Since 2017, Clark County has nearly tripled the daily rate it pays foster care agencies and parents to provide therapeutic care for children with severe mental, physical and emotional disabilities.
The rate increase — from $43.50 to $115 per child each day — is to offset changes to Nevada’s Medicaid program that have diminished a funding stream for children in the specialized foster care program.
With about 350 children enrolled in specialized foster care through the county’s Department of Family Services, the increased rate could cost the county an additional $9 million every year.
Family Services increased its daily rate in July 2017 and again in March. The latest action came after state administrators this year decreased the funding available to foster care agencies through one popular Medicaid-billable service, while they also continued to struggle to establish new avenues of funding through other Medicaid services.
“We basically increased our rate to fill the funding gap on the state’s side,” Assistant County Manager Kevin Schiller said. “It’s a complete cost shift to the county.”
Leaders of local foster agencies praised the county for providing the funds, which they say are critical to keeping their doors open and preventing children from being displaced.
“Without them these kids would be in the hospital, acute centers or Child Haven (emergency shelter),” said Dave Doyle, operations director of the Eagle Quest foster care agency.
State funding shrinks
Nevada Medicaid implemented its funding changes to improve specialized foster care, said Cody Phinney, deputy administrator of the state’s Division of Health Care Financing and Policy.
Phinney said the state hopes foster agencies will stop over-relying on a Medicaid-billable service called basic skills training and diversify the services they provide to children in their care.
While basic skills training provided foster agencies with steady funding — as much as $72.70 per child each day — state officials worried it was being used as a one-size-fits-all approach to caring for children with a wide range of disabilities.
“Fundamentally, Medicaid is trying to encourage providers to have individualized plans for each recipient we cover,” Phinney said.
In July, Nevada Medicaid introduced new rules forcing foster agencies to gradually decrease the basic skills training hours they billed. In January, Medicaid also decreased the rate it paid for basic skills training.
State officials have long promised the lost funding would be offset by allowing agencies to bill for other Medicaid services better suited for the children in their care.
A plan was supposed to be put into effect by January, but it remains on the drawing board.
The state is set to reveal details about its plan to the public for feedback later this month. Nevada will request the federal government amend the Medicaid state plan, Nevada Division of Child and Family Services administrator Ross Armstrong said.
“We’re committed to finding a way to ensure there’s a way to bill for medically necessary and appropriate services for youth in their care,” Armstrong said.
‘Never feel relaxed’
The state has also stopped contracting with independent medical providers to perform behavioral health assessments for children enrolled in the county’s specialized foster care program.
The practice, launched in July, was intended to ensure previous assessments provided by foster agencies were accurate, but it also a created a backlog of children who needed assessments before they were eligible for Medicaid-billable services.
That caused another temporary funding gap, which the county also covered, until foster agencies were returned the responsibility of conducting the assessments.
While the county has repeatedly stepped in to cover funding gaps, one foster care executive said she remains worried about what changes the state could impose next.
“I can never feel relaxed, because there’s always another shoe about to drop,” said Valerie Hicks, executive director of Specialized Alternatives for Families and Youth of Nevada. “You’re never confident the thinking through of the processes are complete.”