North Carolina waiver project. The state requested an extension for this
project. The short-term extension was granted, but a final decision has not yet been
made.

CRS-15
Ohio
Type: Capped IV-E Approved: February 14, 1997
Implemented: October 1, 1997 Completed: Expected October 31, 2003b
Interim Report: November 5, 2000 Final Report: Expected June 30, 2003
Summary: Fourteen counties were granted the ability to flexibly use capped allocations
in order to provide — or establish contracts for — all services necessary to achieve
safety, permanency, and well-being in children at risk of entering or already in foster
care. Fourteen additional counties participated in the control group. Length of stay in
foster care remained the same for both the experimental and control groups. The state
requested an extension for this project. It received the automatic short-term extension,
but HHS has not yet made its final decision.
Oregon
Type: Capped IV-E Approved: October 31, 1996
Implemented: July 1, 1997 Completed: Expected July 31, 2003b
Interim Report: July 2002 Final Report: Expected March 31, 2003
Summary: Branch offices in the state may receive a portion of their foster care budgets
to spend more flexibly and consider the following three options for the use of these funds:
(1) foster care prevention, (2) expansion of established services, and (3) innovative
service plans. The most frequently used innovative services were enhanced visitation and
drug and alcohol facilitators, and the most frequently developed service was family
decision-making. Thirty-two of the 35 eligible counties in the state (one county is not
eligible) participated to varying degrees in the project. The state estimates 3,300 families
received one or more waiver services between July 1, 1997 and September 30, 2001. In
addition to this project, Oregon had initiated its own program of flexible funding to the
counties. Children in counties with some form of flexible funding were more likely to
remain at home or return home within 12 months of placement than children in counties
with no flexible funding. No significant differences were found between the groups in
the rate of re-abuse within 1 year or in permanency rates within 1 year of removal.
Oregon requested an extension for this project and received a short-term extension. HHS
has not made a final decision regarding the request.
Type: Assisted Guardianship Approved: October 31, 1996
Implemented: July 1, 1997 Completed: Expected July 31, 2003b
Interim Report: July 2002 Final Report: Expected March 31, 2003
Summary: Under this project, Oregon may establish assisted guardianship for children
who meet the following eligibility requirements: have been in substitute care for more
than 12 months; have lived with the prospective guardian for at least 6 months; and be
at least 12 years old if the prospective guardian is not a relative (or any age if the
guardian is a relative). The assisted guardianship payment cannot be more than the foster
care payment. As of December 31, 2002, 276 children had guardianships established
with 178 families. Approximately 70% of the guardianships were with relatives of the
children. More than half of the state branch offices participated in this project. No
outcome findings were available for this project. Oregon requested an extension for this
project and received a short-term extension. HHS has not made a final decision regarding
the request.

CRS-16
Washington
Type: Managed Care Approved: September 29, 1998
Implemented: March 27, 2002 Completed: Expected March 31, 2007
Interim Report: Expected Sept. 30, 2004 Final Report: Expected Sept. 30, 2007
Summary: The state is allowed to contract with providers for all necessary care,
maintenance, and direct social services for eligible children. Children eligible to
participate in this project are those, ages 6 to 17, who are at risk of entering, or are
already in, high-cost group care or high-cost family foster care and who are in need of
mental health or special education services. One county is participating in the project,
but the state may implement the project in up to six sites, which may contain one or more
counties. As of September 2002, there are seven children in the experimental group and
five in the control group. No outcome findings have been reported.
Source: Table prepared by the Congressional Research Service (CRS) based on information provided
by the states (as of February 2003) and included in Summary of the Child Welfare Waiver
Demonstration Projects and Profiles of the Child Welfare Waiver Demonstration Projects, both by
James Bell Associates, Inc., Arlington, VA, Feb. 2003.
Note: Table information is current as of February 2003. Completion dates include the short-term
extensions if applicable.
a. Connecticut ended its waiver project before its original completion date in order to implement the
program statewide.
b. These completion dates reflect the short-term extension automatically granted by HHS when a state
requests a waiver extension. According to HHS, some of the short-term extensions will be
lengthened (thereby pushing back the completion dates) in cases where the short-term extension
would have expired before a final decision has been made.
c. Maryland ended its Managed Care project early due to budget constraints.
d. The end date for Maryland’s Services to Substance-Abusing Caretakers project was based on a date
5 years after the implementation of the state’s Managed Care project.

