Child Welfare: An Analysis of Title IV-E Foster Care Eligibility Reviews

CRS Report for Congress
Child Welfare: An Analysis of Title IV-E
Foster Care Eligibility Reviews
March 29, 2005
Cheryl Vincent
Visiting Research Associate
Domestic Social Policy Division


Congressional Research Service ˜ The Library of Congress

Child Welfare: An Analysis of Title IV-E
Foster Care Eligibility Reviews
Summary
Title IV-E of the Social Security Act authorizes states to seek federal
reimbursement for certain costs of providing foster care for children who can no
longer safely remain in their homes. The statute permits states to make a claim for
federal reimbursement of costs that are linked to providing foster care to each
federally eligible child. In FY2003, the most recent year for which data are available,
states sought federal reimbursement under this authority for approximately $4.5
billion in foster care costs. The U.S. Department of Health and Human Services
(HHS), periodically conducts Title IV-E Foster Care Eligibility Reviews to ensure
that states are properly determining the eligibility of children for federal foster care
support and are thus making correct claims for reimbursement.
Federal eligibility for foster care is defined in Section 472 of the Social Security
Act and is also described in regulations. A child is eligible for federal foster care if
(1) a judge has made certain determinations regarding the necessity of his/her
removal from the home, regarding the timely efforts of the state child welfare agency
to prevent the child’s removal, and regarding timely efforts to find a new permanent
home for the child; (2) if (except for the removal from his or her home) the child
would have met the state’s program requirements for the Aid to Families with
Dependent Children (AFDC) program (as that program existed on July 16, 1996); (3)
the child is placed in a licensed foster family home that is determined to be safe or
in an otherwise eligible licensed care facility; and (4) the child is the care and
placement responsibility of the state.
Title IV-E eligibility reviews are designed primarily to improve program
management in the federal foster care program. A January 25, 2000 rule established
the current form of the review and includes certain checks that flow from the 1997
Adoption and Safe Families Act (P.L. 105-89), which are intended to ensure both the
safety of children in foster care and the timely actions of the state child welfare
agency to establish permanence for children. Since all aspects of the new rule
became effective, HHS has conducted reviews in 43 states; of these, 16 were found
not to be substantially compliant with Title IV-E foster care eligibility rules.
Requirements associated with judicial determinations dominated as reasons for cases
being found ineligible, making up 61% of errors. Time limits for obtaining judicial
determinations concerning permanency planning created a significant challenge for
states. Safety and licensing disqualifications constituted 24% of errors. Problems
were due mainly to lack of documentation to verify that state safety requirements
were met. Provisions related to AFDC eligibility made up 15% of all errors. About
half of AFDC errors were related to income rules, while the rest were linked to other
program rules such as establishment of “deprivation.” Only 1% of errors were a
result of the responsibility and care of the child not being vested with the state.
This report provides an overview of the current Title IV-E Foster Care
Eligibility Review process and a discussion of state performance on available reviews
conducted after the January 25, 2000 rule’s effective date. This report will be
updated as additional state performance reports become available.



Contents
In troduction ..................................................1
Summary of Findings from Early Reviews..........................2
Title IV-E Foster Care Review Process.............................3
Title IV-E Eligibility Requirements................................5
Judicial ..................................................6
Provider .................................................7
AFDC ...................................................8
State ....................................................8
Standards of Compliance and Disallowance.........................8
Appeals Process for Review Findings..........................9
Program Improvement Plans................................10
Analysis of Title IV-E Eligibility Reviews.........................10
Initial Primary and Primary Reviews..........................12
Secondary Reviews.......................................14
Strengths and Weaknesses Found Among States................16
Appendix A.....................................................18
List of Figures
Figure 1. Distribution of Errors in Title IV-E Foster Care Eligibility Reviews...3
Figure 2. Review Errors Related to Judicial Requirements.................12
Figure 3. Review Errors Related to Provider Requirements................13
Figure 4. Review Errors Related to AFDC Eligibility.....................13
List of Tables
Table 1. Stages of Title IV-E Foster Care Eligibility Reviews...............4
Table 2. Federal Eligibility Criteria for Title IV-E Foster Care..............6
Table 3. Overview of Errors Across All 43 States.......................12
A1. Review Dates and Outcomes Individually by Statea..................18
This report was written by Cheryl Vincent, a Presidential Management
Fellow on detail from the U.S. Department of Health and Human
Services, under the supervision of Karen Spar and Emilie Stoltzfus,
Domestic Social Policy Division.



Child Welfare: An Analysis of Title IV-E
Foster Care Eligibility Reviews
Introduction
Congressional interest in ensuring that states achieve positive results for
children in foster care has sparked a number of reforms in federal policy and
regulations over the past decade. Among these were amendments requiring a new
review system designed to assess a state’s ability to achieve safety, permanency, and
well-being for the children it serves. This report will examine one aspect of this new
review system, Title IV-E Foster Care Eligibility Reviews. These reviews, which are
smaller in scope than the much more frequently discussed Child and Family Services
Review (CFSR), are meant to determine whether a state is making proper claims for
federal reimbursement under the Title IV-E Foster Care program. In particular, the
review is concerned with whether a state has in place the systems to ensure timely
permanency and other judicial determinations and adequate safety checks of provider
homes. Apart from fiscal accountability, these aspects of the Title IV-E eligibility
review are designed to promote strong program management.
Since the early 1980s, the U.S. Department of Health and Human Services
(HHS) has conducted reviews to monitor state compliance with child welfare
protections included in Titles IV-B and IV-E of the Social Security Act. Title IV-B
authorizes funds to states for a broad range of child welfare services, including child
protection, family preservation, family support, time-limited family reunification, and
adoption promotion and support services. Title IV-E authorizes the foster care,
independent living, and adoption assistance programs. Past reviews of these
programs were called “427” reviews, in reference to protections originally outlined
in Section 427 of the Social Security Act, and Title IV-E financial reviews.
Traditionally, reviews focused on case management practices and file documentation.
Child welfare advocates, state and federal officials, and ultimately, Members of
Congress became critical of “427” and Title IV-E financial reviews for procedural
and programmatic deficiencies. Concerns included the lack of formal regulations to
establish uniform review standards, and the punitive, rather than collaborative, nature
of the review process. Additionally, there was a perception that focusing on paper
compliance and legal requirements did not lead to improved services for children and
families. As a result, beginning in 1989 Congress issued a series of moratoriums
prohibiting HHS from collecting penalties associated with these reviews.
In 1994, amendments to the Social Security Act (P.L. 103-432) directed HHS
to issue formal regulations establishing a new review system to monitor programs
under Titles IV-B and IV-E of the Social Security Act and to incorporate the concepts
of technical assistance and standardized corrective action into review processes.
Subsequently, Congress passed the Adoption and Safe Families Act of 1997 (ASFA,
P.L. 105-189), which was intended to ensure both the safety of children in foster care



