State Innovations in Child Welfare Financing. Maryland: Baltimore Child Welfare Managed Care Project


The Baltimore Child Welfare Managed Care Project, Maryland’s title IV-E waiver demonstration, began serving clients in January 2000. It targets children age 0 to 5 in out-of-home care and their siblings and families. It is testing cost neutrality – i.e., can the contractor obtain better outcomes without costing more money.

The Baltimore child welfare agency refers cases that fit the criteria to the evaluator, who randomly assigns them to the initiative or to regular services. Upon referral, the contractor takes over all functions: case management, assessment, foster care payments, service plan, service delivery, wraparound care. The contractor is receiving $24 million to serve 500 children over three years. There is a stop-loss provision: if the cost for a child exceeds $3,500 per month, the state pays 90 percent of the costs over $3,500 and the contractor pays 10 percent.

The initiative’s evaluation will include a process evaluation, a cost-benefit study, and a cost-neutrality study. The contractor has agreed to improve benchmarks on length-of-stay, time to permanency, and re-entries. Early results indicated reduced length-of-stay and re-entry rate and increased adoption rate for children in the initiative.

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