CRS-17
Appendix B: Summary of State Waiver Project Expenditures,
FY2000-FY2002
Table B-1. State-by-State Expenditures of Title IV-E Funds
for Waiver Projects, FY2000
Federal IV-E
State IV-E
Total IV-E
State
expenditures
expenditures
expenditures
California
$704,430
$704,430
$1,408,860
Colorado
256,946
256,945
513,891
Connecticut
277,815
277,812
555,627
Delaware
104,974
104,974
209,948
Illinois
115,863,208
115,863,205
231,726,413
Indiana
2,044,046
1,411,175
3,455,221
Maine
186,151
94,958
281,109
Maryland
881,150
881,151
1,762,301
Michigan
483,192
458,261
941,453
Mississippi
21,005
21,006
42,011
New Mexico
49,584
(24,792)
24,792
North Carolina
14,493,305
10,570,983
25,064,288
Ohio
153,937
153,936
307,873
Oregon
539,092
359,995
899,087
Texas
20,835
20,835
41,670
Washington
168,176
165,956
334,132
Total
$136,247,846
$131,320,830
$267,568,676
Source: Table prepared by the Congressional Research Service (CRS) based on information provided
by the U.S. Department of Health and Human Services.
Note: This table only reflects Title IV-E related expenditures. The total costs of the waiver projects
may include additional funding streams. Negative numbers reflect adjustments made by states to
previous expenditures.

CRS-18
Table B-2. State-by-State Expenditures of Title IV-E Funds
for Waiver Projects, FY2001
Federal IV-E
State IV-E
Total IV-E
State
expenditures
expenditures
expenditures
California
$6,331,771
$6,082,046
$12,413,817
Colorado
186,291
186,288
372,579
Connecticut
380,869
380,867
761,736
Delaware
120,851
120,851
241,702
Illinois
110,237,664
110,237,658
220,475,322
Indiana
2,769,699
1,839,504
4,609,203
Maine
158,793
81,366
240,159
Maryland
9,411,989
9,411,989
18,823,978
Michigan
759,145
710,796
1,469,941
Montana
39,113
36,718
75,831
New Mexico
64,126
45,867
109,993
North Carolina
15,989,678
11,851,510
27,841,188
Ohio
270,074
270,072
540,146
Oregon
789,405
526,270
1,315,675
Texas
219,537
219,532
439,069
Washington
64,737
64,187
128,924
Total
$147,793,742
$142,065,521
$289,859,263
Source: Table prepared by the Congressional Research Service (CRS) based on information provided
by the U.S. Department of Health and Human Services.
Note: This table only reflects Title IV-E related expenditures. The total costs of the waiver projects
may include additional funding streams.

CRS-19
Table B-3. State-by-State Expenditures of Title IV-E Funds
for Waiver Projects, FY2002
Federal IV-E
State IV-E
Total IV-E
State
expenditures
expenditures
expenditures
California
$10,785,467
$10,547,428
$21,332,895
Colorado
232,896
232,896
465,792
Connecticut
(33,830)
(33,828)
(67,658)
Delaware
112,151
112,151
224,302
Illinois
152,876,835
152,918,453
305,795,288
Indiana
3,569,525
2,332,767
5,902,292
Maine
283,712
142,412
426,124
Maryland
5,934,922
5,934,922
11,869,844
Michigan
1,039,754
952,917
1,992,671
Mississippi
88,762
88,760
177,522
Montana
106,587
61,388
167,975
New Hampshire
112,968
112,966
225,934
New Mexico
166,259
65,313
231,572
North Carolina
14,953,122
11,204,315
26,157,437
Ohio
451,444
451,442
902,886
Oregon
1,290,854
889,642
2,180,496
Texas
291,458
289,966
581,424
Washington
(10,000)
(9,750)
(19,750)
Total
$192,252,886
$186,294,160
$378,547,046
Source: Table prepared by the Congressional Research Service (CRS) based on information
provided by the U.S. Department of Health and Human Services.
Note: This table only reflects Title IV-E related expenditures. The total costs of the waiver projects
may include additional funding streams. Negative numbers reflect adjustments made by states to
previous expenditures.