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Stephanie Pellitt

, National Council for Behavioral Health

Family First Act Passed in Short-Term Spending Bill

February 15, 2018 | Children and Youth | Federal Budget | Comments
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Last week, Congress passed the Family First Prevention Services Act, a sweeping reform of the child welfare system as part of a larger spending package. The measure allows states to use federal foster care matching funds for prevention services addressing mental health, substance use and parenting skills to keep at-risk children from entering the foster care system. The Act also limits federal reimbursements for foster youth who are placed in congregate care settings. After coming close to passage in 2016, the Family First Act was tucked into last week’s massive budget deal, fast-tracking its enactment.


The main provision of the Act will allow states to use funds derived from Title IV-E of the Social Security Act – the entitlement that pays for child welfare – for “time-limited” services aimed at preventing the use of foster care. Currently, Title IV-E funds are only used as foster care maintenance payments or as assistance to adoptive families. For parents of children who are candidates for foster care, states can elect to provide up to 12-months of mental health services, addiction treatment or in-home parent skill training with the goal of keeping the child with their parent(s) or a biological relative. Notably, these time-limited prevention services would not be subject to the Title IV-E income eligibility requirements for the child or parent.

Additionally, the Act would support residential addiction treatment facilities that allow for children to live with their parents as the parents receive treatment. For instance, if a child meets the IV-E foster care income tests, then a state can seek IV-E reimbursement for a child placed in a residential addiction treatment facility alongside their parent. There must be a formal recommendation made for the placement, and the facility must provide parenting and counseling sessions, in addition to rehabilitation services.


To finance the expansion of the Title IV-E payments, the Act limits federal payments for child placements in congregate care facilities and delays the expansion of certain federal adoption subsidies. The Family First Act states that no federal IV-E foster care payments will be made to a congregate care facility beginning with the third week of a child’s placement, although several wide exceptions for continued federal participation are included. For example, “qualified residential treatment programs” or QRTPs would be eligible for payments beyond two weeks. These facilities are defined by the following characteristics:

  • Licensed by at least one of three accreditors: Commission on Accreditation of Rehabilitation Facilities; Joint Commission on Accreditation of Healthcare Organizations; Council on Accreditation.
  • Has a trauma-informed treatment model that includes service of clinical needs.
  • Has registered or licensed nursing staff in accordance with the model, and that a nurse is on call at all times.
  • Is inclusive of family members in treatment plans and programs.
  • Plans for at least a six-month window of support after discharge.

The limitations on group care do not take effect until October 2019. However, these provisions have garnered some controversy, which could prompt states to apply to for a two-year delay on these limits, as is allowed by the new law.