BILL ANALYSIS Ó
SENATE COMMITTEE ON APPROPRIATIONS
Senator Ricardo Lara, Chair
2015 - 2016 Regular Session
AB 403 (Mark Stone) - Public social services: foster care
placement: funding
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|Version: July 16, 2015 |Policy Vote: HUMAN S. 5 - 0 |
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|Urgency: No |Mandate: Yes |
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|Hearing Date: August 17, 2015 |Consultant: Jolie Onodera |
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This bill meets the criteria for referral to the Suspense File.
Bill
Summary: AB 403 states the intent of the Legislature to improve
California's child welfare system and its outcomes through the
use of comprehensive initial child assessments, increasing the
use of home-based family care and the provision of services and
supports to home-based family care providers, reducing the use
of congregate care placement settings, and creating faster paths
to permanency to reduce the duration of a child's involvement in
the child welfare and juvenile justice systems.
This bill, among its numerous provisions, establishes the
framework for the commencement of the development of the reforms
to the existing foster care placement system and payment
structures through the codification of a number of
recommendations included in the Department of Social Services'
report, California's Child Welfare Continuum of Care Reform
(CCR).
Fiscal Impact:
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Local child welfare and probation agencies : Major initial
investments in the tens of millions of dollars (General Fund*)
annually over a number of years to local agencies for
increased costs for activities including but not limited to
comprehensive initial child assessments, recruitment,
retention, and support services (including staffing, training,
specialized care, and child care) for home-based family care
providers, increased services costs for higher rates for
wraparound services, foster family agencies (FFAs), and
short-term residential treatment centers (STRTCs), potential
impacts of the formalized role of child and family teams,
performance and outcome measurement and data collection, and
accelerated statewide implementation of the Resource Family
Approval (RFA) process.
2015 Budget Act : Includes initial funding to support
recommendations in the CCR report consisting of $20.3 million
($17.2 million General Fund) to increase foster parent and
relative caregiver recruitment, retention, and training
efforts, and $7.3 million ($4.3 million General Fund) to fund
a 15 percent increase in FFA social worker rates.
DSS licensing, oversight, and administration : Significant
one-time and ongoing costs (General Fund) for the development
of revised rate structures, multiple sets of regulations for
new and revised licensing categories and RFA due process
procedures, development and implementation of a system of
governmental monitoring and oversight, the development of
revised training curricula, and automation system changes. The
magnitude and duration of these costs will be dependent on the
complexity and structure of the processes developed, which are
undetermined at this time.
DHCS administration : Significant one-time costs (General
Fund) to promulgate regulations regarding program standards,
oversight, enforcement, and due process for the mental health
certification of STRTCs and FFAs that provide intensive or
therapeutic treatment services, and to collaborate with DSS on
a monitoring and oversight program.
EPSDT/specialty mental health services : Major costs
potentially in the millions to tens of millions of dollars
(Federal Funds/Local Revenue Fund 2011(Behavioral Health
Subaccount)) annually for increased services and
administration for both new and existing cases to the extent
the bill's reforms result in more appropriate placements and
assessments of need for children entitled to these services.
Pursuant to 2011 Realignment, responsibility for specialty
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mental health and EPSDT services rests with the counties.
Long-term impact : Unknown, potentially significant future
cost savings to the child welfare and juvenile justice systems
to the extent the reforms result in better-informed and
appropriate initial placements provided with targeted
services, coupled with greater use of family-based care and
declining use and duration of congregate care placements and
costs, resulting in shorter and/or fewer stays in the child
welfare and juvenile justice systems. This overall savings is
predicated on numerous interdependent factors including but
not limited to the availability of adequate capacity and
quality of placement options for youth, the successful
provision of services to meet the individual needs of each
child, an effective system of monitoring and local interagency
coordination to ensure identified services are being provided
and transitions to home-based family care are made timely, the
rates developed for STRTCs/FFAs and the number of GH
placements from each RCL level transitioned to the
restructured rates, successful efforts to maximize federal
financial participation, the ability of families to meet the
specialized needs of this population, and performance measures
and standards developed including data collection to enable
analysis and accountability.
