In 1996, the Florida legislature adopted the privatization strategy for the state child welfare system by calling for pilot “Community Based Care (CBC)” projects that would implement the lead agency model on a county-by-county basis. In 1999, the legislature expanded the CBC requirement statewide; the original target date for privatizing all 67 counties was Jan. 2003, but the public agency has requested a two-year extension on that target date and it is likely to be granted. Across the state, 14 counties are in some stage of privatization, representing about 50 percent of the active child welfare cases in the state. Initially Florida planned to operate the initiative under a title IV-E waiver, which was granted by the federal government, but the state decided not to use the waiver, due at least in part to the stringent research requirements.
Under CBC, state child welfare workers still take initial calls of alleged maltreatment and conduct investigations, but one private agency is selected for each county to take over the primary responsibility for foster care, adoption, and family support. The agency can either provide services directly or subcontract with service providers.
Unlike any other child welfare privatization initiative in the United States, Florida’s CBC initiative is funded through “global budget transfers” (like block grants) to lead agencies. Other privatization initiatives use capitated or case rates. Florida’s initiative thus potentially transfers a large amount of risk (based on intensity, duration, and volume) to contractors. A statewide risk pool can be tapped in cases of excess referrals or catastrophic service costs. The initiative is supported through IV-B, IV-E, Medicaid, TANF, social services block grant, CAPTA, adoption incentive grants, and state funds.
The first pilot project implemented was the Coalition for Children and Families in Sarasota County, which began serving clients in January 1997. The lead agency is the Sarasota YMCA. All children in the county who are determined by state child welfare workers to be abused or neglected and in need of services, whether in-home or out-of-home, are referred to the Coalition, which then provides for all case management and services. A multidisciplinary team develops the case plans and participates in monitoring and decisionmaking. The Coalition has an active caseload of 1,600-1,700 children. Lead agencies are allowed, under state law, to receive “excess earnings” of federal reimbursements as bonuses, and the Coalition has been successful in doing that. The money has been used for maintenance adoption subsidies and out-of-home care for IV-E-eligible children.