and the timely actions of the state child welfare agency to establish permanence for
children. On January 25, 2000, HHS published a final rule in the Federal Register
to establish a formal review process consistent with both the 1994 Social Security
Act amendments and with implementation of ASFA.1 Under the final rule, states are
reviewed for conformity with specific federal requirements for child protection,
foster care, adoption, family preservation and family support, and independent living
services. The final rule replaced previous “427” and Title IV-E financial reviews
with two separate reviews: the Child and Family Services Review and the Title IV-E
Foster Care Eligibility Review. This report is an analysis only of state Title IV-E
Foster Care Eligibility Reviews.2
Summary of Findings from Early Reviews
Since implementation of all the requirements under the new review process,
HHS has conducted reviews in 43 states and of these, 16 states were found not to be
substantially compliant with Title IV-E foster care eligibility requirements.3 (See
Figure 1.) Requirements associated with judicial determinations dominated as
reasons for cases being found ineligible, making up 61% of errors. Time limits for
obtaining judicial determinations concerning permanency planning created a
significant challenge for states. Safety and licensing disqualifications constituted
24% of errors. Problems were mainly due to lack of documentation to verify that
safety requirements were met. Provisions related to AFDC eligibility made up 15%
of all errors. About half of AFDC errors were related to income rules, while the rest
were linked to other program rules such as establishment of “deprivation.” Only 1%
of errors were a result of the responsibility and care of the child not being vested with
the state.
The final rule requires states to be attentive to the maintenance, content and
organization of files for federally eligible foster care children and their providers.
Many of the recommendations for improvement given by reviewers focused on
appropriate paperwork and documentation in case files that substantiate timely
judicial determinations, current provider licensing, and AFDC eligibility


1 Federal Register, vol. 65, no. 16. Part II, U.S. Department of Health and Human Services,
Administration for Children and Families, 45 CFR Parts 1355, 1356, and 1357; Final Rule,
Jan. 25, 2000 (65 FR 4091).
2 Child and Family Services Reviews (CFSR) and Title IV-E Foster Care Eligibility Reviews
are distinctly separate reviews. The CFSR assesses activities funded by both Title IV-B and
IV-E to determine system-wide state compliance with federal law. Title IV-E Foster Care
Eligibility Reviews determine only the eligibility of state expenditures for foster care for
federal reimbursement under Title IV-E. This report does not include an analysis of CFSR.
3 This report includes only initial primary or primary reviews covering a six-month period
beginning after the final rule effective date for provisions related to permanency hearings
— Mar. 25, 2001. All 50 states have received reviews, and some have received both initial
and primary reviews. Yet, this analysis makes a distinction between reviews covering a
period before or after the effective date of all the final rule’s provisions (Mar. 25, 2001).
Twenty-two state initial primary reviews were conducted before this date but were not
included in the analysis, since they were not yet being assessed for compliance with all the
requirements in the final rule.

requirements. Reports frequently cited the need for child-specific language in court
orders and case narratives to track a child’s placement history and validate
re-determinations of eligibility. Additionally, the prompt responsiveness of state
child welfare agencies to provisions in the new rule and preparedness for reviews
played an important role in determining performance on these early reviews. This
report is intended to provide an overview of how states have fared thus far under the
new review process. The balance of this report discusses in detail the process and
outcomes of these state reviews.
Figure 1. Distribution of Errors in Title IV-E Foster Care
Eligibility Reviews
Source: Prepared by Congressional Research Service (CRS) based on analysis of state Title IV-E
Foster Care Eligibility Review final reports.
Note: Percentages may not sum to 100 due to rounding.
Title IV-E Foster Care Review Process
Title IV-E of the Social Security Act authorizes the federal foster care program,
through which states may seek reimbursement for a percentage of eligible foster care
maintenance payments, and related administrative, training, and data collection costs
for federally eligible children.4 To access Title IV-E funds, a state must verify a
child’s eligibility based on several requirements established in the law. These
requirements are related to the content of judicial determinations made on behalf of
children, provider safety regulations, and certain characteristics of the child,
including income of the family from which the child is removed.


4 Title IV-E of the Social Security Act also establishes the Adoption Assistance program,
which is an open-ended entitlement program. Title IV-E eligibility reviews look at claims
for foster care payments only.

