Congressional Hearings
THE OPIOID CRISIS: IMPLEMENTATION OF THE FAMILY FIRST PREVENTION SERVICES ACT (FFPSA)
Congressional Hearings
SuDoc ClassNumber: Y 4.W 36
Congress: House of Representatives
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| AUTHORITYID | CHAMBER | TYPE | COMMITTEENAME |
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| hswm00 | H | S | Committee on Ways and Means |
[House Hearing, 115 Congress]
[From the U.S. Government Publishing Office]
THE OPIOID CRISIS: IMPLEMENTATION OF THE
FAMILY FIRST PREVENTION SERVICES ACT (FFPSA)
=======================================================================
HEARING
before the
SUBCOMMITTEE ON HUMAN RESOURCES
of the
COMMITTEE ON WAYS AND MEANS
U.S. HOUSE OF REPRESENTATIVES
ONE HUNDRED FIFTEENTH CONGRESS
SECOND SESSION
__________
JULY 24, 2018
__________
Serial No. 115-HR08
__________
Printed for the use of the Committee on Ways and Means
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
U.S. GOVERNMENT PUBLISHING OFFICE
33-873 WASHINGTON : 2019
COMMITTEE ON WAYS AND MEANS
KEVIN BRADY, Texas, Chairman
SAM JOHNSON, Texas RICHARD E. NEAL, Massachusetts
DEVIN NUNES, California SANDER M. LEVIN, Michigan
DAVID G. REICHERT, Washington JOHN LEWIS, Georgia
PETER J. ROSKAM, Illinois LLOYD DOGGETT, Texas
VERN BUCHANAN, Florida MIKE THOMPSON, California
ADRIAN SMITH, Nebraska JOHN B. LARSON, Connecticut
LYNN JENKINS, Kansas EARL BLUMENAUER, Oregon
ERIK PAULSEN, Minnesota RON KIND, Wisconsin
KENNY MARCHANT, Texas BILL PASCRELL, JR., New Jersey
DIANE BLACK, Tennessee JOSEPH CROWLEY, New York
TOM REED, New York DANNY DAVIS, Illinois
MIKE KELLY, Pennsylvania LINDA SANCHEZ, California
JIM RENACCI, Ohio BRIAN HIGGINS, New York
KRISTI NOEM, South Dakota TERRI SEWELL, Alabama
GEORGE HOLDING, North Carolina SUZAN DELBENE, Washington
JASON SMITH, Missouri JUDY CHU, California
TOM RICE, South Carolina
DAVID SCHWEIKERT, Arizona
JACKIE WALORSKI, Indiana
CARLOS CURBELO, Florida
MIKE BISHOP, Michigan
DARIN LAHOOD, Illinois
BRAD R. WENSTRUP, Ohio
Gary J. Andres, Staff Director
Brandon Casey, Minority Chief Counsel
______
SUBCOMMITTEE ON HUMAN RESOURCES
ADRIAN SMITH, Nebraska, Chairman
JACKIE WALORSKI, Indiana DANNY DAVIS, Illinois
CARLOS CURBELO, Florida LLOYD DOGGETT, Texas
DAVID SCHWEIKERT, Arizona TERRI SEWELL, Alabama
DARIN LAHOOD, Illinois JUDY CHU, California
BRAD R. WENSTRUP, Ohio
DAVID G. REICHERT, Washington
C O N T E N T S
__________
Page
Advisory of July 24, 2018 announcing the hearing................. 2
WITNESS
Jerry Milner, Associate Commissioner, Children's Bureau, and
Acting Commissioner, Administration on Children, Youth and
Families, United States Department of Health and Human Services 6
MEMBER QUESTIONS FOR THE RECORD
Rep. Danny K. Davis to Jerry Milner.............................. 142
Rep. Jackie Walorski to Jerry Milner............................. 144
Rep. David Reichert to Jerry Milner.............................. 144
Rep. Judy Chu to Jerry Milner.................................... 144
Rep. Adrian Smith to Jerry Milner................................ 146
Rep. Danny K. Davis to Jerry Milner.............................. 147
Rep. Brad Wenstrup to Jerry Milner............................... 159
Rep. Lloyd Doggett to Jerry Milner............................... 159
Rep. Terri Sewell to Jerry Milner................................ 161
Rep. Judy Chu to Jerry Milner.................................... 161
Rep. John Lewis to Jerry Milner.................................. 163
Rep. Carlos Curbelo to Jerry Milner.............................. 164
PUBLIC SUBMISSIONS FOR THE RECORD
Zero to Three, statement......................................... 166
CSH, statement................................................... 176
FamiliesFirst Network of Lakeview, statement..................... 180
Florida Coalition for Children, statement........................ 181
Karin Axner, statement........................................... 183
Children's Home Society of America, statement.................... 185
Alliance for Strong Families and Communities, statement.......... 189
County of Los Angeles Department of Children and Family Services,
statement...................................................... 195
Eagle Accreditation, statement................................... 198
Never Too Late, Inc., statement.................................. 200
The Methodist Home, statement.................................... 201
New York State Office of Children and Family Services, statement. 203
Center for Fiscal Equity, statement.............................. 213
THE OPIOID CRISIS: IMPLEMENTATION
OF THE FAMILY FIRST PREVENTION
SERVICES ACT (FFPSA)
----------
TUESDAY, JULY 24, 2018
U.S. House of Representatives,
Committee on Ways and Means,
Subcommittee on Human Resources,
Washington, DC.
The Subcommittee met, pursuant to call, at 10:03 a.m., in
Room 1100, Longworth House Office Building, the Honorable
Adrian Smith [Chairman of the Subcommittee] presiding.
[The advisory announcing the hearing follows:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman SMITH. The Subcommittee will come to order.
Welcome to today's hearing on the implementation of the Family
First Prevention Services Act.
After steady declines in the number of children in foster
care, we have, unfortunately, begun to see an increase again.
Both the data and the experience of those on the front lines
indicate substance abuse, specifically opioid use and overdose,
are a contributing factor.
More than 3 years ago, this Subcommittee set out to reverse
this trend and do what Americans across this country expect of
us. We worked together across the aisle and across the Capitol.
Inspired by a desire to improve outcomes for children, we knew
we had to strengthen families, whether they are biological,
foster, or adoptive.
We remained steadfast to the questions we were hearing from
former foster youth, such as, ``Why did you take me away,''
``Why didn't you help my mom,'' or ``Why didn't you help my
dad?'' Backed by research in the field, we set out to change
the role of Federal taxpayer dollars in foster care and
adoption. We wanted to reset the incentives and focus resources
earlier, with upfront prevention services for substance abuse,
mental health, and parenting for all families, so fewer
children would have to experience additional trauma of being
removed from his or her home.
We listened to advocates, researchers, States, providers
and, most importantly, foster youth during the multiyear policy
development process. For me, one of those voices was Nebraska's
own Boys Town and Reverend Steven Boes, where, for more than
100 years, Boys Town, has been helping children and healing
families. Feedback from Boys Town helped us further our goal of
providing the right kind of supports at the right time for each
child in care.
Now, 6 months after the enactment of the Family First
Prevention Services Act, we return to talk about the
implementation of this important law, again using those same
voices to drive our questions today.
To provide the answers, we are pleased to be joined by HHS
Associate Commissioner for the Children's Bureau and lead
policy official for the implementation of Family First, Jerry
Milner. He brings with him more than 40 years of practice,
management, and technical assistance experience in child
welfare at the local, State, and Federal levels of government.
He has been a busy man over the last 6 months, traveling the
country to spread the word about Family First and address
outstanding questions.
Thank you, Mr. Milner, for being here today and for all of
your efforts to Family First.
I also want to commend my home State of Nebraska for being
on the leading edge of implementation and setting a strong
example for others under the leadership of Dr. Courtney
Phillips, CEO of the Nebraska Department of Health and Human
Services; and Director Matthew Wallen of the Division of Child
and Family Services, DCFS.
In June, DCFS hosted a kickoff meeting, marking the
official start of the State's efforts to implement the act and
included a number of child welfare stakeholders, such as
judges, advocates, providers, families, and others often
involved in the State's child welfare system.
This type of cross-collaboration is precisely what Family
First is all about and will create the type of positive systems
change to improve outcomes for children and families for years
to come.
They also set up working groups on specific topics which
need to be addressed under Family First, and those groups will
be meeting regularly over the next few months to develop
strategies for implementing Family First. Nebraska DHHS also
created a website where the public can engage in the process of
implementing Family First and monitor the progress.
The use of technology also exists to their creative
thinking families in the rural and sometimes remote areas of
our state when it comes to providing prevention services. And
they are thinking about ways to dovetail Family First with
their existing ``Bring Up Nebraska'' initiative, which is a
primary prevention program focused on developing nurturing
communities to raise strong and healthy children.
Every State is different and will have to chart its own
course for Family First, but States like Nebraska, Oregon, and
others are showing it can be done when everyone focuses on what
is truly important: better outcomes for children and families.
I now recognize the distinguished Ranking Member, Mr.
Davis, for 5 minutes for his opening statement.
Mr. DAVIS. Thank you, Mr. Chairman.
And before getting into my opening comments, I would like
to recognize my colleague Congresswoman Karen Bass, who is here
today observing our hearing. Congresswoman Bass is a tremendous
leader on foster care issues, was a valued partner and resource
throughout our efforts to enact this landmark change in foster
care. I look forward to continuing to work closely with her and
as we implement the law. And I might indicate that she also
organized the foster care caucus that any number of us are
members of.
Mr. Chairman, thank you for scheduling this bipartisan
oversight hearing. Child welfare is a deeply important issue to
me and to the people of Illinois. I am grateful that we are
working together so closely to ensure effective implementation
of the landmark new law, the Family First Prevention Services
Act, or Family First.