Proposition 30* : Provides that to the extent this legislation
has an overall effect of increasing the costs already borne by
a local agency for programs or levels of service mandated by
2011 Realignment, it shall apply to local agencies only to the
extent that the state provides annual funding for the cost
increase. Recognizing the wide variation between counties in
geographic size, population of impacted children, and the
level and costs of services and supports currently being
provided, as well as the varying impacts and timing of this
measure on local agencies within each county (including child
welfare, county probation, county mental health), the point at
which each local agency's overall costs may decrease will
likewise vary. At this time, the methodology including
baseline assumptions for calculating this "overall effect"
pursuant to Proposition 30 is unclear.
Annual THP-Plus FC COLA : To the extent the specified
provision in this bill is determined to codify existing law
with regard to the rate structure established by the workgroup
pursuant to WIC §§ 11402(b) and 11403.3(a)(1)(B), no new state
costs.
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Background: In response to the legislative mandate pursuant to SB 1013
(Committee on Budget and Fiscal Review) Chapter 35/2012, which
required the Department of Social Services (DSS) to establish a
stakeholder workgroup to develop recommended revisions to the
current rate-setting system, services, and programs serving
children and families in the continuum of eligible foster care
placement settings including, at a minimum, all programs
provided by foster family agencies and group homes, the DSS led
a multi-year effort and produced the report, California's Child
Welfare Continuum of Care Reform (January 2015), which outlines
a comprehensive approach to improving the experiences and
outcomes of children and youth in foster care.
The report envisions a new model of care based on the premise
that children are best served by living in their communities in
a setting of home-based family care coupled with the provision
of appropriate supports and services. With the intent of
eliminating the practice of long-term placements into congregate
(group home) care in favor of utilizing placements into
congregate care that are time-limited in duration and focused on
specific treatment goals, the new model of care supports
subsequently transitioning children into home-based family care
while ensuring appropriate levels of services and supports are
maintained.
The report recommendations include but are not limited to more
comprehensive assessments of children and families to enable
informed and appropriate initial placement decisions, emphasis
on home-based family care placements of children, the importance
of appropriate support of those placements with available
services, revised goals for congregate care placements, input
from a child and family team with regard to placement decisions
and assessment of needs, and greater transparency and
accountability for child outcomes. As indicated in the report
and notably relevant to this fiscal analysis:
Several of the recommendations in this report will
need short-term upfront investments as changes to the
placement system are phased in. In the longer term,
these recommendations are expected to become
cost-neutral by creating placement cost savings and
will permit strategic leveraging of federal Title IV-E
and Title XIX funding to further improve child
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outcomes. It is worth noting that California is one of
twelve states in which the state is responsible for
policy, regulation and outcome monitoring, with
counties responsible for operation of the program
itself. California also is unique in its current
financial relationship: The 2011 realignment of child
welfare services transferred all of the non-federal
placement costs and corresponding revenue to the
counties. This realignment also provides that new
administrative requirements, regulations, or enacted
legislation after September 30, 2012, that has an
overall effect of increasing the costs already borne
by county child welfare or juvenile probation
programs, applies to local agencies only to the extent
that the State provides annual funding for the cost
increase.
This reform effort is focused on improving outcomes
and requires significant changes to current
out-of-home care placements and supports. This reform
effort will improve the assessment process and alter
the roles of various placement settings and their
service arrays, and occurs in the context of other
system changes that serve to increase access to
existing federally-entitled services. While this
reform effort will change how and where services are
provided, it does so without creating new services.
This bill seeks to commence the establishment of the framework,
including the development of revised funding structures and
components necessary to implement the model of care as outlined
in the report recommendations, towards realization of the
overarching goal of a reduced reliance on congregate care as a
long-term placement setting and increased capacity of home-based
family care to better address the individual needs of all
children and caregivers, with the goal of the achievement of
safety, permanency, and well-being.