Title IV-E reviews are conducted to validate a state’s claim for federal
reimbursement of payments made on behalf of eligible children. Responsibility for
carrying out reviews lies with the Children’s Bureau, a division of the Administration
for Children and Families (ACF) within HH5S. Reviews assess the accuracy of the
state’s claim for reimbursement by examining the case records of the child, and
provider and payment documentation. Reviews are a collaborative effort, conducted
by teams comprised of both federal and state staff. The process is designed to occur
in stages, with a different timetable, sample size, compliance standard, and penalty
structure for subsequent reviews (depending on whether a state is determined to be
in compliance).6 Table 1 describes the three stages of Title IV-E eligibility reviews.
Table 1. Stages of Title IV-E Foster Care Eligibility Reviews
Initial Primary Review — The first Title IV-E eligibility review conducted in a statea
following passage of the final rule on January 25, 2000. It is intended to give states an
opportunity to implement the requirements included in the regulations. Based on a
sample of 80 cases, not more than eight cases can be in error for the state to be in
substantial compliance. Federal funds are disallowed for any ineligible cases found in
the sample.
Primary Review — If a state is found to be in compliance on an initial primary review,
primary reviews occur at three-year intervals thereafter, as long as a state continues to be
compliant. Primary reviews have a higher threshold — based on a sample of 80 cases,
not more than four cases can be in error to be compliant. Federal funds are disallowed
for any ineligible cases found in the sample.
Secondary Review — If a state fails an initial primary or primary review, it must develop
a Program Improvement Plan (PIP) and a secondary review is conducted upon completion
of the plan. A larger sample of 150 cases is taken. For the state to be in compliance, not
more than 10% (15) of cases can be in error and the dollar amount of ineligible claims
cannot exceed 10% of total claims in the sample. If a state is not compliant, a tougher
penalty structure is used to calculate the total disallowance amount. HHS determines the
percent of ineligible claims from the sample and applies this percentage to all Title IV-E
foster care claims made during the six month period under review.
Source: Table prepared by the Congressional Research Service (CRS), based on information in the
ACF, Title IV-E Foster Care Eligibility Review Guide.
a. As defined in the ACF, Title IV-E Foster Care Eligibility Review Guide, p. 2. However, some
initial primary reviews did cover a partial period under review that occurred before Jan. 25,
2000. (AL, AZ, ID, IL, KS, MT, NH, NJ, SC, TX, WV received initial primary reviews that
covered a six-month period from Oct. 1, 1999 through Mar. 31, 2000).


5 Title IV-E Foster Care Eligibility Reviews are only one form of fiscal accountability
review of federal foster care payments, and do not supersede ongoing monitoring including
audits and other checks by the HHS Office of the Inspector General and the Government
Accountability Office, or quarterly reviews by the ACF Regional offices that may result in
disallowance or deferrals of Title IV-E claims.
6 For more information see Administration for Children and Families, Administration on
Children, Youth and Families, Children’s Bureau, Title IV-E Foster Care Eligibility Review
Guide, Nov. 2001. (Hereafter cited as ACF, Title IV-E Foster Care Eligibility Review
Guide.)

To conduct a review, a sample of cases is drawn from the Adoption and Foster
Care Analysis and Reporting System (AFCARS). AFCARS includes case level
information on all children in foster care for whom state child welfare agencies have
responsibility for placement.7 The sample drawn for each review consists of cases
of individual children who received at least one Title IV-E foster care maintenance
payment during the six month reporting period under review. For initial primary and
primary reviews, a sample of 80 cases is selected. During secondary reviews, a larger
sample of 150 cases is drawn.
Reviewers use an on-site review instrument that includes questions related to
the child and provider case records in order to determine whether the eligibility
decision of the state agency was supported by appropriate documentation. The
instrument includes an eligibility review checklist that covers each of the statutory
requirements for Title IV-E eligibility. After each review, a final report is prepared
to document the determination of compliance or non-compliance. Final reports
include information regarding the dates and location of review, a summary of review
findings, including a case record summary of each ineligible case, areas in need of
improvement, strengths and model practices, and notification of any disallowance of
federal funds.8
Title IV-E Eligibility Requirements
States are reviewed based on the requirements of Title IV-E of the Social
Security Act (SSA) and as defined by regulation.9 Both the eligibility of children and
the eligibility of the foster care provider/placement setting is reviewed. In brief, the
case record of the child must contain documentation that demonstrates the following:
!Conditions in the home from which the child was removed were
contrary to the child’s welfare and that reasonable efforts were made
to prevent removal (or a judicial determination of removal through
voluntary placement);
!Documentation that the state has made reasonable efforts to finalize
a permanency plan;
!The state agency has responsibility for placement and care of the
child;
!But for his/her removal from the home, the child would be eligible
for AFDC under the state plan as it was in effect July 16, 1996;
!Placement in a licensed or approved foster family home or facility;
and
!Verification of provider safety requirements.


7 U.S. Department of Health and Human Services, Children’s Bureau, Data & Info. Systems
— About AFCARS, at [http://www.hhs.acf.gov/programs/cb/afcars].
8 Final Reports from Title IV-E Foster Care Eligibility Reviews are posted on the Children’s
Bureau website for public access, at [http://www.acf.hhs.gov/programs/cb/].
9 Section 472 (a) and (b) of the Social Security Act; 45 CFR §§ 1356.21, 1356.71.

For simplification, these eligibility requirements have been separated into four
broad categories depending on whether errors were associated with judicial, provider,
AFDC, or state-related requirements. (See Table 2.)
Table 2. Federal Eligibility Criteria for Title IV-E Foster Care
TypeTitle IV-E eligibility criteriaSocial SecurityAct45 CFR
JudicialJudicial determination that conditions in the
home are Contrary to the Welfare of the
child . 472(a)(1) 1356.21(c)
Judicial determination that the state made472(a)(1);
Reasonable Efforts to Prevent Removal of471(a)(15)
the child from the home.(B)(I)1356.21(b)(1)
Judicial determination that the state has made
Reasonable Efforts to Finalize a472(a)(1); 471(a)
Permanency Plan for the child.(15)(B)(ii)1356.21(b)(2)
If removal is result of Voluntary Placement
Agreement, judicial determination that
continued placement is in child’s best interest.472(d),(e) and (f)1356.22
ProviderChild is placed in a Licensed foster family472(a)(3),1356.71(d)(1)
home or facility.(b),(c)(iv);1355.20
State has conducted a Criminal Records
Background Check or other safety
requirements on provider.471(a) (20); 475(1)1356.30
AFDCThe child would have been eligible for
AFDC based on income, age, deprivation,1356.71(d)
and specified relative requirements.472(a)(1), and (4)(1)(v)
StateResponsibility for placement and care of child1356.71(d)(1)
is vested with the State agency.472(a)(2)(iii)
Source: Table prepared by the Congressional Research Service (CRS), based on information in the ACF, Title
IV-E Foster Care Eligibility Review Guide, Appendix VII.
Judicial. In order to comply with Title IV-E requirements, a child’s case file
must include documentation showing that his/her removal was done as a result of
judicial determinations that continuation in the home would be contrary to the child’s
welfare, that the state has made reasonable efforts to preserve the family unit, and the
state has made reasonable efforts to make and finalize a permanency plan for the
child in a timely manner. Permanency plan goals may include reunification,
adoption, legal guardianship, or placement with a relative. In addition, for children
who are removed from the home under a voluntary placement agreement, a judicial
determination indicating that continued voluntary placement is in the child’s best
interests is required.
As promoted by ASFA and included in the final rule, timeliness of judicial
determinations is a primary focus of Title IV-E Foster Care Reviews. For each type
of court order the following deadlines must be met in order for a case to be
considered in compliance:



!Contrary to the welfare judicial determinations must be made in the
first court ruling that sanctions the removal of a child from the
home.
!The judicial determination regarding reasonable efforts to prevent
removal of the child from the home must be made within 60 days
from the removal date.10
!Determinations regarding reasonable efforts to finalize the
permanency plan must be made within 12 months of a child’s
removal and at least once every 12 months thereafter.11
!Children in voluntary placement are only eligible for foster care
maintenance payments made in the first 180 days of foster care,
unless a judicial determination is issued that finds continued
voluntary placement is in the best interests of the child.
Provider. Under the January 25, 2000 rule, states are no longer allowed to
provisionally license a provider while completing a criminal records background
check. Some states chose to do this, primarily for relative placements. However,
HHS determined this practice to be inconsistent with the provisions included in12
ASFA to ensure a child’s safety is a pre-eminent concern. Foster family homes
provisionally licensed were required to be fully licensed by September 28, 2000.13
To be eligible for Title IV-E funding, a foster care provider must meet standards
for full licensure or approval that are established by the state. The responsibility for
establishing minimum licensing standards is vested with the state.14 The review
determines whether the foster family home or facility has a valid license during the
period under review. Reviews also consider whether a provider is a Title IV-E
eligible facility. An eligible facility may be a foster family home, a group home, a
private child care institution, or a public child care institution that accommodates 2515
or fewer children. States are also assessed based on whether federal safety
requirements have been met. Federal safety requirements pertain to criminal records


10 The date of removal is defined as “the earlier of: the date of the first judicial finding that
the child has been subjected to child abuse or neglect; or, the date that is 60 calendar days
after the date on which the child is removed from the home.” This definition determines the
date used in calculating all time period requirements for periodic reviews. (45 CFR Part

1355.20).


11 The Jan. 25, 2000 final rule issued by HHS gave states a transition period to fulfill the
judicial determination requirement related to permanency planning. The effective date of
the permanency plan provision was delayed a year to Mar. 25, 2001.
12 The final rule does allow states to make certain exceptions to their licensing rules for
relatives, but only if they are not safety-related (e.g., required number of bathrooms), and
only if the exception is made on a case-by-case basis.
13 ACF, Title IV-E Foster Care Eligibility Review Guide, p. 20.
14 Section 471(a)(10) of the Social Security Act.
15 Certain ineligible placement settings are specified in law. These include, “detention
facilities, forestry camps, training schools, or any other facility operated primarily for the
detention of children who are determined to be delinquent.” (Section 472(c)(2) of the Social
Security Act).

background checks for providers. While federal law permits states to opt out of
criminal records background checks, federal regulations provide that the state must
nonetheless keep documentation that safety considerations have been made.16
AFDC. Federal reimbursement for eligible costs incurred on behalf of a foster
care child may only be claimed if that child would have been eligible for Aid to
Families with Dependent Children (AFDC), but for their removal from the home.
In 1996, the Personal Responsibility and Work Opportunity Reconciliation Act
(PRWORA) replaced AFDC with Temporary Assistance for Needy Families
(TANF), but retained the link between Title IV-E eligibility and the AFDC program.
As a result, states must continue to determine a child’s Title IV-E eligibility based
on AFDC policies and procedures as defined in the state’s plan on July 16, 1996.
AFDC eligibility requires documentation that (1) the child was financially needy
according to the state’s standards as of July 16, 1996; (2) the child was deprived of
parental support or care at the time of removal due to death, continued absence from
the home, physical or mental incapacity of a parent or unemployment of a principal
wage-earning parent; (3) the child is under the age of 18, unless the state exercised
the school attendance option for students who are 18; and (4) the child was living
with a parent or specified relative prior to removal (i.e., parent, grandparent, sibling,
step-parent, step-sibling, uncle, aunt, first cousin, nephew or niece).
State. The court order removing the child from the home (or voluntary
placement agreement) must indicate that the state agency has responsibility for
placement and care of the child, or if another public agency (or Indian tribe) is
administering Title IV-E, a written agreement pertaining to responsibility for
placement and care is required.
Standards of Compliance and Disallowance
As displayed in Table 1, during initial primary reviews and primary reviews a
sample of 80 cases is assessed. A state is compliant in an initial primary review if
the number of cases found ineligible does not exceed eight. States found compliant
receive a subsequent primary review after three years. The state must reach a higher
standard of compliance during primary reviews; the case error rate threshold is
reduced to no more than four ineligible cases out of a sample of 80. During the
initial primary and primary reviews, federal funds are disallowed for all ineligible
cases found in the sample for the period of time the cases were in error.
Administrative costs claimed are also subject to disallowance.17


16 Section 471(a)(20) of the Social Security Act, and 45 CFR § 1356.30(e). For more
information on this issue, see CRS Report RL32430, Child Care and Child Welfare:
Background Checks, by Kendall Swenson.
17 An Oct. 2, 2002 Program Instruction issued by HHS (ACYF-CB-PI-02-08) delayed the
effective date of a policy that would have disallowed administrative costs for an otherwise
eligible child placed in an unlicenced family foster home until formal regulations are issued.
On Jan. 31, 2005, HHS published a Notice of Proposed Rulemaking, which seeks to
implement this policy. See 70Federal Register 4803 (Jan. 31, 2005).