Frederick Douglas was fond of saying that it is easier to
build strong children than to repair broken men. There are very
few places that this lesson is more evident than in our
troubled foster care system, which has historically provided
help only when it was too late to keep families together.
When I ask foster youth what policymakers could do to make
child welfare better, they almost always say: ``You could have
helped my mom and dad.''
That is exactly what we tried to do in Family First.
I am proud of our work together to enact this law to
fundamentally shift child welfare from separating families to
strengthening them, but our work is not done until children and
families receive the help that they were promised. That is why
we hold this hearing today, and that is why we will continue
our active involvement in its implementation.
Family First provides a number of opportunities to
strengthen families and build strong children. For families
struggling with mental health, substance abuse, or parenting
skills and challenges, it will provide uncapped Federal
matching funds for State services to address those challenges
and to make foster care unnecessary. Importantly, these
services are available to parents, children, and other family
members. They are also available to youth in foster care who
are pregnant and those who are parents, both mothers and
fathers, to prevent the cycle from repeating.
To trigger the Federal investment in these services, States
will need to develop prevention plans and provide a
contribution. Child welfare advocates state that local
officials and State legislators have told us they have a number
of questions that need to be answered so that we can do that.
We will ask our questions today, and we hope to get answers
that will support positive action.
Another aspect of the new law that is close to my heart is
the opportunity to better support grandparents and other
kinship caregivers. My congressional district has the highest
percentage of children living with grandparent caregivers in
the Nation. We know that if children can't live safely with
their parents, being with family is the next best option. But
these kin caregivers need help and support.
I commit to personally making sure that the new Federal
funding for kinship navigators provides services to all
grandfamilies that need them and that States update their
policies to involve and support kin.
The Department of Health and Human Services has already
begun issuing policy guidance and soliciting applications for
kinship navigator funds and regional partnership grants to
address family substance abuse that will be available even
before the permanent prevention funding, but there is a great
deal of work to do.
I appreciate Jerry Milner for being here with us today to
answer our questions and his commitment to making the law a
success. I look forward to working with the administration as
we move ahead on behalf of the families we represent.
Thank you, Mr. Chairman, and I yield back.
Chairman SMITH. Thank you, Mr. Davis.
I would like to welcome our witness to the table: Mr. Jerry
Milner, Associate Commissioner at the Children's Bureau and
Acting Commissioner of the Administration on Children, Youth
and Families, and with the United States Department of Health
and Human Services.
Our witness is reminded to limit his oral testimony to 5
minutes. And certainly, your written statement will be included
in the record. I would also like to remind our witness and
Members that time is limited today and that the topic for
today's hearing is oversight of the implementation of Family
First Prevention Services Act.
While there are certainly many important issues we are all
facing today, this hearing is part of a larger effort to make
Family First a success by addressing outstanding questions that
are holding States back from moving forward on this very
important legislation.
I would kindly suggest that if there is a veering off
track, I will not hesitate to make sure that we bring the
hearing back to its primary focus.
With that, Mr. Milner, you may begin when you are ready.
STATEMENT OF JERRY MILNER, ASSOCIATE COMMISSIONER, CHILDREN'S
BUREAU, AND ACTING COMMISSIONER, ADMINISTRATION ON CHILDREN,
YOUTH AND FAMILIES, UNITED STATES DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Mr. MILNER. Thank you, Chairman Smith, Ranking Member
Davis, and Members of the Subcommittee. Thank you very much for
inviting me here today to testify about something that is near
and dear to me and the work that I have done over many years
now.
I also want to acknowledge the large number of former
foster care youth who are in the room today, many of whom I
know and have had the pleasure of meeting with over time. I
unabashedly say that their voice gives me a voice, and it means
a lot to me that they are here today.
I began my career as a case----
Chairman SMITH. One moment. If you don't mind my
interruption, former foster youth in the audience, would you
raise your hand? Very good. It is great to have you here. And,
again, I apologize for interrupting, but your input is very
valuable, and we are glad you are here. Please proceed.
Mr. MILNER. Thank you. I began my career as a case-carrying
social worker, and child welfare has, frankly, remained my
life's work. Before joining the administration, my experience
in child welfare included providing technical assistance to
States to improve services to children and families as well as
serving as Alabama's State child welfare director.
In more than four decades of work in child welfare, I have
seen far too many situations where all the factors that place
children at risk of serious harm went unaddressed by the child
welfare system until a serious injury, psychological damage, or
something much worse occurred. These things do not typically
happen because of a lack of will or a lack of skill within the
child welfare workforce but, rather, because of the way our
system has been designed and funded.
Traditionally, the majority of Federal funds have been used
for foster care, and in comparison we spend only a tiny
fraction of Federal funds for actual prevention of child
maltreatment before children become known to child welfare
agencies. It does not have to be that way.
I am pleased to report to you that we have made significant
progress in implementing the Family First Act, and we are
absolutely committed to timely and effective implementation.
By permitting, for the first time States and Tribes to use
title IV-E funds to prevent children from entering foster care,
the Family First Act provides a pathway for the child welfare
system to help some families stay together rather than placing
their children in foster care. Our approach to Family First
implementation allows for as much flexibility as the statute
permits. We do not intend to regulate definitions of key
concepts beyond what is already in the statute. We will also
strive to provide maximum flexibility to States and Tribes in
claiming funding for prevention services. Our first program
instruction to States and Tribes was published on May 31st and
addressed the amendments to title IV-B of the Social Security
Act and the Chafee Foster Care Independence Program. Our
program instruction on the amendments to title IV-E, the Foster
Care Prevention and Permanency Program, was published on July
9th.
In order to participate in the new title IV-E Prevention
Services Program, States and Tribes will submit a plan to us
that describes how they will carry out the program. We will
provide information to States and Tribes on how to submit this
plan in a further program instruction that we expect to publish
in the first quarter of Federal fiscal year 2019.
We are in the process now of procuring contract support to
create the clearinghouse that will identify interventions that
satisfy the requirement for reimbursement under the Prevention
Services Program, and we expect to award a contract in the
coming weeks.
I also want to acknowledge a few of the implementation
challenges that States and Tribes, as well as other
stakeholders in the child welfare community, are sharing with
us. We have heard concerns about the availability of the array
of prevention services needed to be effective, about developing
alternative placement options for children in congregate care
who may not be able to succeed in a foster family home, about
the expensive upfront cost of evidence-based programs and about
the time limits on reimbursable prevention services in light of
wait lists and delays in getting families into services. Some
States that have had the flexibility of title IV-E waivers for
quite some time are also concerned about the loss of that
flexibility.
While some of these challenges are undoubtedly very
complex, we are committed to providing States and Tribes with
assistance to promote their opportunities for success. Creating
a child welfare system that we can be proud of as a Nation and
one that children, families, and communities will see as a
source of support and strength as opposed to a system to fear
will take collaboration across the three branches of
government.
We have a collective duty and a responsibility to ensure
that Federal policy and funding protects children to the best
extent possible, which includes living in resilient, healthy
families. I look forward to working with you as we continue
implementation, and I am happy to answer your questions.
Chairman SMITH. Thank you, Mr. Milner. Thank you for
sharing your insight and expertise.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Chairman SMITH. In preparation for this bipartisan hearing
on implementation, Ranking Member Davis and I solicited
questions directly from States and their representative
organizations. In total, we received nearly 200 questions, and
today we are going to do our best to get them answered so
States can continue to move forward with the important task of
implementing this important bill to strengthen families and
improve outcomes for children.
We heard States greatly appreciate the Children's Bureau's
efforts to provide summaries and overviews through the recent
program information releases, but State and local leaders
request more specific information on timelines for policy
releases and expected implementation milestones, both for the
Children's Bureau as well as for implementing State agencies.
We also heard human services leaders and child welfare
administrators welcome the opportunity to implement a new
vision for child welfare and to expand the continuum of
services oriented toward prevention.
In order to move forward with key decisions on
implementation or delay, budget forecasting, workforce
planning, community-based partner engagement and State
legislative activities, State and local leaders need a more
concrete and regular communication and guidance from the
Children's Bureau to facilitate implementation.
Please tell us more about the timeline for upcoming
guidance, what States can expect will be included and not
included in upcoming guidance, also timelines for States taking
action, submitting plans and the like. And for States that are
delaying, how are those timeframes impacted? On the issue of
State option to delay implementation for 2 years, the law is
explicit that States have full control over their decision to
delay implementation, but yet the program guidance mentions no
less than six times approval by HHS and asks for a decision by
November 9.
There was no deadline requirement for this decision in the
law, and by expecting a decision now for a year later appears
to push States to make rushed decisions about these important
reforms before thoughtful consideration and discussions can
happen with various stakeholders, before the results of State
elections allow new policymakers to make decisions about
resource allocations, and before State and local budgets are
finalized that would impact the State's ability to implement
these reforms.
I understand the November 9th deadline is not binding but
merely for planning purposes, and a State can change its mind
at any point, both to go ahead or delay. Is that correct?
Mr. MILNER. That is correct.
Chairman SMITH. Thank you. On the topic of what families
will be eligible for prevention--what families will be eligible
for prevention services, known as the candidate of imminent
risk issue, I would like to highlight what you said in your
written and oral testimony. The Children's Bureau does not
intend to regulate a definition beyond what is already in law,
correct?
Mr. MILNER. That is correct.
Chairman SMITH. Does this mean States should be setting out
to define it themselves and, if they wanted to in the future,
could adjust it?
Mr. MILNER. Presumably so. States have flexibility under
the current title IV-E Foster Care Program to make certain
decisions about who is a candidate there. We want to give them
that maximum flexibility there as well, and we don't intend to
impose any restrictions on those definitions beyond what is
already in statute.