Proposed Law:
This bill includes overarching legislative intent language to
improve California's child welfare system and its outcomes, with
an expectation that the short-term funding provided by the state
to local agencies to implement the bill's provisions will reduce
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overall costs to local agencies and allow local savings to be
reinvested in child welfare services. This bill also states the
intent of the Legislature to maintain children's safety,
well-being, and healthy development when they are removed from
their own families by placing them with relatives or someone
familiar, whenever possible or appropriate, or with other
caregiving families, and to achieve this intent, the Legislature
recognizes numerous factors, as specified. In summary, this bill
provides for the following:
Group Home (GH) and Residential Care Reforms
Creates a new licensure category of "short-term
residential treatment centers" (STRTCs), defined to mean a
residential facility licensed by DSS and operated by a
public agency or private organization that provides
short-term, specialized, and intensive treatment,
including core services, as defined, and 24-hour care and
supervision to children, as specified.
Effective January 1, 2017, sunsets existing law
authorizing a GH to accept children assessed as seriously
emotionally disturbed (SED). Provides for a conditional
one-year extension to individual GHs to accept SED
placements.
Requires DSS to license STRTCs commencing January 1,
2017, and authorizes DSS to license STRTCs prior to January
1, 2017. As a condition of licensure, requires STRTCs to
meet the following criteria:
o Have national accreditation from an entity
identified by the DSS, as specified. Provides DSS the
authority to extend provisional licenses for STRTCs
for up to two years, if it determines this additional
time is required to secure accreditation.
o Obtain and have in good standing a mental
health certification.
Requires STRTCs to have a written plan of operation, as
specified by DSS, and requires a county licensed to operate
an STRTC to describe its conflict-of-interest mitigation
plan in its plan of operation.
Effective January 1, 2017, authorizes STRTCs to accept
for placement a child who meets all of the following
criteria:
o A child who does not require inpatient care in
a licensed health facility.
o A child who has been assessed as requiring the
level of services provided in order to maintain the
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safety of the child or others due to behaviors that
render the child or those around the child unsafe, and
who meets at least one of the following conditions:
§ A child who has been assessed as
meeting the medical necessity criteria for
specialty mental health services under the
Medi-Cal Early and Periodic Screening, Diagnosis,
and Treatment (EPSDT) program.
§ A child assessed as SED.
§ A child who has been assessed as
requiring the level of services provided in order
to meet his or her behavioral or therapeutic
needs, which in appropriate circumstances may
include the following children:
A commercially or sexually
exploited child.
A private voluntary
placement, as specified.
A juvenile sex offender.
A child who is affiliated
with or impacted by a gang.
Requires providers to ensure that AFDC-FC funded
children accepted for placement have been approved for
placement by an interagency placement committee (IPC), as
specified.
Effective January 1, 2017, sunsets the existing GH rate
classification system, but provides that DSS may grant an
exception on a case-by-case basis for a GH to extend its
rate through December 31, 2017, both for child welfare and
probation youth, and potentially beyond that date, with
six-month reviews, to meet the needs of probation youth, as
specified. Provides for an interim GH rate classification
process until January 1, 2018, for those GHs provided an
extension.
Commencing January 1, 2017, requires DSS to commence
development of a new payment structure for STRTC program
placements claiming Title IV-E funding that includes
consideration of the following factors: core services,
specialized and intensive treatment supports, staff
training, health and safety requirements, accreditation,
mental health certification, and maximization of federal
financial participation.
Prohibits DSS from establishing a rate for an STRTC or
FFA that provides intensive and therapeutic treatment
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unless the provider submits a recommendation from the host
county or primary placing county that the program is needed
and that the provider is willing and capable of operating
the program at the level sought.
Commencing January 1, 2017, provides that the rate paid
for a dependent infant living with a dependent teenage
parent receiving AFDC-FC benefits in an STRTC shall equal
the infant supplement rate for STRTCs established by DSS.
Requires DSS to develop and establish an administrator
certification training program for STRTCs, as specified,
and establish a process no later than January 1, 2017, for
convening a peer review panel for review of plans of
operation for STRTCs.
Foster Family Agency (FFA) Reforms
Removes the requirement for DSS to develop licensing
regulations differentiating between FFAs that provide
treatment of children in foster families and those that
provided nontreatment services.
Expands the definition of FFA to include a public
agency, and requires a county licensed to operate an FFA to
include a conflict-of-interest mitigation plan in its plan
of operation.