If reviewers find that ineligible payments were made outside the six-month
period under review, those cases are classified as “non-error cases with ineligible
payments.” Federal funds are disallowed, but the cases do not count against the
state’s threshold for compliance. Reviewers in Florida’s Title IV-E initial primary
review noted, “An additional 14 cases were identified that contained ineligible
payments made outside of the period under review. Although these cases will not be
considered as ‘error cases’ for determining substantial compliance, the ineligible
maintenance payments and the associated administrative costs are nevertheless
subject to disallowance.”18
States that are not compliant during their initial primary or primary reviews
must develop a program improvement plan (PIP) and will receive a secondary review
once the plan is completed. In a secondary review a sample of 150 cases is taken.
For the state to be in compliance, not more than 10% (15) of cases can be in error and
the dollar amount of ineligible claims cannot exceed 10% of total claims in the
sample. If a state is not compliant, a tougher penalty structure is used to calculate the
total disallowance amount. HHS determines the percent of ineligible claims from the
sample and applies this percentage to all Title IV-E foster care claims made during
the six-month period under review. Thus, repeated non-compliance elicits more
severe disallowance penalties during secondary reviews since it is not restricted to
only ineligible cases found in the sample. If a state is faced with a disallowance, the
state must repay these funds.
Appeals Process for Review Findings. States may choose to pursue an
appeals process to contest ineligible cases and disallowance of federal funds resulting
from Title IV-E eligibility reviews.19 Of states found not compliant in either their
initial primary or primary reviews, at least six have filed appeals with the
Departmental Appeals Board (DAB). California and Indiana filed appeals that
resulted in the Administration for Children and Families (ACF) revising its original
decision regarding their compliance by lowering the number of ineligible cases below20
the threshold. Pending appeals also include disputes related to cases being
ineligible based on the requirements that states make reasonable efforts to finalize a
permanency plan within 12 months. South Carolina filed an appeal with the DAB
stating that, “... court orders did in fact contain some language in support of
reasonable efforts to prevent removal and finalize a permanency plan, albeit not the
‘magic words’ that ACF was looking for.”21 South Carolina has taken the position
that it should not be held accountable for omissions by the judiciary. Several states
have also filed a consolidated appeal contending that an administrative costs
disallowance for cases deemed ineligible during a primary review is not supported


18 U.S. Department of Health and Human Services, Administration for Children and
Families, Children’s Bureau, Florida Title IV-E Foster Care Eligibility Review for the
Review Period Apr. 1, 2003 to Sept. 30, 2003.
19 45 CFR § 1356.71(j)(4).
20 In California, an addendum to the final report (Nov. 3, 2003) reversed the error finding
for two sample cases based on documentation submitted after the review. In Indiana, the
initial primary review was amended to drop two of the cases originally cited as ineligible.
21 Docket Number A-04-133, Departmental Appeals Board.

by federal regulation. These and other pending appeals may prompt some
adjustments in the ACF review process depending on final rulings by the board.
Program Improvement Plans. States that are found not compliant during
their reviews must develop and implement a Program Improvement Plan (PIP) to
address areas identified as weaknesses. Once a review is completed, states are given
90 days to submit a PIP and are given one year to implement any needed corrective
action. A secondary review is then conducted to re-evaluate state compliance with
Title IV-E regulations. The secondary review process is the same as the initial
primary and primary reviews, only the sample size is larger and the penalty structure
differs. PIPs are developed with technical assistance from the ACF regional office
in order to correct problems in areas of non-compliance. Plans must include specific
goals and action steps required to correct identified areas needing improvement, and
include a description of how progress on the PIP will be evaluated by the state. PIPs
are intended to facilitate compliance through collaboration and technical assistance
provided by ACF regional and federal staff.
PIP goals and activities have included certification of new foster homes,
improving record keeping, implementing a tracking system for provider license
renewals, increased monitoring of court orders, and hiring and training of specialized
Title IV-E eligibility staff. Some plans included state legislative changes that are
required to facilitate compliance with Title IV-E provisions. For example, in the
final report for Louisiana’s primary review it was suggested that the state seek
statutory changes to clarify what constitutes full licensure under state statute, since22
provisional licenses are no longer allowed.
Analysis of Title IV-E Eligibility Reviews
This discussion is limited to those states that received reviews covering a period
beginning after the effective date of all the provisions included in the January 25,
2000 final rule. The effective date of the final rule’s requirement that all providers
be fully licensed was September 28, 2000, and the effective date that states make
reasonable efforts to finalize a permanency plan was March 25, 2001.23 Forty-three
states received Title IV-E eligibility reviews covering a six-month period after March

25, 2001 and have been assessed for compliance with the same basic requirements24


under the new rule. Table 3 provides an overview of the errors that states received
on initial primary or primary reviews across judicial, provider, AFDC and state-


22 U.S. Department of Health and Human Services to State of Louisiana Department of
Social Services, letter from Dec. 2, 2004.
23 Twenty-two states received initial primary reviews with a period under review that
occurred prior to Mar. 25, 2001. These state reviews were not included in the analysis
because they were not being assessed for the same basic requirements as those states with
a period under review after Mar. 25, 2001, namely the permanency planning provision.
24 Puerto Rico and the District of Columbia received Title IV-E Foster Care Eligibility
Reviews after Mar. 25, 2001, but were not included in the analysis. The District of
Columbia review encountered extensive data reporting problems in AFCARS. Puerto Rico’s
review was compromised by difficulties related to Title IV-E payment and claiming
information.

