There’s a looming crisis in our state’s support system for our most challenged at-risk youth. It may only impact a small portion of Colorado’s children and teens, but if not addressed, it could create significant gaps in care for youth who depend on behavioral health and substance-abuse services.
At issue is implementation of the federal Family First Prevention Services Act (FFPSA). Commonly referred to as Family First, this 2018 federal law seeks to limit federal reimbursement for residential-treatment facilities and to classify them as Qualified Residential Treatment Programs (QRTPs). QRTPs must support the needs of children in foster care who cannot be safely placed in a family foster home.
The Centers for Medicare and Medicaid Services, the regulating federal body for Medicaid, has since labeled QRTPs as Institutions for Mental Diseases (IMD). This designation is intended to prevent the “warehousing” of patients in favor of in-home care and limits facilities to only 16 beds as part of receiving Medicaid support for patients.
So why do these wonky federal designations like IMD and QRTP matter to Colorado’s foster youth?
Colorado has an established system of Residential Child Care Facilities (RCCFs) where licensed and trained professionals provide behavioral health services and substance-abuse treatment for hundreds of children and teens each year. These facilities are placed around the state to provide high level care and support a continuum of care in Colorado’s foster system. Many RCCFs have more than 16 beds, which is necessary to provide economies of scale within the reimbursement rates the state provides, and to meet state and federal licensing requirements.
Compounding this situation, Colorado’s foster system is severely under capacity. According to a 2019 Colorado Department of Human Services report, our state is at least 900 foster homes short of its current need — and that’s before the potential consequences of limiting RCCFs to 16 beds. Clearly, if the state of Colorado continues its current interpretation of Family First, hundreds of children and teens who need highly specialized treatment would be left without appropriate options, leading to more failed foster placements, juvenile detention and homelessness.
The intention of Family First, and the state’s current policy direction, of transitioning from residential care to more family-like, in-home settings is commendable. However, many of Colorado’s foster youth have unique needs and significant trauma that often require intensive mental, substance and behavioral treatments to allow them to return to their homes, foster care or independent living. Providing these services in residential settings helps stabilize children and youth and allows them to step down from higher levels of care into community and home-based placements. This continuum of care allows these children to be better able to live and succeed in culturally appropriate, family-like settings.
While Colorado’s RCCFs are willing to transition to QRTPs, there needs to be a reasonable transition period to address reimbursement rates, relocation of facilities, adequate placements for youth transitioning from RCCF care, and revisiting the rules and licensing requirements currently in place. We believe that state officials are charting an overly aggressive transition for RCCFs that will leave children and teens with far fewer options. To make this continuum of care work, our state’s system needs to be able to provide the right level of and treatment, at the right time, and the current proposals from the state’s health departments simply do not do that.
The General Assembly’s Joint Budget Committee, the bipartisan committee that sets the state’s spending priorities, is considering a three-year plan to provide a more adequate timeframe to address these concerns while bringing the state into compliance with Family First. We fully support the JBC’s efforts and hope state regulators will work with legislators to address these concerns.
In addition, there is hope on the horizon at the federal level. Members of Congress know about this problem and have begun bipartisan discussions about fixing this unintended consequence. But time is critical.
Without a change at the federal level, and if the state of Colorado continues toward a 16-bed limit, policy changes could significantly limit placements for children and teens who need immediate help. And for some facilities, a 16-bed limit could lead to closures, leaving entire regions of our state without residential care options.
It is critical for so many Colorado children and teens that the unintended consequences of Family First are addressed. Congress needs to act quickly to resolve this issue. And the state of Colorado needs to closely watch federal legislation while adopting a reasonable transition period and plan for changes to Colorado’s residential-care system.
Without a proper system that provides different levels of care and different residential options, Colorado cannot successfully serve children and youth moving forward and this breakdown of our system will hurt hundreds, and possibly thousands, of our state’s most vulnerable youth.
Becky Miller Updike, Ph.D., is executive director of the Colorado Association of Family and Children’s Agencies. The association represents Colorado’s network of residential-care facilities, including Alternative Homes for Youth, PSI Cedar Springs Hospital, Inc., Denver Children’s Home, Devereaux Cleo Wallace, Family Tree, Griffith Centers for Children, Jefferson Hills, Laradon, Mt. St. Vincent Home, Mountain States Children’s Home, Rite of Passage, Savio House, Shiloh House, Southern Peaks Regional Treatment Center, Third Way Center, and Turning Point.