Family First Act: Who’s In, Who’s Out, What’s Up In The Air

The Family First Act was signed into law in February 2018, and mostly takes effect in October 2019

In just a few weeks, the two major provisions of the Family First Prevention Services Act will take effect. The law, passed in February 2018, dramatically changes the rules of Title IV-E, the entitlement through which most federal funds for child welfare services flows.

The current IV-E structure supports only foster care placements, adoption subsidies and administrative costs related to both. Under Family First, states can tap into IV-E to pay for certain approved substance abuse, mental health and parenting services aimed at preventing the need for foster care in some child welfare cases.

The law also limits the use of IV-E funds for group homes and other so-called congregate care settings. With some notable exceptions, states will only be able to draw down federal dollars for those types of placements for up to two weeks.

But how much will actually change on October 1, 2019?

It’s hard to say. States are entitled to seek up to a two-year delay on those congregate care limits, but must forfeit access to the new prevention funding if they do. And to access the prevention money, a state has to have a new IV-E prevention plan approved by the Administration for Children and Families.

Here’s a little Youth Services Insider rundown of where things stand with the Family First Act.

Thirteen States, and the Nation’s Capital

That’s how many child welfare agencies might implement Family First this year. We arrive at that number based on the fact that as part of our annual Who Cares project, The Imprint individually asked each state if they intended to take on the law this year or not.

Here are the states that said yes: Alaska, Arkansas, Delaware, Kansas, Kentucky, Maryland, Missouri, Nebraska, New Mexico, North Dakota, Utah, Washington and West Virginia.

(Almost) No Plans

Washington, D.C.’s Child and Family Services Agency (CFSA) was the first system to submit a IV-E prevention plan, and it has not been approved yet.

“They responded with clarifying questions about a month ago … and we responded but haven’t heard back,” said CFSA Director Brenda Donald. “We are expecting a response any day now.”

Three other states have submitted plans this month: Arkansas, Kentucky, and Utah. ACF spokesperson Monique Richards confirmed to YSI that there will be no prevention funds flowing without an approved plan, even for the services approved as evidence-based by the Family First clearinghouse.

There is also the issue of transition funding for services that are not on the clearinghouse list. ACF recently released guidance that permits states to make a case for non-clearinghouse services, but apparently the expectation is that those arguments will be included with submitted IV-E plans.

“No state has submitted a plan that includes interventions rated pursuant to a state conducted independent systematic review,” said ACF.

Thirty-Five Out, Not All Officially

Based on The Imprint’s questions to states, there are 35 states that are planning to put off the congregate care limits, and therefore the prevention funding.

According to information provided to us by ACF, eight of those states have not yet formally notified the federal agency of their intent to delay. They are: Hawaii, Maine, Massachusetts, Montana, Oregon, South Dakota, Vermont and Virginia.

YSI was curious: what happens if a state hasn’t formally delayed in writing? Are they then expected to adhere to the limitations on IV-E congregate care funds? We assume so, but ACF was a little obtuse in responding.

“We have not provided guidance on this issue to date as no state has posed this question,” the agency said. Hmmm.


The Golden State was the most vocal critic of Family First as it was making its way through Congress. But based on The Imprint’s research, the California Department of Social Services (CDSS) is the last state agency left that has not made a call on delaying or not.

“CDSS has not requested a delay and is working with other involved parties to determine an implementation date,” agency spokesperson Adam Weintraub told The Imprint in mid-August.


In all likelihood, California is waiting to see if there is a last-minute stay of execution for IV-E waivers, which most of the state’s most populous counties operate under. These waivers started in 1996 as a way to test specific interventions not allowed under IV-E, and have morphed in some cases into more general flexibility agreements without connection to specific tests.

All of the IV-E waivers are set to expire in October when Family First takes effect, but a group of leaders from waiver states and counties have lobbied for a reprieve. Sens. Marco Rubio (R-Fla.) and Dianne Feinstein (D-Calif.) introduced a billthat would do just that, extending waivers for two years to 2021. Rep. Don Bacon (R-Neb.) authored companion legislation in the House, which has 15 co-sponsors.

Neither bill has budged since introduction, but in our humble opinion, that could not matter less. If the right people agree, it can easily get slid into a temporary spending bill … just as the Family First Act was!

Cleanup Legislation

There is also a last-minute effort afoot to push a package of Family First-related items that was initially introduced by Sens. Sherrod Brown (D-Ohio) and Debbie Stabenow (D-Mich.) – Bacon also jumped on a companion bill for that. The Child Welfare and Mental Health Coalition has urged members to corral support for the Family First Transition and Report Act, which you can read the details of here.

The bill would get rid of the IV-E income test in foster care, which pretty much everyone agrees is dumb but would cost billions of dollars without some form of cost correction. But other provisions are smaller in scope, including more support for relative caregivers and some short-term funding to help recruit foster parents and license residential treatment centers.

One piece of the bill that probably should get through, if nothing else, is a delay on the rule that half of a state’s expenditures on Family First be on models that meet the highest threshold of evidence. As we reported recently, there is a lot of confusion right now around how some states can meet this test if their state Medicaid program pays for those services.

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