Figure 2. Review Errors Related to Judicial Requirements
related requirements. The categories “initial primary” and “primary” reviews are
mutually exclusive, meaning no state is represented in both columns. (Appendix A
provides information on review dates and outcomes individually by state.)
This analysis simply looks at the frequency of errors that occurred across Title
IV-E requirements. Of the 43 states included, 28 received initial primary reviews and25
15 received primary reviews. The most common reason for cases to be in error was
related to the judicial determination that states make reasonable efforts to finalize a
permanency plan (40% of all errors), followed by errors related to provider licensing
(14% of all errors), and criminal records background checks (10% of all errors).
Permanency plan errors dominated in both initial primary and primary reviews.
Provider licensing problems also resulted in a substantial number of cases being
found ineligible in both reviews, 12% and 16% respectively. Errors related to AFDC
eligibility requirements were generally below 5% in both types of reviews, with the
exception being AFDC income eligibility requirements in initial primary reviews,
which made up 9% of all errors in those reviews.


25 All of the fifteen states that received primary reviews, received initial primary reviews that
were not included in the analysis because the period under review was before Mar. 25, 2001.

Table 3. Overview of Errors Across All 43 States
Initial primaryPrimaryTotal errors
TypeDescription(28 states)(15 states)(43 states)
JudicialContrary to the welfare9%4%8%
Reasonable efforts to prevent8%10%9%
remo val
Reasonable efforts to finalize33%55%40%
permanency plan
Voluntary placement5%2%4%
agreement
P r ovider Licensing 12% 16% 14%
Criminal background check12%5%10%
AFDC Income 9% 2% 7%
Specified relative1%2%2%
Ag e 1 % 2 % 2 %
Dep r ivatio n 4 % 1 % 3 %
Unsp ecified 2% 1% 2%
StateResponsibility for placement2%01%
and care vested with state
Source: Table prepared by CRS based on analysis of state Title IV-E Foster Care Eligibility Review
final reports.
Note: Bolded percentages highlight most dominant errors in reviews. Percentages may not sum to
100 due to rounding.
Source: Table prepared by CRS based on analysis of state Title IV-E Foster Care Eligibility Review
final reports.
Note: Percentages may not sum to 100 due to rounding.
Initial Primary and Primary Reviews. Nine of the 28 states that received
initial primary reviews were found not compliant, which means the number of
ineligible cases exceeded eight; seven of the 15 states that received primary reviews
were found not compliant, which means the number of ineligible cases exceeded the
primary review threshold of four. While only 15 states have received primary
reviews under the new rule, 47% have been found not compliant. This is a higher
percentage of non-compliance than found in initial primary reviews, where 32% of
states were found not compliant. The lower error rate threshold (four instead of
eight) is the most obvious reason for this trend but the persistence of errors related
to permanency plan judicial determinations in both reviews also appears to be a
factor. It is in this area that states have had to make the most adjustment in
responding to the requirements in ASFA and the final rule, particularly in bringing
their court systems up to speed and ensuring that staff are monitoring cases for
compliance. The following gives a brief account of errors associated with each
category.



Judicial. Across the 43 states reviewed, errors associated with judicial
determinations were primarily a result of incorrect (or lack of) language used within
a court order, and/or the orders were not made within the required time frame.
Contrary to the welfare errors resulted from lack of appropriate language, and the
finding not being included in the first court order after the child’s removal.
Reasonable efforts to prevent removal errors were largely because the state did not
obtain the court order within the required 60-day limit. Nearly every state
experienced errors because permanency plan determinations were not timely, which
means they did not obtain these orders within the required 12-month time frame.
Provider. Errors associated with licensing and criminal records background
checks were most often due to lack of appropriate documentation in provider files.
Some states continued the use of provisional licenses beyond the effective date
(September 28, 2000) of the provision in the final rule prohibiting them, and others
had ineligible cases due to invalid or expired licenses of providers. Lack of timely
renewal of provider licenses created lapses in eligibility for otherwise federally
eligible IV-E foster care children.
Figure 3. Review Errors Related to Provider Requirements
Source: Figure prepared by CRS based on analysis of state Title IV-E Foster Care Eligibility Review
final reports.
Note: Percentages may not sum to 100 due to rounding.
AFDC. Throughout the reviews, AFDC eligibility errors were often the result
of a lack of sufficient documentation in a child’s case file to validate the child was
financially needy, removed from a specified relative and/or deprived of parental
support. This was especially an issue for re-determinations of AFDC eligibility,
where many files lacked a case narrative or history to support continued eligibility
under these requirements. AFDC “unspecified” includes errors that were identified
only as “AFDC-related” in final reports.



Figure 4. Review Errors Related to AFDC Eligibility
Source: Figure prepared by CRS based on analysis of state Title IV-E Foster Care Eligibility Review
final reports.
Note: Percentages may not sum to 100 due to rounding.
State. Less than 1% of errors during reviews were a result of this requirement.
Errors were mostly due to the court order or voluntary placement agreement not
explicitly indicating that the state agency has responsibility for the child’s placement
and care, or the court order that extended the child’s placement in foster care was not
timely or could not be located at all.
Secondary Reviews. Of the 16 states that were not in compliance on their
initial primary and primary reviews after the March 25, 2001 effective date for the
permanency planning provision, none have had secondary reviews that are available.
Yet, four states that received and failed an initial primary review before the March
25, 2001 effective date have had their follow-up secondary reviews with final reports
available.26 These states, Iowa, Kansas, Maine, and New Jersey, were not assessed
for compliance with the permanency plan provision on their initial primary review,
but were assessed for compliance with this requirement during their secondary
reviews.


26 These four states were part of the twenty-two state reviews not included in this analysis
because the period covered by the review occurred prior to Mar. 25, 2001.