Chairman SMITH. Okay. Very good. Can you reflect a little
bit on the timelines that I mentioned earlier?
Mr. MILNER. Yes, sir. I am happy to. Let me first of all
say we are absolutely committed to timely implementation, but
we are also committed to doing it well. I am far more
interested in seeing States truly move the culture and the
foundation of their child welfare systems to one that is
designed to strengthen families and gets the outcomes that
Family First contemplates as opposed to a purely technical
implementation that may not, in fact, improve the outcomes for
children and families. We issued our first information
memorandum in April of 2018, which was an overview of the
requirements of the Family First Act. Our first program
instruction was issued in May of 2018, which covered the
requirements under title IV-B of the Social Security Act. Our
second PI was issued July 9, I believe, which covers the
requirements of title IV-E of the Social Security Act.
We currently have in clearance a Federal Register notice in
clearance, which will be issued regarding the Family First
requirement that we issue model licensing standards; and we
will be sending that information out for comment before
finalizing it. We expect in the first quarter of Federal fiscal
year 2019 to issue additional program instructions for both
States and Tribes on the new IV-E Prevention Funding Program,
which is part of Family First.
In the meantime, I think it is important to note that while
we recognize that States and Tribes have a tremendous number of
questions, as evidenced by the 189 that I received sometime
yesterday afternoon, we are trying our best to be as responsive
as we can to those questions going forward. Many of the answers
to those questions have been addressed in the program
instructions. Many of those questions are addressed in the
statute itself. Where there are gaps, we are committed to
issuing either clarifying instructions for States and Tribes or
meeting with them in order to answer those questions. We are
participating in, and cohosting with the Casey Family Programs,
a series of three listening sessions across the country to
address State concerns and to respond to the questions. I
participated in the first of those a couple of weeks ago in
Seattle, and we have two more forthcoming. Even as we speak
today, we have a State call that is being conducted to answer
questions and to help respond to the concerns that States are
raising with regard to the implementation of the Family First
Act. We have four more of those calls scheduled with States.
Chairman SMITH. Thank you. On the model licensing
standards, you expect that to be available when?
Mr. MILNER. Very soon. It is in clearance right now. We
have drafted that. Within the coming weeks, that should be out
there and available for comment.
Chairman SMITH. So well in time for States to run that
through their respective legislative processes?
Mr. MILNER. Yes. Our deadline on that is October 1 of 2018.
We will come out with that before that October 1 deadline.
Chairman SMITH. Okay. Thank you very much.
I now recognize the distinguished Ranking Member, Mr.
Davis, for 5 minutes for any questions he might have.
Mr. DAVIS. Thank you very much, Mr. Chairman.
And, Mr. Milner, thank you again. Starting October 1, 2018,
the Federal Government will provide a dollar-for-dollar match
for State expenditures for the Kinship Navigator Program, which
will help provide needed support to grandparents and other kin
caregivers who have stepped up to keep children with their
families and out of care. The law clearly provides this funding
separately from the prevention funding, and it was Congress'
intent that kinship navigator programs be allowed to serve all
kin caregivers, not only those caring for children at imminent
risk of foster care. This broader target population of kinship
families is consistent with previously federally supported
Kinship Navigator Program funding in the Fostering Connections
to Success and Increasing Adoption Act of 2008, which is
referenced in Family First.
Is it your understanding of the law as well that States
should serve a broader population of kinship caregivers beyond
simply those caring for children at imminent risk of care?
Mr. MILNER. Yes, sir.
Mr. DAVIS. Thank you for that.
Similarly, the requirement that 50 percent of interventions
must meet the well-supported evidence standard only applies to
the prevention services funding, not to the kinship navigator
programs. The kinship navigator programs simply need to be
evidence-based, which means they meet the promising standard in
the law. Is that your understanding of the law as well?
Mr. MILNER. I believe. I am clear that the kinship
navigator programs must meet the evidence-based requirements. I
am less clear in the moment about the 50 percent requirement
there, but we will be absolutely glad to clarify that for you.
Mr. DAVIS. Thank you very much for that.
In your testimony, you said there might not be any models
of kinship navigator programs that meet the evidence standard.
What are you doing to make sure there are models available to
States in time for States to claim funding in fiscal year 2019?
Mr. MILNER. Well, first of all, to clarify that statement,
we have heard from a number of stakeholders that there are not
many or possibly any kinship navigator programs out there that
would meet the evidentiary standards required by Family First.
We believe one program that we have begun to look at that might
meet those standards, and we are actually going to be pursuing
that, hopefully, as one of our priorities in determining the
evidence-based programs that are reimbursable under Family
First.
Apart from that, you mentioned the prior work that we have
funded. We are going to be looking at those programs as
possible candidate programs in the kinship navigator realm that
we could fold into the list of approvable services to be funded
under title IV-E.
We are also working with our Office of Planning, Research,
and Evaluation to fund a contract that is designed to build the
evidence for promising programs out there so that we can expand
the entire array of reimbursable services. Kinship navigator
programs are a part of that work that is going forward.
Mr. DAVIS. And, finally, Family First makes pregnant and
parenting foster youth categorically eligible for prevention
services even if their children are not at imminent risk of
entering foster care. We wrote the language to ensure that this
group of youth include fathers as well as mothers.
Family First allows service provision on behalf of pregnant
and parenting youth, meaning that services should be available
to their kin caregiver. Does HHS plan to emphasize these
important points in its guidance to States to ensure that they
know teen fathers and kin caregivers of pregnant and parenting
foster youth can also be served?
Mr. MILNER. Absolutely. The whole issue of responsible
fatherhood and engagement of fathers in the lives of their
children and families is of critical importance to us. It has
been an area that I personally have been focused on through the
Child and Family Services Reviews since 2001, and we continue
to work with States on ways to improve their response to that.
I am going to add that, just a few weeks ago, I was
fortunate enough to meet with a group of parenting youth who
were either still in foster care or emancipated from foster
care and a couple of those youth who were about to become
parents. That was in your home State of Nebraska, Chairman
Smith. That group of youth gave me a tremendous amount of
information about how important it is that they get the
services that they need.
I will also say that they gave me hope. They gave me hope
that, despite so many obstacles that they have faced, their
goals were incredibly lofty. One of the young women in that
meeting had strong desires of attending law school. My special
assistant who was with me there and is also a lawyer was able
to meet with her and link her up with some resources that she
could begin that whole process of living out her dream and her
goal.
So you are raising a critical issue here, and we are
entirely supportive of providing as much of an array of
services to that population served under Family First as we
can.
Mr. DAVIS. Thank you, Mr. Chairman, and I yield back.
Chairman SMITH. Thank you.
I now recognize Mrs. Walorski from Indiana.
Mrs. WALORSKI. Thank you, Mr. Chairman.
And thank you, Mr. Milner, for being here. For all of you
that came with him, thank you so much. Seeing your faces this
morning gives me hope and very tangible evidence, sitting here
today with all of you being here. Thank you so much for joining
us today.
The opioid crisis has put unprecedented strains on our
communities and social service agencies. Indiana has seen a
huge spike in the number of children in the foster care system
due in large part to this epidemic. I was proud to vote for the
Family First Prevention Services Act because we needed to
reframe the conversation and to put a greater emphasis on
prevention rather than just treating problems as they happened
and to verify that children were being placed in quality
settings.
Mr. Milner, when it comes to accreditation of group homes,
there is a lot of anxiety in my home State of Indiana. Part of
that stems from the fact that Family First congregate care
provisions, only facilities that meet the qualified residential
treatment program criteria are eligible for Federal
reimbursement. In order to meet these criteria, a facility must
be accredited by an independent not-for-profit accrediting
organization. I think this is a great thing. This ensures
quality. However, the anxiety kicks in when they look at the
fact that the process takes 1 to 2 years to complete, and there
is a limited number of accrediting organizations who will be
facing a significant uptick in their workload.
How are you planning to work with States to ensure these
aren't negative impacts on service delivery?
Mr. MILNER. It is a tough issue, and in no way do I want to
minimize the importance of that issue. Among the States, Tribal
representatives, and other groups out there that I talk to,
that is one of the top two issues that I consistently hear
about.
We are meeting with the different organizations that could
potentially be involved in this. I would be misrepresenting to
you if I said we understand completely the range of possible
accreditation options out there. We don't have all of those
details worked out. But in our consultation with States, as we
are hearing about their concerns--and I mentioned that we are
in the process of having three of these listening sessions
around the country as well as five calls--they are raising
those concerns to us. We are committed to developing an
implementation strategy and a plan that will, to the best of
our ability, address those critical concerns. It is, frankly, a
very big concern.
Mrs. WALORSKI. Would States with a pending accreditation be
allowed to provide reimbursable services? And can any IV-E
funds be made available to assist providers in being
accredited?
Mr. MILNER. I am not aware of any IV-E funds that would
allow States to use that for the accreditation process. I am
not going to speak definitively on that, but I can say that I
am not aware of that. And could you repeat your first question,
please? I am sorry.
Mrs. WALORSKI. Sure. Would States with a pending
accreditation be allowed to provide reimbursable services?
Mr. MILNER. I am not aware of any flexibility in the
statute that would permit that.
Mrs. WALORSKI. Are States able to identify accreditation
standards apart from the national standards?
Mr. MILNER. The standards would apply to the accrediting
body. So the body that--for example, the Council on
Accreditation and the Joint Commission on Accreditation of
Healthcare Organizations would probably have slightly different
accreditation standards there. So it would depend upon the
accrediting body that the State chose to use.
Mrs. WALORSKI. Will standards defining trauma-informed
program models be incorporated into those standards?
Mr. MILNER. I think the statute does require that the
programs, the qualified RTPs, provide services that are trauma-
informed. So they would have to be a part of that process.
