State Innovations in Child Welfare Financing. Structural Models


The structural models of the various initiatives varied substantially regarding how many functions were retained by the public agency versus contracted out. In all the initiatives reviewed, the initial intake and child protective services (CPS) investigations were retained by the public child welfare agency. Beyond those initial functions, however, management and service delivery structures could be categorized into lead agency models, managed care organization models, public agency models, and administrative service organization models (see McCullough and Schmitt, 1999; and U.S. General Accounting Office, 2000). Most (15) of the initiatives followed the lead agency model, with three (Colorado, Illinois, and New York) following a public agency model and two (Georgia and Wisconsin) using a managed care organization model. Massachusetts utilized a mixed (managed care organization and lead agency) model, as did Missouri (managed care organization and administrative services organization) and Ohio (lead agency and public agency).

Flexibility for Kentucky’s Lead Agency

The Quality Care Initiative (QCI) in Kentucky has endeavored to give the lead agency greater flexibility in serving children. QCI covers one county and serves three populations: adolescent girls in need of out-of-home care, children transitioning from out-of-home placement back into their homes, and children just entering the child welfare system. What is distinctive about QCI is that the lead agency has more responsibility for serving these children and more flexibility in how it serves them. But the state has not dropped out of the process altogether; it remains a partner in thinking through major difficulties. These discussions have the tone of constructive problem-solving rather than the state issuing directives. If this pilot can demonstrate that it results in improved outcomes for these populations of troubled children while keeping costs down, it is expected to gradually expand over the next few years.

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