As discussed earlier, secondary reviews are required of states that are found not
compliant in their original reviews. Secondary reviews are conducted after
implementation of a Program Improvement Plan (PIP), which is intended to outline
goals and activities to address areas of weaknesses in determining Title IV-E
eligibility. Iowa, Kansas and Maine were found compliant on their secondary
reviews, meaning out of the 150 case sample, the number of ineligible cases did not
exceed 15. New Jersey was found not compliant during the secondary review. Since
only four states have undergone secondary reviews, it is difficult to assess the
effectiveness of PIPs and technical assistance at improving state compliance with
Title IV-E requirements. Yet, these examples do provide some insight into specific
problem areas that states are addressing to come into compliance with requirements.
Kansas was originally found not compliant in their initial primary review for 21
ineligible cases.27 Thirteen errors were attributed to judicial determinations (contrary
to the welfare and reasonable efforts to prevent removal), 10 errors were a result of
incorrect AFDC eligibility determinations, and reviewers found eight provider
licensing errors. The state implemented a PIP that focused on activities to better train
staff on Title IV-E requirements, especially related to AFDC provisions. In the
state’s secondary review, only two ineligible cases were found due to two errors
related to AFDC eligibility determination and one error in provider licensing. The
final report noted that the state has been able to successfully implement many of the
practices described in the PIP.
In Iowa, 22 cases were found ineligible during the initial primary review. The
majority of errors, 15, resulted from incorrect AFDC eligibility determinations.
Reviewers found that the eligibility form was difficult to follow and did not clearly
identify a child’s eligibility based on income resources, removal from the home of
a specified relative, and deprivation of parental support. The state also received 12
errors due to judicial-related problems (on contrary to the welfare and reasonable
efforts to prevent removal determinations), and three errors for provider licensing
issues. In Iowa’s secondary review, seven cases were determined to be ineligible and
the state was found to be compliant. Problems with judicial determination provisions
resulted in five errors and two errors were cited for licensing documentation not
being found in the file. The review found no errors due to AFDC eligibility
determinations.
In Maine, the initial primary review found 24 ineligible cases, with 22 errors
associated with provider licensing requirements, three judicial determination errors
and six errors related to AFDC. The majority of these errors were due to the lack of
timely fire inspections in foster care facilities. The state addressed this issue by
working to improve communication with the Fire Marshall’s office, implementing
a tool to track licensing tasks, and by increasing the term of a foster home license
from one to two years. In the state’s follow-up secondary review all cases reviewed
had fire inspections up to date, although the reviewers found three other licensing
errors, four errors because financial need or deprivation for AFDC eligibility was not
established, and six errors related to judicial determinations.


27 The number of ineligible cases does not always match the total number of errors, since a
case could be deemed ineligible based on multiple errors.

New Jersey was found not compliant in its initial primary and secondary
reviews. In the initial primary review, the predominant reasons for error were invalid
or expired licenses of providers (33 errors) and problems with timely judicial
determinations (17 errors). The initial primary review report noted that the state
relied on the issuance of temporary licenses which resulted in lapses in eligibility,
and that the content and language of court orders was not sufficient. The state
developed a PIP that included certification of 3,000 new foster homes, hiring Title
IV-E specialists, and improving provider certification record keeping and tracking
systems. In the secondary review, the state had problems meeting judicial
requirements (48 errors), specifically with the provision that agencies make and
finalize a permanency plan within 12 months of the child’s removal from the home,
which made up 22 of the 48 judicial-related errors. The state also had 30 provider
licensing errors and 19 AFDC eligibility determination errors.
Strengths and Weaknesses Found Among States. Final reports for
each of the states reviewed included a section that identified strengths and
weaknesses of state agency practice related to Title IV-E eligibility determinations.
Though these recommendations varied widely across states, depending on the
severity of compliance problems, there were several points repeated by reviewers that
highlight some trends. Many of the recommendations for improvement centered
around appropriate paperwork and documentation in case files that substantiate
timely judicial determinations, current provider licensing, and AFDC eligibility
requirements.
Strengths. Organization of case files, preparation for reviews and attention to
detail when managing cases was a strength for many states. Examples of these
practices are efficient tracking of children and use of case narratives that contain
documentation of specific services provided to families to prevent removal of the
child from the home. Also, the use of a standard filing format, separation of foster
care eligibility files from the children and family files, and collaborative teamwork
preparing for reviews were noted as best practices. In the area of provider licensing
and safety, strengths were found in clear documentation of criminal records
background checks and certification of foster family homes/facilities, developing a
licensing checklist for files, and use of a software system to manage licensing
renewals. Other examples of strengths included a well-documented Title IV-E
eligibility process, and clear eligibility determination forms that show income
eligibility and whether deprivation of parental support exists. Reviewers noted that
the design of Title IV-E eligibility forms was helpful to the review and that well-
designed forms were important for facilitating compliance.
Staff and management was also an area of strength for some states. One of the
most often noted strengths was that the agency had a centralized staff whose
exclusive function was the determination of Title IV-E eligibility. Reviewers found
that a direct result of this specialization was more accurate and timely decisions
regarding eligibility and re-determination of eligibility. Collaboration with the courts
was an important component in the Title IV-E eligibility process and reviewers
highlighted strengths in this area. Training initiatives with judicial personnel,
completion of a judge’s handbook, development of court incentives to hear cases
timely, and hiring a Court Improvement Project Coordinator were strengths noted in
reviews. Reviewers emphasized best practices in states where court orders were



child specific and well written, the court system was responsive to foster care cases,
and court orders were descriptive of case specific circumstances. Additionally, some
states established practices that assessed for judicial determinations more frequently
than required by statute. For example, Arizona completes voluntary placement
determinations in 90 days as opposed to 180 days and California assesses
permanency plan efforts every six months instead of 12.
Weaknesses. Some of the strengths and weaknesses identified mirror each
other, but they also reveal points of emphasis by reviewers. In the area of judicial
determinations, lack of child specific court orders was often cited as an area in need
of improvement, especially when states used a form or check off type of order as
evidence of judicial determinations. Reviewers recommended discontinuing the use
of boiler plate court orders that do not reflect court decisions made for each child or
adequate language related to judicial requirements. Other examples are inappropriate
use of long-term care as a permanency goal, and surpassing the 180-day limit for
voluntary placements. Across states, obtaining timely determinations for permanency
plans was a frequent problem. Reviewers recommended implementing a “tickler”
system to notify staff of the due date for the required court orders.
In states with licensing errors, reviewers recommended the licensing bureau
develop training for staff on ACF Title IV-E review processes. It was problematic
during reviews if the licensing staff were not available or did not participate in
reviews to make clarifications or answer questions. Weaknesses also included the
use of provisional licenses, and lack of a tracking process and organized record
keeping to establish the licensing history of providers. AFDC eligibility was an area
of weakness for a few states, especially for re-determination of Title IV-E case
eligibility. Reviewers often found that AFDC linkages did not clearly identify the
month that the eligibility determination was made, lacked documentation of financial
resources, and had no process in place for communicating to staff changes in family
circumstances. Further training of staff on AFDC requirements and centralization
of eligibility determinations within the agency were recommendations given by
reviewers. In some states, there was substantial variation among particular counties
in the completeness of case histories. Reviewers emphasized better communication
to make standards for handling federally eligible foster care cases uniform throughout
the state.