Mrs. WALORSKI. Great.
Thank you, Mr. Chairman. I yield back. Thank you.
Chairman SMITH. Thank you.
I now recognize Ms. Sewell for 5 minutes.
Ms. SEWELL. Thank you, Mr. Chairman.
Firstly, I want to welcome our guest, Commissioner Milner,
a fellow Alabamian. Since you went to both schools, War Eagle
and Roll Tide.
Mr. MILNER. War Eagle.
Ms. SEWELL. I believe Members of both sides of the aisle
saw the passage of the Family First legislation as a huge
success. We all know that foster care placements are on the
rise. In 2016, 3,769 children in my home State of Alabama, our
home State, entered the foster care system, and over 36,000
Alabama kids were involved in an investigation of maltreatment.
However, the Family First Act has provided States like
Alabama with an opportunity to invest Federal funds in
preventive services that will keep kids out of foster care,
wherever possible. Right now, Alabama spends about $54 million
on foster care, but only one-fifth of that on preventive and
permanency services.
Under the new Family First law, this spending imbalance can
be corrected and States like Alabama can begin to invest more
resources in substance abuse, mental health, and parenting
skills training. However, in order for States to successfully
implement the new law, HHS must provide the proper guidance and
assistance to States, which leads me to my first question.
When the Family First law requires HHS to identify national
model foster care licensing standards and requires States to
report whether they have implemented them or not, the House has
passed that provision three times that HHS should help identify
national model foster care licensing standards. And the House
has passed provisions three times, including voting for a
separate bill, H.R. 2866.
At the time that we were debating H.R. 2866, my colleague
Mr. Kelly from Pennsylvania and I engaged in a floor colloquy
to make very clear our intent that the National Association for
Regulatory Administration model standards, which were the
result of a multiyear effort incorporating input from key
national associations and professional licensors, should be the
foundation of such standards.
I would like to enter for the record a copy of the model
family foster home licensing standards from the National
Association for Regulatory Administration.
Chairman SMITH. Without objection.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
Ms. SEWELL. It was our expectation, Congressman Kelly and
I, and our hope that, after reviewing the model licensing
standards, the States would modify their own standards to
address any inappropriate barriers to licensing relatives
caring for children or kinship caregivers whom the child
welfare system is increasingly relying on, often as a result of
the opioid crisis.
How will you encourage or how will HHS encourage these
licensing standards?
Mr. MILNER. Well, first of all, let me say that we have
reviewed the NARA standards. I have personally reviewed the
document that you have just entered into the evidence. We have
also reviewed standards from other licensing bodies, in
addition to State-specific and some Tribal-specific licensing
standards as well.
We have put that information into our proposed standards in
a Federal Register notice which, again, is currently going
through clearance. We expect, and will strongly encourage,
States, Tribes, and others, including the accrediting bodies,
to respond to give us comments before we finalize those rules
and regulations. That is going to be forthcoming quite soon.
Ms. SEWELL. Sure. You know, regarding the 12-month limit on
substance abuse treatment services and family-based residential
treatment, what happens if a patient lapses, say, in the 14th
month? I guess I am trying to get at incidences where people
will actually relapse after the 12-month period. Clearly, while
there is a 2-month gap, the reality is that that person still
needs treatment.
Mr. MILNER. Sure.
Ms. SEWELL. So what would happen for those who lapse beyond
the 12 months?
Mr. MILNER. As far as Federal title IV-E funding is
concerned, I am not aware of provisions where the funding for
that service could go beyond 12 months. It is a very technical
question, and I will go back and be absolutely certain about
that.
Beyond that, you have hit on a concern and a challenge that
I think many States are raising to us. While it is incredibly
positive that we can now spend money up to 12 months for
services that we previously could not do with very serious
cases of substance abuse, particularly with the rise in opioid
use right now----
Ms. SEWELL. And the recurrence of that.
Mr. MILNER. Yes, absolutely.
Ms. SEWELL. I am just trying to get to the point of future
access to treatment. And the reality is that maybe we should
consider a longer period.
Thank you, Mr. Chairman, for letting me extend. And thank
you, sir.
Chairman SMITH. Thank you.
I now recognize Mr. Reichert from Washington State.
Mr. REICHERT. Thank you, Mr. Chairman.
Glad to hear that you stopped by the Casey family in
Seattle. I have done a lot of work with them.
I do have a question for you at the end of my 5 minutes,
but I can't help myself; I have got to make a few comments
first.
First of all, I would like to thank you so much for your
service. I know that the young people in the audience today and
those listening, looking at your record starting as a
caseworker and continuing on all these years to help children,
that takes compassion and dedication. I am a 33-year veteran of
law enforcement. And also, just for the information of the
students and the young people in the room, I am a survivor of
domestic violence, the oldest of seven kids, and a runaway. And
I think you will find that most of the people up here have a
story to tell.
And so, when you look at us, we are people like you. We
went through struggles and trials. And so I am assuming that
out of all the hands that were raised in the audience, I am
assuming all of you want to be Members of Congress. Raise your
hand, please, who wants to be a Member of Congress. I don't see
any hands, Mr. Chairman.
Chairman SMITH. They may have higher expectations.
Mr. REICHERT. How about President? Oh, there is one, okay.
Thank you. Yeah, don't do it, somebody said.
I just wanted to share that with you because, you know, it
is all real formal and everything, but we care about you, and
we are here to try and figure out a way to help. Right?
Mr. MILNER. Thank you.
Mr. REICHERT. So I look at this, and some have mentioned
the opioid problem. It is just devastating our country and our
children. And, you know, the percentage of children entering
foster care is due to, a lot of it, parental substance abuse
and its dramatic increase. And, in fact, every 25 minutes a
baby is born suffering from opioid withdrawal. Every 25 minutes
a baby is born addicted to opioids, every 25 minutes. In
Washington State, 5,700 children were placed into foster care
in 2016, 34 percent of infants--34 percent of infants.
The passage of the Family First law gives us an awesome
opportunity to bend this curve, and we can do that. So this is
not about just children. It is not only children, but it is
about drug and alcohol abuse. It is about human trafficking. It
is about crime. It is about keeping families together and
keeping children safe and healthy, keeping them in school then,
right? If they have a loving home and a loving family, they get
educated. They get jobs. They are successful. They have pride
in their lives and their families. That is what this is about,
and it is about the success of America.
And there is one agency in Seattle that I am particularly
close with because I have two drug-addicted grandchildren who I
was a foster grandparent and an adoptive grandparent. And they
went through an organization called PICC, the Pediatric Interim
Care Center, in Kent. And what they do is they provide
specialized 24-hour care for drug-exposed and medically fragile
newborns. They offer treatment that allows the baby to
completely withdraw from drug dependency and transition, and
they want to get them home safely without medication. They want
to keep the families together. So they work with mom and dad if
they are around and try to keep them together. If they don't,
then they get adopted into families like my daughter's and her
husband's and they become a blessing to all of us.
So how can an organization like PICC, how can we ensure and
be sure that programs like PICC are eligible for prevention
services funding provided by Family First?
Mr. MILNER. They are eligible. Private agencies have long
been a foundational part of the service delivery system in the
child welfare system in our country. Under Family First, the
requirements to deliver services that are evidence-based will
still be there for the private providers, but we are actively
encouraging State child welfare agencies to work in strong
collaboration with their partners in the private sector, the
rest of the public sector, the faith-based community, as well
as other organizations.
Mr. REICHERT. What is the process? They have got to be
evidence-based, but what is the process, real quick?
Mr. MILNER. Typically, they would have some sort of
contractual arrangement with the State child welfare agency to
be a service provider there.
Mr. REICHERT. And meet the evidence-based?
Mr. MILNER. Yes.
Mr. REICHERT. I yield back. Thank you. Thank you.
Mr. MILNER. Thank you.
Chairman SMITH. Thank you.
And next we have Ms. Chu from California.
Ms. CHU. Thank you.
Last night I went to the congressional foster care dinner
that Karen Bass is the head of and heard very wonderful
testimony from foster care children or former foster care
children, who said how much Family First would change their
lives and finally provide the resources available to keep
families together versus letting more kids enter the foster
care system. So I think this is certainly a step in the right
direction.
But States have a lot of questions about the implementation
of this, and that includes my home State of California and my
county of Los Angeles, which is responsible for the largest
child welfare system in the Nation and in 2017 oversaw nearly
35,000 children. It currently has a IV-E waiver, which has
allowed them to provide innovative preventive services,
including substance and mental health services to populations
who are not title IV-E eligible, but they have also done a
dramatic job to reduce the foster care population 23 percent
between 2007 and 2010, and they have also reduced the number of
children in group homes and other institutionalized settings by
one-third.
So I think they have been trying to do the same kind of
goals that are in Family First. And they have also provided
home visiting services, aftercare networks, creative
partnerships with other community agencies like job centers,
and reduced the number of children entering care and increasing
permanency.
I understand, Commissioner Milner, that you had a
productive meeting with L.A. County about their program, and my
first question would be whether you saw that they were making
progress along these lines in a similar fashion to Family
First?
And then my second question has to do with the timeline for
implementation and whether there can be any kind of
consideration for those who are on the title IV-E waiver
programs, whether there can be guidance or technical assistance
or any kind of other consideration for counties like Los
Angeles to help them transition from their waiver to the
implementation of the provisions of the Family First Act.
Mr. MILNER. Let me say that thank you very much for raising
that issue. It is a very important issue for me and for those
of us in the Children's Bureau. Yes, I did have a very
productive onsite visit with Bobby Cagle and his staff in L.A.
County. I have also met with the board of supervisors for L.A.
County to hear their concerns; last week, I spent a couple of
days up in San Francisco visiting a community-based program;
and I have made visits down to San Diego as well.