Establishes new requirements for FFAs, including the
maintenance of a written plan of operation as required by
DSS. Additionally:
o On and after January 1, 2017, requires FFAs to
have national accreditation from an entity identified
by the DSS, as specified.
o Authorizes DSS to issue a provisional license
to an FFA for up to two years and may extend the term
of the provisional license in order for the FFA to
secure accreditation.
o On and after January 1, 2017, requires an
FFA's plan of operation to demonstrate its ability to
support the differing needs of children and their
families and include a program statement that contains
a description of its core services and supports,
treatment practices that will be used, description of
services to be provided to meet treatment needs of
children assessed.
o Requires FFAs that provide treatment services
to maintain in good standing the appropriate mental
health certification issued by the DHCS.
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Sunsets existing provisions of law on the rate setting
system for FFAs on January 1, 2017, and on that same date
requires DSS to commence development of a new payment
structure for the Title IV-E funded FFA placement option
for FFAs that provide nontreatment, treatment, intensive
treatment, and therapeutic foster care programs based on a
list of enumerated factors. Provides for an interim rate
structure until January 1, 2018.
Provides that DSS may grant an exception on a
case-by-case basis for an FFA to extend its rate through
December 31, 2017, both for child welfare and probation
youth, as specified, and establishes an interim rate system
for FFAs through January 1, 2018, for those FFAs granted an
extension.
Authorizes FFAs that provide treatment services to
accept for placement children who do not require inpatient
care in a licensed health facility and who meet at least
one of the following conditions:
o A child who has been assessed as meeting the
medical necessity criteria for specialty mental health
services under the Medi-Cal EPSDT program.
o A child assessed as SED.
o A child who has been assessed as requiring the
level of services provided in order to meet his or her
behavioral or therapeutic needs.
Effective January 1, 2017, requires FFAs to approve
resource families in lieu of certifying foster homes.
Probation Youth
Commencing January 1, 2016, requires county probation
departments to do the following:
o Work with GH providers to develop STRTCs that
meet the needs of probation-supervised youth in foster
care.
o Work with FFAs to develop strategies to
recruit, retain, and support specialized foster homes
for probation youth.
o Work with DSS on strategies to identify,
engage, and support relative caregivers.
o Work with DSS to define probation youth
outcome measures to be collected and analyzed to
assess implementation of this act.
Commencing January 1, 2018, requires DSS in consultation
with the Chief Probation Officers of California, to assess
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the capacity and quality of placement options for probation
youth in foster care, as specified.
Requires DSS to provide an interim report to the
Legislature no later than January 10, 2019, and a final
report no later than January 10, 2021, to include specified
data and whether there is a continued need for probation
placement in GHs.
Child and Family Team (CFT) Activities
Defines a CFT as a supportive team that informs the
process of placement and services to children and youth in
foster care or who are at risk of foster care placement.
Provides that a CFT is comprised of the child or youth, the
child's family, the caregiver, the placing agency
caseworker, a county mental health representative, and a
representative of the child's or youth's tribe or Indian
custodian, as applicable, and may include other persons as
specified and appropriate.
Requires the case plan to be developed in collaboration
with the CFT. Requires the placing agency to consider the
recommendations of the CFT and document the rationale for
any inconsistencies between the case plan and the CFT
recommendations.
After January 1, 2017, requires a CFT meeting to be
convened by the county placing agency for the purpose of
identifying the supports and services needed to achieve
permanency and enable the child or youth to be placed in
the least restrictive, most family-like setting.
Resource Family Approval (RFA) Process
Mandates statewide implementation of the RFA process no
later than January 1, 2017. Under existing law,
implementation by all counties is authorized effective July
1, 2017, but statewide implementation is not required until
July 1, 2019.
Revises RFA standards and requirements to include
successfully meeting a home environment assessment and
permanency assessment standards.
Commencing January 1, 2016, authorizes DSS to establish
participation conditions, and select and authorize FFAs
that voluntarily submit implementation plans and revised
plans of operation in accordance with requirements
established by DSS to approve resource families in lieu of
certifying foster homes. Authorizes DSS to adjust the FFA
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AFDC-FC rate for implementation of these activities.
Effective January 1, 2017, requires FFAs to approve
resource families in lieu of certifying foster homes. No
later than July 1, 2017, requires FFAs to provide a
detailed description of the RFA process to all certified
family homes and notification that in order to care for a
foster child, RFA is required by December 31, 2019.