CRS-18
Appendix A
A1. Review Dates and Outcomes Individually by Statea
Date ofPeriod underSampleIneligibleTotalStateJudicialProviderAFDC
StatereviewCompliance statusreviewsizecaseserrorserrorserrorserrorserrors
abama
mary)07/14/03Not Compliant04/01/02-09/30/0280232602141
a s k a
itial Primary)09/15/03Substantial Compliance10/01/02 - 03/31/0380110010
iki/CRS-RL32836kansasitial Primary)06/23/03Not Compliant04/01/02 - 09/30/028010100091
g/w
s.ororniaSubstantial Compliance
leakitial Primary)06/02/03( Amended)04/01/02 - 09/30/02808100451
://wikilo r a d o
httpitial Primary)04/21/03Substantial Compliance04/01/02 - 09/30/0280350212
nne c t i c ut
itial Primary)03/24/03Substantial Compliance04/01/02 - 09/30/0280770610
are
itial Primary)07/21/03Substantial Compliance10/01/02 - 03/31/0380770421
r id a
itial Primary)02/23/04Substantial Compliance04/01/03 - 09/30/0380450122
r gia
itial Primary)08/04/03Substantial Compliance10/01/02 - 03/31/0380220200
o
mary)06/07/04Substantial Compliance04/01/03 - 09/30/0380440121



CRS-19
Date ofPeriod underSampleIneligibleTotalStateJudicialProviderAFDC
StatereviewCompliance statusreviewsizecaseserrorserrorserrorserrorserrors
o is
mary)08/16/04Substantial Compliance10/01/03 - 03/31/0480440310
dianaSubstantial Compliance
itial Primary)03/17/03(Amended)04/01/02 - 09/30/02809130346
nt uc ky
mary)11/01/04Substantial Compliance10/01/03 - 03/31/0480220101
ui s i a n a
mary)07/30/04Not Compliant10/01/03 - 03/31/0480550050
iki/CRS-RL32836land
g/witial Primary)07/29/02Not Compliant04/01/01 - 09/30/0180384403941
s.or
leakassachusettsitial Primary)11/03/03Not Compliant10/01/02 - 03/31/0380990711
://wikiigan
httpitial Primary)03/22/04Not Compliant04/01/03 - 09/30/038012141832
i nne so t a
itial Primary)04/26/04Substantial Compliance04/01/03 - 09/30/0380230102
i ssissip p i
itial Primary)02/10/03Not Compliant04/01/02 - 09/30/028013130634
tana
mary)06/16/03Not Compliant04/01/02 - 09/30/0280223303111
r aska
itial Primary)09/15/03Substantial Compliance10/01/02 - 03/31/0380660330
a d a
itial Primary)04/22/02Substantial Compliance04/01/01 - 09/30/0180340202



CRS-20
Date ofPeriod underSampleIneligibleTotalStateJudicialProviderAFDC
StatereviewCompliance statusreviewsizecaseserrorserrorserrorserrorserrors
Hampshire
mary)12/01/03Substantial Compliance10/01/02 - 03/31/0380440031
Mexico
itial Primary)07/14/03Substantial Compliance04/01/02 - 09/30/0280670133
York
itial Primary)04/28/03Not Compliant04/01/02 - 09/30/0280316244909
rth Carolina
itial Primary)08/26/02Substantial Compliance10/01/01 - 03/31/0280000000
iki/CRS-RL32836rth Dakota
g/witial Primary)04/14/02Substantial Compliance04/01/01 - 09/30/0180440400
s.or
leakiomary)09/27/04Substantial Compliance10/01/03 - 03/31/0480110010
://wikilaho ma
httpitial Primary)09/22/03Substantial Compliance10/01/02 - 03/31/0380000000
o n
itial Primary)08/26/02Substantial Compliance10/01/01 - 03/31/0280670250
ode Island
mary)07/26/04Substantial Compliance10/01/03 - 03/31/0480120020
uth Carolina
mary)04/19/04Not Compliant04/01/03 - 09/30/0380212302201
uth Dakota
itial Primary)05/13/03Substantial Compliance04/01/02 - 09/30/0280550401
nne sse e
itial Primary)12/01/03Not Compliant10/01/02 - 03/31/0380263708290



CRS-21
Date ofPeriod underSampleIneligibleTotalStateJudicialProviderAFDC
StatereviewCompliance statusreviewsizecaseserrorserrorserrorserrorserrors
xas
mary)08/18/03Substantial Compliance10/01/02 - 03/31/0380000000
itial Primary)09/16/02Substantial Compliance10/01/01 - 03/31/0280330030
o nt
itial Primary)09/16/02Not Compliant10/01/01 - 03/31/02802635012221
ginia
mary)08/23/04Not Compliant10/01/03 - 03/31/048014150555
iki/CRS-RL32836a shi ngt o n
g/wmary)09/20/04Substantial Compliance10/01/03 - 03/31/0480110010
s.or
leakest Virginiamary)09/08/03Not Compliant10/01/02 - 03/31/0380252902162
://wikii sc o nsin
httpitial Primary)03/04/02Not Compliant04/01/01 - 09/30/0180232521931
oming
mary)06/21/04Not Compliant04/01/03 - 09/30/0380151501230
Prepared by CRS based on analysis of state Title IV-E Foster Care Eligibility Review final reports.
cludes only those 43 state reviews with a six month period under review after Mar. 25, 2001, the date that all aspects of the final rule were effective.