All of those programs have in common, I believe, a very
strong commitment to moving their systems toward one that
strengthens families, strengthens children, and prevents bad
things from happening to children. L.A. County has done a
tremendous amount of work there. The First 5 work, which is a
home visiting program, is one that they are really quite proud
of.
The loss of the flexibility of the title IV-E waiver
dollars is going to be a big hit for the counties in California
because the State office has pushed those flexible waiver
dollars down to the counties, where they have used those
dollars to create upfront primary prevention services for
children and families, not just preventing them from coming
into foster care but preventing them from being maltreated in
the first place.
The transition to Family First means a lot of different
things for them, including a loss of the flexibility. Even
though they are able to use title IV-E dollars now for certain
prevention services, Family First does not replace the entire
flexibility that they have under the IV-E waivers right now,
where they have a capped allocation, and they are using that
money accordingly.
California has expressed great interest in some sort of a
transitional authority to continue that, to help them make the
transition in ways that they can be even more successful with
Family First rather than at a certain point just having to give
up the flexibility that they have had.
We would actually support that. And I believe that there is
a strong need for us to do this in an orderly fashion in a way
that allows States to plan as carefully and as thoughtfully as
they can to move to the new system under Family First.
Ms. CHU. Thank you so much for that answer. I really
appreciate it.
Chairman SMITH. Thank you.
Now we move on to Mr. Wenstrup from Ohio.
Mr. WENSTRUP. Thank you, Mr. Chairman.
Thank you, Mr. Milner, for being here today. Just in the
scheme of the big picture, I just want to share that my wife
and I just recently experienced the joy of adoption.
Mr. MILNER. That is wonderful.
Mr. WENSTRUP. It is wonderful. And we would like to see
more of that take place. It is a beautiful thing.
And Family First presents a real opportunity to shift kind
of the way we think about the role of Federal foster care
dollars and how they can be more effectively spent. Our system
in Ohio, in Cincinnati area especially, is very overcrowded. It
is a real problem for the agencies. And we have this
opportunity to provide alternatives for our youth, and I think
that that is something that we all look forward to. We have
been greatly affected by the opioid epidemic. As a matter of
fact, that has been a huge driver of the need for an increase
in our foster care system to be able to work.
But Ohio has held the title IV-E waiver since 1997, and so,
across the State, we are anxiously awaiting a timeline of how
we deal with this transition from the waiver to Family First.
We really need some guidance on that, and the sooner, the
better--if we are going to be effective. We want some clarity
on that if you can provide it, and is there technical
assistance? I am following up on that question. But the sooner
we can get a real timeline, it would be very, very helpful.
And then the other thing that I am concerned about is, what
is the process for States to identify and get approved new
practices that are not specifically preapproved? How can we
innovate in the areas of making this whole system work better?
Mr. MILNER. I was fortunate enough to spend some time with
the child welfare leadership from Ohio last week. We had teams
of 10 people from every State come here to Washington, which
included not just the child welfare agency but the legal/
judicial community and the prevention partners. And it was a
pleasure to be able to spend some time at the Ohio table and
also to hear some of their concerns.
The process of getting services introduced into the
approvable pool is going to be an ongoing process, as well it
should. We will come out with an initial list of programs that
we will be reviewing, but Family First is inspiring a great
deal of attention to building the evidence for programs out
there so that we hope to expand the array of services over
time. States can submit to us programs that they want us to
consider.
Again, later this year, we will also again be issuing a
Federal Register announcement that will describe that process
for reviewing the criteria that we intend to use to review for
programs that are reimbursable under the prevention funding
stream and also provide guidance for States to submit those
programs if they want us to take a look at those----
Mr. WENSTRUP. So where are you in that stage right now? I
mean, where----
Mr. MILNER. I am sorry?
Mr. WENSTRUP. Where are we as far as staging? You can
submit an idea, an innovative idea right now. Do you have a
particular form you fill out? Do you have to have
documentation? I mean, I think that is what we are looking for,
and then the timeframe of that.
Mr. MILNER. We will contract for a clearinghouse that will
be responsible for carrying out those activities of reviewing
the programs, soliciting nominations or candidates for programs
to be in that pool. The procurement is on the street at this
point and we expect that contract to be issued by October 1.
As soon as we get the clearinghouse procedures in process,
those procedures, we will be able to release and move forward
with it. States could submit programs to us right now. Clearly,
we don't have the ability at this moment until we have the
clearinghouse in place to actually conduct a review of those
programs and start adding them to the bank. But we anticipate
moving forward with that on October 1.
Mr. WENSTRUP. And some of the ideas that people come
forward with, are they going to be able to test the waters a
little bit? In other words, you want to have evidence-based
ideas, if you will, preferably. Are they going to be able to
test the waters, try something on a small basis and then expand
it if it is successful? Is that what we can look forward to?
Mr. MILNER. I am not sure if I understand the question.
Certainly, an evidence-based program could be implemented on a
limited basis. If you want to do it in one of your counties and
perhaps not statewide, there is nothing prohibiting you from
doing that.
The statute is quite specific, however, that to be
reimbursable under the prevention funding services stream, it
must meet the criteria for evidence-based, either at promising,
supported, or well-supported levels.
Our intent is to open the promising door as wide as we can
open it, so that States can begin to use or continue to use
services that they believe are effective in serving children
and families while they build the evidence to get those
services up to the higher rungs of the evidence ladder.
Mr. WENSTRUP. Thank you. My time has expired.
Chairman SMITH. Thank you.
I next recognize Mr. LaHood from Illinois.
Mr. LAHOOD. Thank you, Mr. Chairman.
And, Mr. Milner, I also want to recognize and thank you for
your service and your lifelong commitment to helping young
people to succeed and all the good work that you do.
And I also want to acknowledge the young people in the
crowd here today. Thank you for being here. Your presence is
important, and we are honored to have you here today as part of
this hearing.
Prior to elected office, Mr. Milner, I spent a lot of time
with the Big Brothers Big Sisters organization. I was a big
brother myself in my hometown of Peoria, Illinois, and saw the
really good work that has gone on there. And, you know, many of
our young people, through no fault of their own, are born into
very difficult situations.
And from a public policy standpoint, trying to figure out
what we can do to help many of these good organizations, I have
also spent time and served on a board locally, the Center for
Prevention of Abuse, that works with young people that are
affected by abuse and also domestic violence. And I am happy
that we are having this discussion here today, and let me get
into a couple issues here.
I guess when we think about strengthening families and the
implementation of the Family First Prevention Services Act and
how we can make sure that this is the most efficient and
effective program possible in this country, implementing a
major reform in the current system comes with its challenges.
And I want to commend your willingness to be here today and
answer questions about this implementation of the legislation
and to make this smooth transition for our State and the local
stakeholders.
It is my understanding that HHS will provide a preapproved,
quote, clearinghouse list of evidence-based practices that the
States will be permitted to use.
Given that there are limited self--sorry. Given that there
are limited well-supported evidence-based programs that have
been tailored for child welfare populations, there is a need
for HHS to provide guidance on States conducting these program
evaluations so that more evidence-based programs are
established in the well-supported category and ultimately added
to the clearinghouse list.
Can you talk a little bit about what is the process for
States to identify and have approved other practices not
specified on the preapproved list of the evidence-based
programs?
Mr. MILNER. Again, going back to Representative Wenstrup's
question, we will come out with our final guidance on that
later this fall, once the clearinghouse established and we have
those procedures in place. I can't tell you precisely that they
are going to fill out a form or we are going to respond in a
certain period of time, but there will be a clearly defined
process so that we can identify services that States and Tribes
want to use.
As soon as we get the comments back on the criteria, the
process, and the priorities for reviewing those services, we
will be in a much better position to guide States on how they
can raise or elevate their services for consideration.
Mr. LAHOOD. Additionally, Mr. Milner, is Federal
reimbursement available for evaluation activities of time-
limited services?
Mr. MILNER. The only funding that I believe Family First
allocates for that is for us to use the clearinghouse and the
technical assistance. One million dollars, not a whole heck of
a lot of money, was allocated for us to do that.
When we have the clearinghouse in place, it will offer that
level of technical assistance, to the extent that the funding
allows it to, on evaluation and implementation of those
services within the States.
Mr. LAHOOD. Got you. Well, we look forward to working with
you as a committee and wish you much success. Thank you.
Mr. MILNER. Thank you so much.
Chairman SMITH. Thanks. Next, I recognize Mr. Schweikert
from Arizona.
Mr. SCHWEIKERT. Thank you, Mr. Chairman. Like Dr. Wenstrup,
we have an adopted daughter. As a matter of fact, she is third
generation adopted now in the family, so obviously we are doing
something wrong. Come on. Can I walk you through, though, first
I know antidotes aren't policy, but they give you a little bit
of a window. Three years ago, my wife and I spent a summer
getting certified to be foster parents. And we had, you know,
folks from the State come as trainers. We had an agency. It was
a trainer. It was very comprehensive, and sometimes the
conversations were absolutely devastating, and heartbreaking. A
couple of the most stressful evenings I ever had with my wife
were the drive home when we had foster families that had been
in fostering for 20 years and the roller coaster that their
lives were.
We also heard repeatedly, particularly in a State like
Arizona, there was a tremendous shortage of those parents,
either those households that were ready to do short-term, long-
term, older kids. So I guess I am asking you saying, okay, we
have done a piece of legislation. There is all sorts of
evidence base, so we have much better math and statistics.
There is some resources with it. Where is the greatest
fragility you see out there in our society? Is it a shortage of
foster parents? Is it a shortage of good data? Is it a shortage
of resources to do intervention for substance abuse? If you had
to give me one, two, and three, overall, what is really missing
out there in the system today?
