The Senate Finance Committee held a joint confirmation hearing for the Biden administration’s two top child welfare officials last week: January Contreras to lead the Administration for Children and Families (ACF), and Rebecca Jones Gaston to lead the Administration on Children, Youth and Families. The former is a large division of the Department of Health and Human Services that oversees all sorts of child and family-related assistance; the latter is a subdivision that focuses mostly on child welfare with a smaller portfolio that includes homelessness, family violence and pregnancy prevention.
There is no timetable for a committee vote on the two women, but Contreras and Jones Gaston’s approval by the committee seems assured. And as is the case with most confirmation hearings, the nominees’ responses were fairly guarded. But the topics of discussion at the hearing are likely a strong indicator of what child welfare issues are front and center for various factions of D.C. in 2022. Here is Youth Services Insider’s breakdown of the subjects that came up in the two-hour session.
Family First Act
For several of the Democratic members of the committee, the Family First Prevention Services Act was top of mind as they questioned the witnesses. The 2018 law opened up the Title IV-E child welfare entitlement to include funds for foster care prevention services approved by an evidence-based clearinghouse, and limits federal funds for the use of group homes and institutions.
Their interest in the law is not surprising: many of them were on the committee when the bill was born out of it in the mid-2010s, and committee chairman Ron Wyden (D-Ore.) co-authored the legislation with former Sen. Orrin Hatch (R-Utah). And while some states were early to implement it, Family First’s main provisions took effect nationwide in October of 2021.
Jones Gaston will have direct oversight over the executive branch’s work on Family First, and is probably the only child welfare director in the country to be involved in implementing it in two states. She led the Maryland system as it became one of the very first states to gain approval for foster care prevention services, and then oversaw the same process in Oregon.
So far, 20 states have had their plan for foster care prevention services approved, 19 have submitted plans but have yet to hear back, and 11 states have not submitted a plan. Additionally, one Native American tribe has been approved (the Eastern Band of Cherokee in North Carolina), and three tribes have submitted plans.
Wyden asked Jones Gaston what her “game plan” would be to move states along on Family First, which in and of itself is a bit of a suggestion that he’s frustrated that more states haven’t started to tap into the prevention funding.
Jones Gaston said the early priority would be to figure out “what’s needed to get approval for those plans that have already been submitted,” and engage with the 11 non-submitting states “around what their concerns are or issues might be.”
Sen. Michael Bennet (D-Colo.) raised two related issues to Jones Gaston: that regional ACF offices had been slow to respond to states seeking counsel on their Family First plans, and general frustration over how few programs had been reviewed and approved by the federal clearinghouse. So far, 43 programs and models have been cleared for the IV-E prevention funding.
Jones Gaston said she was committed to working to find ways to get more “evidence-based practices into our clearinghouse” and “make sure they are the services that are needed for the diverse populations that we serve across this country.”
It will be interesting to see if the administration moves more of the back-and-forth on Family First back to the Washington office. Trump’s child welfare leadership team wasn’t exactly opposed to Family First — after all, it was Trump who signed it — but it was not their priority, as different factions of the team pursued things like legal counsel for kids and parents, or securing permission for faith-based providers to follow ideology in choosing which foster and adoptive parents they work with.
Aside from some early guidance from the Children’s Bureau, the previous administration largely routed questions from states on Family First to regional offices.
Sen. Sherrod Brown (D-Ohio) told Jones Gaston that in his home state, counties and providers are confused over the rules around using Medicaid in the care of youth who are placed in qualified residential treatment programs, a new designation of congregate care programs established in Family First. For most residential care, the federal funds tap out at two weeks; for these treatment-oriented options, funding can continue pursuant to regular court reviews about whether it’s appropriate.
In Youth Services Insider’s opinion, Brown’s comment is indicative of a bigger, looming battle in congregate care over Medicaid. Because in actuality, there is no confusion: For decades, federal law has prohibited the use of Medicaid in residential care with only a few exceptions for the elderly and for youth and young adults with serious mental illness. And the Centers for Medicare and Medicaid Services made clear last summer that it would not be adding qualified residential treatment programs as exceptions; legislation would be required to do that.
But the confusion is understandable, because the truth is, plenty of congregate care providers have been improperly billing Medicaid for years without repercussions from the feds. We did a deep dive on this back in 2019, which you can read here.
Senator Bennet also brought up the unaccompanied minors program in his questions to Contreras, who will likely oversee the program since the Office of Refugee Resettlement is part of ACF, arguably the most discussed part of the agency given the attention paid to issues at the southern border. The nutshell version of this process: border patrol turns asylum-seeking unaccompanied minors from Central America over to ACF, which is tasked with their shelter, education and health until it finds them a sponsor in the states (usually a parent or relative).