Provides that a certified family home with an approved
adoptive home study completed prior to January 1, 2018,
shall be deemed to be an approved resource family.
No later than July 1, 2017, requires counties to provide
a detailed description of the RFA process to all licensed
foster family homes (FFHs), approved relatives and
nonrelative extended family members (NREFMs), and that in
order to care for a foster child, RFA is required by
December 31, 2019. Provides that a licensed FFH, an
approved relative, or NREFM with an approved adoptive home
study completed prior to January 1, 2018, shall be deemed
to be an approved resource family.
Requires counties to provide supportive services to all
certified family homes with a child in placement to assist
with the resource family transition and to minimize
placement disruptions.
Authorizes counties to provide supportive services to
all licensed FFHs, relatives, and NREFMs with a child in
placement to assist with the resource family transition and
to minimize placement disruptions.
Requires DSS to implement due process procedures
including providing a statewide fair hearing process for
denials, rescissions, or exclusion actions.
Requires counties to ensure resource families have the
necessary caregiver training, including a minimum of 12
hours of pre-approval training and a minimum of 8 hours
annually thereafter.
Specifies that resource families shall not be subject to
civil penalties imposed pursuant to the Community Care
Facilities Act.
Provides that personal identifying information of
resource families shall not be disclosed by any state or
local agency pursuant to the California Public Records Act,
except as specified.
Other Provisions
Requires DSS to provide available funding to counties
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for the purpose of recruiting, retaining, and supporting
foster parents, relative caregivers, and resource families
based on DSS approval of plans submitted by each county
that requests funding for staffing, exceptional child needs
not covered by the caregiver-specific rate, child care,
intensive relative finding, engagement, and navigation
efforts, and emerging technological or other
non-traditional approaches to outreach to potential foster
homes, resource families, and relatives.
Requires DSS to develop a system of governmental
monitoring and oversight of STRTCs and FFAs to be carried
out in coordination with DHCS. Oversight responsibilities
must include, but not be limited to, ensuring conformity
with federal and state law, including program, fiscal, and
health and safety reviews.
Requires DHCS to promulgate regulations for oversight,
enforcement, and due process for the mental health
certification of STRTCs and FFAs that provide treatment
services.
Effective January 1, 2017, sunsets the existing rate for
wraparound services and establishes a new rate of $8,573,
based on a revised methodology, as specified. Commencing
January 1, 2018, and annually thereafter, provides for a
cost-of-living increase (COLA) to be applied to the
wraparound services rate, subject to the availability of
county funds, equal to the CNI, as specified.
Sunsets existing provisions of law outlining foster
parent training requirements on January 1, 2017, and
replaces with an annual training requirement of 8 hours, as
specified.
No later than January 1, 2017, requires DSS to consult
with stakeholders to develop regulations or identify policy
changes necessary to allow for the sharing of information
with caregivers regarding a child's educational, medical,
dental, and mental health history and current needs.
Authorizes DSS to license temporary shelter care
facilities on or after January 1, 2016, only to counties
operating a licensed GH as of January 1, 2016, and limits
placement duration to no more than 10 calendar days, as
specified. Requires DSS to provide a report to the
Legislature by January 1, 2021, on the use of temporary
shelter care and whether there is a continued need for the
licensing and operation of these facilities.
On and after January 1, 2017, provides that facilities
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with licensed capacity of 184 that were in operation prior
to January 1, 2015, that offer placements for the purpose
of attending an onsite high school may continue to operate
under an appropriate licensing category subject to
submittal of a transition plan to DSS.
Codifies legislative intent to provide an annual COLA
equal to the CNI, as specified, on THP-Plus Foster Care
Program payments.
Related Legislation: AB 1299 (Ridley-Thomas) 2015 would shift
responsibility for the provision of medically necessary mental
health services for foster youth placed out-of-county, from the
county of original jurisdiction to the foster youth's county of
residence, in order to increase access to mental health services
for youth. This bill is scheduled to be heard today by this
Committee.
SB 238 (Mitchell), SB 253 (Monning), SB 319 (Beall), and SB 484
(Beall) 2015, are four bills proposing a set of reforms aimed at
curbing excessive and inappropriate authorization and
administration of psychotropic medications to foster youth.