Mr. MILNER. I think we need to focus squarely on resolving
the reasons that children need to come into foster care to
begin with. I think that if we don't focus our efforts on the
primary prevention of child maltreatment, we are going to
continue to chase our tails. We are going to continue to be
scurrying around trying to find more money in State budgets,
more caseworkers, more lawyers, more foster homes, and we are
going to continue to raise children in the foster care system
who don't have all the skills they need to become healthy,
productive adults.
Mr. SCHWEIKERT. Okay. You are actually heading in the
direction--so child maltreatment----
Mr. MILNER. Yes.
Mr. SCHWEIKERT [continuing]. Is that parents with substance
abuse, is it households that have a mental health issue? I
mean, and I am asking for some granularity on--and I know
this--and I am not asking for antidotes, but I am asking, sir,
for your perception.
Mr. MILNER. I think it is all of the above. I think quite
honestly, many families, if not all families, could be at risk
of having involvement in the child welfare system with a slight
twist of fate. The most successful programs that I am visiting
out there I could name them: Live Well San Diego is one of
those programs; the Center for Family Life in Brooklyn, New
York. The list goes on. They provide services that strengthen
families before they get into the ditch of child maltreatment
and trauma, and can't get themselves out of that. It could be
targeted to families that already have displayed some risk, but
simply by strengthening families in communities and offer them
a nonstigmatizing way to get the support they need would go a
long way.
Mr. SCHWEIKERT. When we use language like strengthening
families----
Mr. MILNER. Yes.
Mr. SCHWEIKERT [continuing]. Give me an actual example of
what the program in San Diego is actually doing.
Mr. MILNER. Addressing the protective factors of families.
We know----
Mr. SCHWEIKERT. No, no, no, no, no. I am asking you what
are they actually doing? They are knocking on the door, are
they demanding drug--I mean, what are they actually doing that
is so powerful that it reaches your top of your mind?
Mr. MILNER. Over 300 partners have come together in San
Diego, including the educational system, the housing system,
the transportation system, the Chamber of Commerce, parks and
recreation, transportation, and the child welfare system.
Mr. SCHWEIKERT. So they built a coalition.
Mr. MILNER. Yes.
Mr. SCHWEIKERT. What are they actually doing?
Mr. MILNER. They are promoting the notion of living well
for the citizens of San Diego, regardless of what the
particular entity is involved with. If it is the medical field,
they address living well and in healthy ways in that domain.
Mr. SCHWEIKERT [continuing]. For your help. Maybe I am
just--because I am, you know, done the foster care training, I
have a household. I have these poor kids that are just living
in hell. How was that system there making--protecting those
kids? What are they doing that is so unique that protects those
children?
Mr. MILNER. I think that they are doing a couple of things.
I think they are trying to help those families get the concrete
supports that they need before they get to the living hell part
of their lives. And that is where primary prevention comes into
play.
Mr. SCHWEIKERT. We will do some follow-up because I would
love more to understand the tactical.
Mr. MILNER. Sure.
Mr. SCHWEIKERT. Is it--and Mr. Chairman, I know I am over
time, and I may be an outlier here. I know we passionately want
to keep families together, but I also passionately want to
protect these kids.
Chairman SMITH. Thank you. And we will begin a second round
here as we do move forward. Let me touch a little bit on
nonchild welfare issues. Family First is unique because the
expectation is for most of the services and interventions--the
expectation is for most of the services and interventions to
come from sources outside of the foster care and adoption
agency. Therefore, it is essential for the Children's Bureau to
take the lead and set an example for how to coordinate and
collaborate with other agencies. How is the Children's Bureau
working with SAMHSA, HRSA, Medicaid, and other HHS agencies on
the development of approved programs that meet evidence
standards to provide substance abuse, mental health, and
parenting programs under FFPSA.
Mr. MILNER. We have begun the process of having discussions
with all of those agencies. HRSA, around the home visiting,
with SAMHSA, our policy folks are already in conversation with
CMS because Medicaid is going to be a tremendous interface
between the work that we do. We have to sort out issues with
Medicaid around payment for evidence-based services, payments
in the facilities, how our board payments would interface with
those. We are in the process now of compiling as many of the
issues that we are aware of that we know that we need to
resolve. We are in the early phases of that, but we are
absolutely committed to working in partnership with those other
Federal agencies to make this a comprehensive implementation
process. I am scurrying around from coast to coast encouraging
States to work in strong partnership with their local partners
for implementation, and it would be hypocritical of me not to
be doing the same thing at the Federal level.
It is not just those obvious agencies that we think we need
to have strong partnerships. We are meeting with other groups
that will have a tremendous impact on implementation, such as
the National Governors Association and the National Association
of Counties. I spoke a couple weeks ago to the National
Conference of State Legislators, and even this morning before I
came here, I was in contact with our Head Start agency to try
to find those interfaces, particularly in some of the very
rural communities out there where an array of prevention
services is going to be hard to come by.
So we are quite aware of that, and it is very high on our
implementation priority list.
Chairman SMITH. Thank you. Now, also, when will States know
more about how to handle the billing situations, like substance
abuse services where services are eligible for Medicaid
reimbursement and Family First, and what is being done to
reduce the potential for double-billing?
Mr. MILNER. That is further into the implementation process
than we are right now. Once we are able to issue our guidance
on the prevention services program, which will come, again,
within the first quarter of Federal fiscal year 2019, we will
be able to respond to those very technical questions.
Chairman SMITH. Because I think you can appreciate that
States might be a little reluctant to move forward, you know,
knowing that they need to, but if there is concern that they
may or may not be able to be reimbursed for that.
Mr. MILNER. I do understand that. I don't think that the
reimbursement procedures are going to be the criteria that
States use to determine whether to go forward with the optional
prevention services programs or not. I certainly hope it is
not. I hope that they are thinking much more broadly about how
they want to serve children and families, and understand that
we are absolutely going to work with them to work out those
very technical details that we are nowhere near being able to
respond to right at this moment.
Chairman SMITH. Okay. How are programs previously funded
under various HHS grants, such as the regional partnership
grants, pregnant and postpartum women, MIECHV home visiting,
children affected by meth, how are they being consulted to
provide input into this list of evidence-based programs?
Mr. MILNER. We are taking advantage of the opportunity to
look at the services that those programs have provided,
particularly our regional partnership grants. I appreciate you
bringing that up. That is one of our programs that we are
absolutely proud of, particularly in the efforts to fight
substance abuse issues within families. We believe that those
programs give us a rich pool of possible interventions if the
evidence base is there. If the evidence base is not there, they
may also identify programs where we can focus efforts to begin
building that evidence, because many of those programs have
actually shown to be quite successful in getting to the desired
outcomes.
Chairman SMITH. Thank you. And now I will recognize Ranking
Member Davis.
Mr. DAVIS. Thank you, again, Mr. Chairman. Commissioner, in
your previous answer, you suggested that Health and Human
Services would need to individually approve any intervention
not in the clearinghouse. We had expected you would do that by
approving the State plan that includes the intervention. Is
that correct, or do you plan a different approval process?
Mr. MILNER. Given the criteria that are set forth in the
statute for an evidence-based program, we will have to review
the actual program itself. Simply putting it in a State plan
will not give us the information we need to know if it meets
the criteria in the statute.
Mr. DAVIS. Following up on your answer to the Chairman on
candidate for care, I appreciate that in your testimony, you
clarified that HHS does not plan to define, and I quote,
candidate for care on imminent risk beyond what is in the
statute. Because the question is repeatedly asked in my State,
I would like to know if other States are hearing the same
question. Could you reaffirm that this means that HHS is not
planning to issue a national definition of imminent risk, or
candidate for care, and will instead rely on States to explain
their State standard in their prevention plans?
Mr. MILNER. It is not our intent, as I put in my written
testimony, to define those concepts any further than the
statute already defines them.
Mr. DAVIS. Does HHS plan to issue any guidance or
parameters for States to use as they explain their eligibility
criteria in their State prevention plans, and if so, when will
those be issued?
Mr. MILNER. We will be issuing guidance on the prevention
services program later this year. We anticipate issuing that
guidance within the first quarter of Federal fiscal year 2019,
and hopefully, we will be able to address those questions
satisfactorily in that program instruction.
Mr. DAVIS. Does the Children's Bureau intend to publish
program guidance for States about drawing down the kinship
navigator match before the provision becomes effective, and if
so, when?
Mr. MILNER. We will produce guidance on the kinship
navigator program that should include--I am getting--that is
getting a little bit more technical than I am prepared for, but
the guidance that we issue on that should cover any kind of
billing procedures. I can't imagine why it would not, but I am
not able to--I am not able to speak any more definitively than
that.
Mr. DAVIS. Do you anticipate that a State would need to
amend its IV-E plan in order to claim kinship navigator
matching funds?
Mr. MILNER. I don't know the answer to that question. We
will have to get back with you on that.
Mr. DAVIS. Under State law, or by law, HHS is required to
provide technical assistance and disseminate best practices for
providing and evaluating the evidence-based prevention services
funded under Family First. Could you identify how this will
take place?
Mr. MILNER. We will be issuing guidance on the
clearinghouse and that whole process in the first quarter of
Federal fiscal year 2019, and, if I am understanding your
question correctly, that should provide the information that
States will need.
Mr. DAVIS. Thank you very much, and I yield back, Mr.
Chairman.
Chairman SMITH. Thank you. Thank you. Next, I recognize Mr.
Reichert from Washington State.
Mr. REICHERT. Thank you, Mr. Chairman. And I want to kind
of drill down into one of the issues that I mentioned in my
first question, and that is human trafficking. And all of us on
this panel, as I said, want to help our youth.
Mr. MILNER. Absolutely.