Bennet noted a recent increase in the number of unaccompanied minors arriving at the border (periodic surges have become somewhat of a seasonal certainty over the past decade). He told Contreras he was “disappointed we haven’t seen a proactive public plan from the Biden administration on what they’re doing to best serve these children,” and asked her to commit to sharing a public strategy for caring for them, and queried whether she thought there was sufficient funding to do so?
Contreras, who has legally represented unaccompanied minors in court and trained ACF employees on this subject, mostly sidestepped those questions. “My priority is the safety of children and the well-being of families,” including those in the unaccompanied minors program.
Sen. John Thune (R-S.D.) also brought up the unaccompanied minors, and perhaps previewed a new conservative line of argument about how it works. Thune asked Contreras whether she felt that the guarantees of shelter and care, followed by sponsorship inside the United States,
“contribute to the pull factors of the unprecedented immigration pressures that we’re seeing at the border.”
The implication there: Youth are drawn to claim asylum not out of fear at home but to get into the unaccompanied minors pipeline and into the states.
Contreras did not answer him head on, saying, “The responsibility of ACF remains similar to our responsibility elsewhere, and that’s trying to protect the children, their safety, as they’re in our care.”
Last year, President Biden issued an executive order instructing executive branch agencies to conduct “equity assessments” to determine if there are any systemic barriers to access or eligibility for benefits and other assistance. Agencies had 200 days to conduct these assessments and hand in their findings to the White House Domestic Policy Council.
Biden’s first child welfare appointment — U.S. Children’s Bureau associate commissioner, who will likely report to Jones Gaston — said her early priority would be racial equity.
“You have to be unafraid to say there’s racism here, and there’s bias here, and we have to call it what it is,” said Schomburg, at an April 2021 virtual town hall. “We can compare and contrast where my family – if I need services – might end up versus where a white family might end up. That’s an uncomfortable conversation to have, but we need to start having it.”
Let’s put it this way: Youth Services Insider is not privy to all the internal machinations within ACF and the Children’s Bureau, but externally, those conversations on racial equity are yet to materialize. A recent information memorandum on racial equity from ACF did little more than affirm the agency’s view that addressing the issue is important, with no mention of past or planned action.
Both Contreras and Jones Gaston mentioned racial equity as a priority in their opening statements.
“Transforming children and family services systems into family well-being systems cannot be done without a focus on equity and inclusion,” said Jones Gaston, in her remarks. “We see disproportionality at every decision point.”
Ranking Minority Member Sen. Mike Crapo (R-Idaho) told Contreras that the committee would soon have to take up reauthorization of the Maternal, Infant, and Early Childhood Home Visiting program, or MIECHV, which provides hundreds of millions to states to help support home visiting programs that send professionals into the homes and lives of new or expectant mothers.
The last round on MIECHV nearly deadlocked, with providers bracing for layoffs and cutbacks. But in February of 2018, Trump signed an emergency spending bill to keep the government open that also included Family First, a reauthorization deal for home visiting, and five more years for the children’s health insurance program.
Last go-round, Republicans wanted to require a state-level match for the home visiting funds as a way to grow the program without growing the federal spend on it. Crapo wanted to know if Contreras had thoughts on how the committee might improve or adjust the program this time around. Contreras would only have partial influence on home visiting if confirmed; it’s mostly housed at another part of Health and Human Services, in partnership with ACF.
Contreras called home visiting “the perfect example of a gateway to a universe of supports” for new or vulnerable families, and said she wanted to make sure recipients of home visiting were also connected to other family supports funded by ACF. She suggested to Crapo that the next reauthorization “build in that equity lens” to ensure rural families and communities of color were not “left behind.”
Another reauthorization brought up by several members was the Title IV-B program, which funnels hundreds of millions to states for family preservation, reunification services and post-adoption supports. There wasn’t much substantive conversation back and forth on it, but it certainly seems top of mind for the committee.
Sen. Catherine Cortez Masto (D-Nev.) asked Jones Gaston what the federal government should be doing to support caseworkers, which was the only acknowledgment during the hearing of the serious workforce crisis happening in child welfare systems around the country. Worker burnout has created huge vacancy rates at many nonprofits and state and local agencies, and those jobs have been hard to fill since the Great Resignation began.
“The impact of the pandemic has been profound for families and for the workforce,” said Jones Gaston.
ACF oversees most federal funding for child care, which if Biden’s Build Back Better agenda were to get back on the radar, could be in line for a massive increase. While not the purview of the child welfare system, the availability of affordable options in this space is increasingly seen as a concrete support that can be used to prevent child maltreatment.
Sen. Elizabeth Warren (D-Mass.) used her time mostly to argue for the need to increase federal child care spending, noting a recent survey showing that 94% of parents adjusted their careers due to child care issues by reducing work hours, switching jobs or leaving the workforce altogether.