Gains Seen on Child Welfare Reform

Nebraska State CapitolLast month, the Nebraska Legislature’s Health and Human Services Committee released its Legislative Resolution 37 report and 18 recommendations that we believe chart a positive new path forward for child welfare reform.

In response to the report, a Dec. 18 World-Herald editorial, “State must get this right,” rightly noted that needed fixes to the state’s child welfare system should include a close look, thoughtful discussion and consensus-building. It is that kind of approach that the HHS committee recommended, including the formation of a Children’s Commission with broad membership to create a strategic plan, and continued review of the reform, with annual reports and sharing of data.

This type of collaborative and evaluative approach has been sorely lacking and a fundamental flaw of the reform effort undertaken by the Nebraska Department of Health and Human Services since the beginning. As recognized by the legislative committee, all branches of government, a wide range of stakeholders, and affected youth and families must be at the table in order for real reform to be achieved.

While careful planning and the development of a clear plan are critical, the state should move forward on central recommendations, including the return of case management responsibilities to the state. Case management is a core government responsibility, and fundamental duties should not be delegated away for children in the state’s care and custody.

Returning case management to the state — while enforcing new caseload standards and adopting best practices in case management, as recommended by the legislative committee — would be a step forward and address major shortcomings of the “old system.”

While disruption in the system is always a concern, key decisions that affect the well-being of children and the rights of families (when they must be involved the system) should be made by the state, rather than private contractors. Therefore, we applaud the legislative committee’s recommendations toward accountable public management of a system for which the state has legal responsibility and for which we all have moral responsibility.

The Legislature also should move forward quickly to reverse restrictive Medicaid policies that (1) result in children being denied necessary services recommended by their treating providers and (2) drive children into the child welfare system in many cases — not due to abuse or neglect but in order to access needed mental health services.

This issue was at the heart of what the state witnessed with the safe-haven law in which parents and caregivers were, and still are, in the unspeakable position of having to relinquish custody of their children in order for them to receive behavioral health treatment.

While some important progress has been made on the safe-haven issue in the establishment of programs, such as the hotline, family navigator and post-adoption/guardianship case management services through Legislative Bill 603, the underlying problem exposed by the safe-haven law is anything but solved.

In many ways, this problem has actually gotten worse as a result of policy choices made by Nebraska’s Medicaid Division to exclude certain children — such as those with specific diagnoses including developmental disabilities and young children in need of particular behavioral therapies — from receiving critical preventive services and treatment. We continue to receive calls from families in these gaps and from families reluctantly contemplating relinquishment.

In addition to the harmful impact on children and families, the state’s policies have the result of unwisely shifting costs from Medicaid to the state child welfare system and private agencies in a way that is undermining the reform effort and that fails to maximize available federal funding for this purpose.

This fundamental issue must be addressed. Therefore, we support the legislative committee’s recommendation to continue to build on the work done by the LB 603 committee, as well as to give specific attention to the cost-shifting from Medicaid to the child welfare system and to ensure a continuum of appropriate residential and community-based services.

Specifically, we urge the Legislature to prohibit restrictive Medicaid policies that have created an ongoing crisis in children’s behavioral health in our state and to prioritize programs to support families and prevent removal from the home.

After witnessing a series of crises, an eroding service infrastructure, a substantial increase in child welfare spending with few or no improvements in outcomes and too many children and families struggling in a dysfunctional system, we now have an opportunity as a state to create a system that truly meets the needs of children and families.

We have a moment to improve the child welfare system, and we can’t afford to let the moment pass.

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