Mr. REICHERT. And most of the young people who are out
there on the streets involved in sort of this lifestyle have
been victimized at home, sexually abused, mentally,
emotionally, physically, and are driven to the streets and they
are abused, victimized again. And then back in the day when I
was working in the sheriff's office, they were victimized once
again by a judicial system that really didn't understand that
these young kids are victims, not criminals.
Today, we have been enlightened a little bit and discovered
that really we need to help these young people involved in
human trafficking. And the reason I know so much about this
topic, you may or may not be aware of my background in law
enforcement. I worked on a serial murder case for 19 years,
called the Green River serial murder case. The person
responsible for the murders in this case pled guilty to 49
murders. We think he killed 60 to 70 little girls and young
women. I personally was at body sites of scores and scores and
scores over those years.
So, Family First allows Federal funds for settings
providing high quality residential care and supportive services
to children and youth who have been found to be or at risk of
becoming sex trafficking victims.
Mr. MILNER. Yes.
Mr. REICHERT. The July 9 program instruction indicates that
ACF will not further define that setting. Does the Children's
Bureau plan to issue any guidance about the kinds of settings?
Mr. MILNER. About the kinds of settings?
Mr. REICHERT. Yes, that this might entail.
Mr. MILNER. I am not sure I am going to be able to answer
the question completely on the types of settings. The law sets
forth the criteria for qualified residential treatment program.
The accreditation body would also add to any of those
requirements there. To my knowledge, we do not have intent of
issuing any further guidance around those particular settings,
but I say that somewhat tentatively.
You are absolutely correct that we do not intend to define
victims of sex trafficking, or at risk of sex trafficking, any
further than it has already been defined in the law.
Mr. REICHERT. Well, I just think we need to take another
look at that and maybe you and I can have a discussion.
Mr. MILNER. Surely.
Mr. REICHERT. Since children in out-of-home care are
already at increased risk of trafficking.
Mr. MILNER. Yes.
Mr. REICHERT. This is going to be important for States to
have a clear understanding, so that they can use this placement
setting appropriately.
Mr. MILNER. I cannot agree with you more. I have had
several conversations with States myself around their intent
and how they would like to define the terms of at risk of sex
trafficking, and I believe that States are coming at it from
different places. But part of our plan also is to allow States
that flexibility, so that they can craft a program that will
best meet the needs of youth in their States.
I also just want to add, just for general interest, I
visited one of those programs in your home State in Seattle a
while back, and I also was fortunate enough to be able to
attend the ribbon cutting for a drop-in center there in Seattle
designed for youth who are victims of sex trafficking, to have
a place to go.
So I have seen firsthand in your State the value and the
importance and talked to some of those youth myself about their
experiences there, so we share that concern and commitment.
Mr. REICHERT. I appreciate your answer. I yield back.
Chairman SMITH. Thank you. I next recognize Ms. Chu from
California.
Ms. CHU. Well, I have more questions from the State of
California. In California, each county is responsible for
administering its own child welfare program, and California is
made up of 58 counties. As a result, the counties vary in
capability and capacity and access to providers who can deliver
prevention services. So Family First requires that the
prevention component to the State's IV-E plan must describe the
target population for the services or programs.
So my question is whether the State has to opt in for the
Family First program, and do all counties and geographic
locations have to provide the same level of prevention
services, or can there be a targeting of those prevention
services on a geographic basis versus having every county do
every service?
Mr. MILNER. Yes. It is my understanding that as you have
said, the State has to take the option, but I do not have the
understanding that every single county would have to provide
the same level of service delivery. In the title IV-E waiver,
which is admittedly a different program, there are four
counties in California that are providing those services, so
that is not a State-wide effort there. I see no reason why that
could not be the same way in Family First, and frankly, would
fully expect it to be that way. You have some very rural
counties in California, as do the other Members in their
States, and the reality is, many of the prevention programs are
going to be hard to come by in those very rural areas. I don't
think we can have a reasonable expectation that there is going
to be a uniform level of service delivery across counties.
Ms. CHU. My other question is about the quality residential
treatment program, or QRTP. Those provisions in the Family
First program have time limits that the States have to meet in
order to be reimbursed for such a placement.
Now, right now, California takes more than 30 days to do an
assessment as to whether a child should or should not be in one
of these facilities in a group home or a foster care home. I
know that the Family First program is a step forward, because
there is some States that don't do any assessment whatsoever,
so there needs to be an assessment.
Mr. MILNER. Sure.
Ms. CHU. But my question is, whether there is any
flexibility on the 30 days in order for the State to be
reimbursed, because it would seem to me that the best thing
would be to have a good assessment, what if it is 31 days? What
would be the situation with that?
Mr. MILNER. The statute requires 30 days. I am not aware of
any flexibility in the statute on that.
Ms. CHU. How about this situation: Would a State be
reimbursed if at the 60-day court review, the court disproves
the placement of the child?
Mr. MILNER. I am not able to answer a question that is
quite that technical, so we will have to respond to you in
writing on that, I am sorry.
Ms. CHU. And how about if a child moves from one QRTP
program to another, would a new 30-day assessment be required?
Mr. MILNER. That is also a very technical question that I
don't think I am prepared to answer for you today. We will get
back with you on that.
Ms. CHU. Okay. I will submit those questions. Then I also
wanted to ask about administrative costs. The requirement that
50 percent of the State's prevention services spending be
related to services or programs does not make clear whether
there can be claims for administrative services like training
and evaluation. So can administrative reimbursement for such
things be in this program?
Mr. MILNER. We will also have to give you a written
response on that. I can't say definitively what is included in
the admin costs at this point.
Ms. CHU. Okay. I appreciate you getting back to me on that.
Mr. MILNER. Thank you.
Chairman SMITH. Thank you. Next is Mr. Wenstrup from Ohio.
Mr. WENSTRUP. Thank you, just a quick follow-up question,
if you will. Our State is one where the county administers the
work.
Mr. MILNER. Yes.
Mr. WENSTRUP. So in these States like that, can the local
areas, counties opt in or opt out, or if programs put in place,
does it have to be statewide, or is there going to be that type
of flexibility for the counties?
Mr. MILNER. As I was saying to Representative Chu, I
believe that States will have to work with their counties to
determine where they are going to be able to offer some of the
specific services. Whether there is a formal opt in or opt out,
I wouldn't attempt to answer that for you at this point with
any real confidence there. The State has to make the decision
to be a part of the program, but then the State would have to
work with its counties in order to determine how they were
going to comply, particularly with the prevention services
program. That is what I am primarily speaking about right now.
The congregate care provisions would not be an optional thing
for a State or a county to select from.
Mr. WENSTRUP. I think we have to think about that because
there may be initiatives that one or two counties really need,
and the others don't.
Mr. MILNER. Sure.
Mr. WENSTRUP. And you don't want to waste money setting
something up that another county doesn't need, but is needed
somewhere else. So I hope that there is that type of
flexibility that can take place within the State, so especially
when they are being run by the county, you know, you don't want
to make them do something they don't need.
Mr. MILNER. Yes.
Mr. WENSTRUP. And allow those that need something else be
able to do it.
Mr. MILNER. And that is entirely consistent with the vision
that we have for child welfare in our country coming from the
Children's Bureau right now. In addition to a strong commitment
to moving towards a primary prevention focus of our work, we
believe that those efforts have to happen at the county and
community level. The best examples that I see of programs
effectively serving and strengthening families out there are
not necessarily happening on a State-wide level. They are
happening in the communities where children and families live.
That is where they can get the services and supports that are
available to them in most situations that are culturally
appropriate for them and that are responsive enough for them to
sustain progress once they have made that progress.
Mr. WENSTRUP. Well, and I have seen some of the benefits
that a local level. One of my counties just in addressing
poverty, was part of a short-term trial called Rural Impact.
The caseworker had authority to make changes. I meet a family
with six kids, and I meet the parents and, you know, they are
living in a one-room home. And he said, I can't take a third
shift job, I have nowhere to sleep. So she gets them into a
home with a couple bedrooms, and they go to work. The whole
dynamic changes. There is that local level ability to fit what
is needed case-by-case that I really hope we are driving
towards so that we can really have a positive fact. And this is
a situation where the person working with you, they are not
just a signature on a piece of paper somewhere. They have been
to your house.
Mr. MILNER. Exactly.
Mr. WENSTRUP. They understand what has taken place. Anyway,
thank you. I yield back.
Chairman SMITH. Thank you. Next, I recognize Mr. LaHood
from Illinois.
Mr. LAHOOD. Thanks, Mr. Chairman. Commissioner Milner, I
wanted to focus a little bit on criminal background checks, and
I mentioned earlier, I was involved with the Big Brothers Big
Sisters program, and I know when we were screening for Big
Brothers and Big Sisters, I worked as 10 years as State and
Federal prosecutor, so we would do the background check for
that. And obviously it is important that we make sure we have
the best people that are involved in the child welfare system.
I know, for instance, there is a clear standard set for
foster parents and adoptive parents and the background check
there. Can you talk a little bit about the proper oversight and
enforcement for States, and particularly, for child care
centers, and whether there is a national standard that has been
established and how that implementation happens, not only for
criminal background, but for maybe other professional
misconduct or drug use and where we are at with the
implementation of that?
Mr. MILNER. With regard to background checks, the Federal
statutes address the criminal background checks, not
necessarily the other areas that you might have some concerns
about. We have long held a requirement that adults in a foster
family home undergo a criminal background records check. Family
First adds a requirement that staff, all staff of the
congregate care facilities must now have that background check,
which must include a check of relevant criminal databases.
Other Federal legislation gets very specific on what would
disqualify someone based on a background check. States do have
some flexibilities in terms of making exceptions to those
rules, but they are required to have very specific procedures
in place if they want to do so.
