Renee Viray stayed calm when her 9-year-old foster son threw his bowl of spaghetti from the dinner table.
She didn’t raise her voice or scold the boy. She simply took him aside after the meal and asked: What was that all about?
“He felt like he didn’t get as much as the others, and he had grown up not having enough to eat,” Viray said. “That’s the anger and emotions that come to surface when these children have experienced so much.”
Viray, 64, credited her demeanor to the continuous training she’s received from her foster care agency, Specialized Alternatives for Families and Youth of Nevada. The agency is one of a handful in Clark County that provide specialized foster care, a program that assists foster parents with caring for children with serious physical, mental or emotional issues that are often the result of trauma.
But anticipated restrictions to Nevada Medicaid funding coming this year have leaders at SAFY and those other agencies fearing that they may have to close.
Agency executives said closing their doors will result in children relocating from their foster homes into psychiatric hospitals or the county’s emergency shelter. Some children, native Nevadans, could be moved into residential treatment centers outside the state and hundreds of miles away from the biological families they are hoped to reunite with some day.
Without SAFY, “I don’t think I probably would have been a foster parent,” Viray said. “I could not help these children based on how I grew up, based on how my neighbors grew up.”
These agencies provide families weekly in-home visits from case managers, mental-health services and 24/7 support. For the 300-some local children who receive specialized foster care it’s far greater than the services they would typically receive from the county’s Department of Family Services.
Under proposed changes from the state, the agencies could lose as much as half the funding they receive for some children in their care, SAFY Executive Director Valerie Hicks said.
“If you want quality, we can’t provide it for the dollars that they’re proposing,” Hicks said. “I’m not willing, and neither are we as an agency, to put at risk the needs of our children.”
Advocates of the funding change argue that it will divert dollars from a costly, ineffective blanket approach to treating children with severe behavioral and emotional problems.
Nevada’s Division of Child and Family Services administrator Kelly Wooldridge said that system will be replaced with one where agencies apply for specific Medicaid-funded services catered to individual foster children’s needs.
“Really the agency should be providing a package of services for the kids in specialized foster care,” she said. “We don’t want any homes or agencies to shut down, and we’ll assist them with getting the services they need so that doesn’t happen.”
Basic skills training
The Medicaid funding currently pays for basic skills training that helps traumatized children shed aggressive behaviors, conquer social anxieties and become better communicators, said David Doyle, director of operations at the Eagle Quest foster care agency.
“You might teach them the importance that amicable body language has in a conversation with their peers or adults,” Doyle said. “You practice with them. You role play with them. You model appropriate behavior in a structured environment, so the kid gets to practice safely in a foster home before being thrown out into a real world environment.”
Since at least 2010 foster care agencies in Clark County have received about $115 a day for each specialized child in their care. The money is a mix of funds from the county’s Department of Family Services ($43.50) and state Medicaid ($72.70).
Some of the money goes directly to foster families, but most is used to pay for foster care agencies’ operations, support services and foster parent training. It also keeps them staffed with social workers and therapists.
But the agencies will no longer be able to rely on the Medicaid payment because of two changes expected to take effect this year: The state plans to decrease the rate it pays agencies to provide basic skills training, and the funding will only be doled out as is authorized as medically necessary by Nevada’s Medicaid fiscal agent, Hewlett Packard Enterprise.
All that will be guaranteed is the county’s portion, which will increase to $62 per child each day starting July 1. County spokesman Dan Kulin said for the county’s Department of Family Services to increase its rate all the way to $115, it would need an additional $7 million in funding each year.
Doyle said the changes could spell disaster for Eagle Quest.
“We’d be at a (funding) rate lower than 20 years ago,” he said. “The truth is we would close our doors because we literally couldn’t operate because our expenses would exceed what we’re being reimbursed.”
Wooldridge said the proposed changes will improve the lives of specialized foster care children.
“We want to phase out the use of basic skills training and replace it with other, evidence-based services that are medically necessary and have been proven to show good outcomes,” she said.
The state is encouraging foster care agencies to apply for Medicaid funding for other services, including psychiatric rehabilitation, family counseling and crisis intervention. Wooldridge said the Division of Child and Family Services is making a service guide that will help agencies identify what treatment each foster child should receive and how the agency can be reimbursed for it.
“Honestly, I think they just don’t realize all of what they’re doing that’s billable to Medicaid,” Wooldridge said.
But Doyle and Hicks agree that they don’t expect to get anywhere near $115 per child each day under the new rules expected to be finalized this summer.
Sandy Arguello, a foster agency executive in Reno who experienced a similar change in Medicaid funding last July, expressed similar concerns.
Other Washoe County foster agencies “are definitely seeing a pattern of fewer or less approvals of (basic skills training) or (psychiatric rehabilitation), and we expect that will continue,” she said. “I don’t think the (Clark County) providers are going to come anywhere near where they can stay in business.”
If the specialized foster care agencies of Clark County do shutter, it is unclear who will pick up the pieces.
Kulin said the county is prepared to work with foster agencies “to find alternative placements for any affected children if necessary.”
The county’s Department of Family Services also is implementing its own advanced foster care program, Assistant County Manager Jeff Wells said. In that program, the county’s child welfare employees would provide clinical and case management services to children formerly in specialized foster care.
But that program has limits.
“Could I, out of just our existing beds in advanced foster care, take all 350 of the (specialized foster care) kids? Not a chance,” Wells said.
Contact Michael Scott Davidson at firstname.lastname@example.org or 702-477-3861. Follow @davidsonlvrj on Twitter.
Other Nevada counties’ funding
Starting July 1, Clark County will give local specialized foster care agencies $62 a day per child under their umbrella of care. That’s in addition to another $72.70 a day per child provided by Nevada Medicaid.
But once the Medicaid portion of funding is no longer ensured, which is expected to happen later this year, the state’s other counties will be guaranteed much more funding.
The state’s Division of Child and Family Services will provide specialized foster care agencies in Nevada’s 15 rural counties a flat funding rate of $125 a day per child beginning July 1.
Washoe County has given its specialized foster care agencies $115 a day per child since last July.
That money comes entirely from the county’s Department of Social Services, which in turn has more oversight over the agencies. Billing for Medicaid services, other than basic skills training, is also allowed.
“We wanted to create a rate that the providers were used to, but we wanted to increase the accountability and training requirements and reporting through a contract,” said Amber Howell, director of the county’s Department of Social Services.
Howell said under the new program children in specialized foster care are switching homes less often. School attendance is up, while hospitalizations are down.
“We’ve seen great outcomes,” she said.