These bills are pending hearing in the Assembly Appropriations
Committee.
Prior Legislation: AB 93 (Committee on Budget) Chapter 10/2015,
the Budget Act of 2015, and SB 79 (Committee on Budget and
Fiscal Review) Chapter 20/2015, the Human Services budget
trailer bill, provided the authority and initial funding to
support foster parent recruitment, retention, and support,
budget bill language specifying how the recruitment, retention,
and support funds are to be spent, and funds to increase FFA
social worker rates.
SB 1013 (Committee on Budget and Fiscal Review) Chapter 35/2012,
among its provisions, required DSS to establish a working group
to develop recommended revisions to the current rate-setting
system, services, and programs serving children and families in
the continuum of foster care settings. This bill also enacted
the RFA program.
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Staff
Comments: This bill establishes the general framework for
commencing development of the reforms described in the Continuum
of Care Reform report, the potential fiscal impacts of which
will be dependent on numerous factors including but not limited
to the outcomes of processes and structures required to be
developed pursuant to the bill's provisions but have yet to be
determined.
The absence of specificity with regard to revised rate
structures, program standards, and implementation details
notwithstanding, this bill will likely require the provision of
substantial funding, potentially in the tens of millions of
dollars annually over a number of years to local agencies to
successfully initiate implementation of such a comprehensive
reform as the bill's legislative intent language describes.
For example, acknowledging the critical need to expand the
existing capacity of family-based placements to enable the
successful transition of youth from existing GH and future STRTC
placements, the bill requires DSS to provide "available funding"
to counties for the purpose of recruiting, retaining, and
supporting foster parents, relative caregivers, and resource
families. While the 2015 Budget Act includes over $17 million
General Fund in one-time funding to support these activities,
significant additional investments will likely be required in
order to continue to build on these initial efforts. Notably,
the Chief Probation Officers of California have indicated only
46 probation youth currently reside with foster families or
FFAs, and approximately 2,100 probation youth are currently
placed in GHs. The availability and ability of home-based family
caregivers to meet the needs of both the probation and child
welfare populations will be a key component to successfully
reducing the use of congregate care placements and costs.
The overall fiscal impact of this measure over time cannot be
known with certainty given the multitude of interdependent
factors and as of yet undetermined components in the bill
including but not limited to the availability of adequate
capacity and quality of placement options for youth, the
successful provision of services to meet the individual needs of
each child, an effective system of monitoring and coordination
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to ensure identified services are being provided and transitions
to home-based family care are made timely, the rate levels
developed for STRTCs/FFAs and the number of GH placements from
each RCL level transitioned to the restructured rates,
successful efforts to maximize federal financial participation,
and the development of performance measures and standards
including data collection to enable analysis of outcomes and
accountability.
Adding to the complexity of determining the potential fiscal
impacts of this bill are the provisions of Proposition 30 and
2011 Realignment. Proposition 30 provides that to the extent
this legislation has an overall effect of increasing the costs
already borne by a local agency for programs or levels of
service mandated by 2011 Realignment, it shall apply to local
agencies only to the extent that the state provides annual
funding for the cost increase. Recognizing the wide variation
between counties, as well as the varying impacts and timing of
this measure on local agencies within each county (including
child welfare, county probation, county mental health), the
point at which each local agency's overall costs may decrease
will likewise vary. To facilitate the ability to measure the
fiscal and programmatic effects of this legislation, the
establishment of performance standards, outcome measures, and
data to be collected and analyzed would be required. It is
unclear how the long-term implementation of the provisions of
this bill will be funded, and to what extent any local agency
savings from reduced congregate care placement costs will be
measured and potentially used to offset other local agency
costs. At this time, the methodology including baseline
assumptions for calculating this "overall effect" pursuant to
Proposition 30 is unclear.
Proposed Author
Amendments: The author has indicated numerous amendments are
forthcoming, both substantive and technical in nature. These
amendments were not available at the time of this analysis.
Recommended
Amendments: Staff recommends the state funding to be provided
to counties for the services to support the recruitment and
retention of home-based family care providers pursuant to WIC §
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16003.5 in Section 98 of the bill specify the funds are to be
provided subject to appropriation by the Legislature.
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