I actually believe Family First is a giant step forward in
terms of requiring the background checks in congregate care
facilities. I should note that we have had a requirement in
place for some time that requires that States address safety
concerns with regard to staff in a much more general way. It
has been a part of our programs where we have found that States
have not, across the board, done all that well with compliance.
Under Family First, I believe we have a greater opportunity
to enforce the more specific requirement through our review
processes. The way that we would primarily review that from the
Federal level is with our title IV-E eligibility reviews, where
we would look at whether or not there was evidence that the
criminal background checks had been conducted or not. We will
be revising those procedures, those forms and that whole
process to comport with Family First as we go into full
implementation.
Mr. LAHOOD. And I guess thinking ahead with full
implementation, so if there is a State that is deficient in
terms of the standard and proper oversight----
Mr. MILNER. Yes.
Mr. LAHOOD [continuing]. Or enforcement, what happens?
Mr. MILNER. They are required to enter into a program
improvement plan and make the correction. Typically, we are not
able to withhold Federal funds until they have had an
opportunity to correct whatever the problem is. So we work with
the States through our regional offices to develop a process
for making the corrective action. If they are not able to
comply with their plan, then they would be subject to Federal
withholding of funds.
Mr. LAHOOD. Okay. Thank you. Those are all my questions.
Chairman SMITH. Thank you. I want to touch on another issue
here, and then I will certainly go to Mr. Davis for some
follow-up as well. Maintenance of effort. We know that Family
First was intended to supplement, not replace the State
efforts.
Mr. MILNER. Sure.
Chairman SMITH. And so the need to calculate the
maintenance of effort is certainly there. Is the Bureau going
to provide guidance to States in terms of how they can
calculate their maintenance of effort?
Mr. MILNER. Yes, we will.
Chairman SMITH. And when can the States expect those----
Mr. MILNER. I would anticipate that that is going to be a
part of our program instructions on the prevention program
itself. The MOE is specific to the prevention services program,
and the PI is where we would be able to cover that later this
year when we issue that guidance.
Chairman SMITH. Okay. And in terms of previous prevention
expenditures, my understanding is that they are intended to
mirror the services and populations that are allowable under
Family First. Is that correct?
Mr. MILNER. I am not sure that I can give you a definitive
response on that.
Chairman SMITH. Okay. If you could follow up on that.
Mr. MILNER. Surely.
Chairman SMITH. Maintenance of effort is not limited to
just funds that were spent in child welfare prior to Family
First because for nonwaiver State mental health, substance
abuse and parenting were not funded under child welfare. Is
that correct?
Mr. MILNER. Correct.
Chairman SMITH. And for waiver States that may have been
spending on substance abuse, mental health, and parenting, how
do you see them calculating their maintenance of effort?
Mr. MILNER. We are going to have to give you something more
specific on that. I am not immersed in the maintenance of
effort part of that. It is far too technical for me to be able
to give you any hint of a satisfactory response, but we will
give you something in writing on that.
Chairman SMITH. Okay. Well, I think all the States would
appreciate that and certainly there is----
Mr. MILNER. Surely.
Chairman SMITH [continuing]. I know, a great deal of
interest on that.
So with that, Mr. Davis, do you have any follow-up?
Mr. DAVIS. Thank you. Thank you, again, Mr. Chairman. And I
also thank you again for holding this very important hearing.
It is my understanding that many kinship navigator programs
have not been evaluated so that they can meet an evidence-based
standard.
Mr. MILNER. Yes.
Mr. DAVIS. What is HHS doing to support identification and
development of additional evidence-based models for these
important services?
Mr. MILNER. I mentioned a little bit earlier, we fund a
contract right now in collaboration with our Office of
Planning, Research and Evaluation that is designed to build the
evidence for a number of programs that are out there. Kinship
navigator programs are a part of that effort.
In addition to that, we are looking to the programs that do
exist, and we have asked for comment on that, particularly in
the Federal Register announcement that we just put out the
criteria for evidence-based practices.
In addition, we will be looking at the one program that we
think might have an evidence base behind it to see if it
comports with the criteria that are in Family First.
Mr. DAVIS. Congress provided appropriated funds so that
every State could receive funding for kinship navigator
programs now, as a bridge to the Family First funding. The
deadline for States to tell HHS their planned use of these
funds was last week.
Mr. MILNER. Correct.
Mr. DAVIS. Can you tell us how many States applied and how
HHS plans to reallocate any funds which were not claimed?
Mr. MILNER. Forty-five States, two territories, and eight
Tribes have indicated to us that they intend to apply for those
funds. Since it is not every one of the States, there will be
some balance that is left over, and we will have to determine
how we are going to distribute that balance of funds across
those who do apply.
Mr. DAVIS. And my last question is that obviously, home
visiting is an evidence-based intervention, which has been
demonstrated to improve outcomes for pregnant mothers,
parenting mothers and fathers, and their children. In your work
on the evidence clearinghouse, are you leveraging the MIECHV
clearinghouse, especially to find interventions appropriate for
pregnant and parenting foster youth?
Mr. MILNER. I am unable to tell you specifically which
clearinghouses we are looking at, but I can tell you that we
are looking very broadly. We also recognize that the home
visiting programs have shown a tremendous amount of
effectiveness in that area, and we have every interest and
every desire to make sure that they are accessible and
available to States and Tribes under the title IV-E prevention
services funding.
Mr. DAVIS. Thank you for being with us. Thank you, Mr.
Chairman, for this very important hearing, and I yield back the
balance of my time.
Chairman SMITH. Thank you, Mr. Davis. And certainly thank
you, Mr. Milner, for your participation here today. Please be
advised that Members will have 2 weeks to submit written
questions to be answered later in writing. Those questions and
your answers will be made part of the formal hearing record.
Now, I know that there were several questions asked today
that you will need to follow up on. Can you say how long that--
how long it might take for you to be able to follow up on these
questions that were posed earlier?
Mr. MILNER. If we have the answers, we should be able to
get those to you without much of a delay at all. I can't tell
you that we have even formulated the answers to all of those
questions, particularly when it gets to things like maintenance
of effort and what is going to be included in that. We are
still very much in the process of consulting with States and
with Tribes.
As I mentioned, yesterday we had a call with States to hear
their concerns and to get their input. Twenty-eight States
participated in that. One of those calls is going on today.
Three more will be taking place. We have two more listening
sessions coming up in August in Atlanta and in Denver coming up
in August. We have several sessions planned with the Tribes to
hear their unique concerns around this. I don't want to
shortcut that consultation process, and that very valuable
input by making all of those decisions without giving States
and Tribes full opportunity to share their concerns with us. So
we may not have answers to all of those questions, and if we
don't have answers, we will absolutely let you know that and
respond when we do have the answers.
Chairman SMITH. Certainly. And I think you can appreciate
the desire by the States and Tribes to have the timely
responses.
Mr. MILNER. I do.
Chairman SMITH. With that I want to say thank you again,
and the Subcommittee stands adjourned.
[Whereupon, at 11:40 a.m., the Subcommittee was adjourned.]
[Member Submissions for the Record follow:]
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[Public Submissions for the Record follow:]
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
| MEMBERNAME | BIOGUIDEID | GPOID | CHAMBER | PARTY | ROLE | STATE | CONGRESS | AUTHORITYID |
|---|---|---|---|---|---|---|---|---|
| Brady, Kevin | B000755 | 8164 | H | R | COMMMEMBER | TX | 115 | 1468 |
| Davis, Danny K. | D000096 | 7927 | H | D | COMMMEMBER | IL | 115 | 1477 |
| Kind, Ron | K000188 | 8216 | H | D | COMMMEMBER | WI | 115 | 1498 |
| Larson, John B. | L000557 | 7866 | H | D | COMMMEMBER | CT | 115 | 1583 |
| Thompson, Mike | T000460 | 7806 | H | D | COMMMEMBER | CA | 115 | 1593 |
| Crowley, Joseph | C001038 | 8068 | H | D | COMMMEMBER | NY | 115 | 1604 |
| Nunes, Devin | N000181 | 7826 | H | R | COMMMEMBER | CA | 115 | 1710 |
| Sanchez, Linda T. | S001156 | 7844 | H | D | COMMMEMBER | CA | 115 | 1757 |
| Higgins, Brian | H001038 | 8088 | H | D | COMMMEMBER | NY | 115 | 1794 |
| Marchant, Kenny | M001158 | 8766 | H | R | COMMMEMBER | TX | 115 | 1806 |
| Reichert, David G. | R000578 | 8212 | H | R | COMMMEMBER | WA | 115 | 1810 |
| Buchanan, Vern | B001260 | 7885 | H | R | COMMMEMBER | FL | 115 | 1840 |
| Roskam, Peter J. | R000580 | 7926 | H | R | COMMMEMBER | IL | 115 | 1848 |
| Smith, Adrian | S001172 | 8040 | H | R | COMMMEMBER | NE | 115 | 1860 |
| Jenkins, Lynn | J000290 | 7950 | H | R | COMMMEMBER | KS | 115 | 1921 |
| Paulsen, Erik | P000594 | 8003 | H | R | COMMMEMBER | MN | 115 | 1930 |
| Chu, Judy | C001080 | 7837 | H | D | COMMMEMBER | CA | 115 | 1970 |
| Reed, Tom | R000585 | 8090 | H | R | COMMMEMBER | NY | 115 | 1982 |
| Sewell, Terri A. | S001185 | 7792 | H | D | COMMMEMBER | AL | 115 | 1988 |
| Schweikert, David | S001183 | 7802 | H | R | COMMMEMBER | AZ | 115 | 1994 |
| Renacci, James B. | R000586 | 8106 | H | R | COMMMEMBER | OH | 115 | 2048 |
| Kelly, Mike | K000376 | 8708 | H | R | COMMMEMBER | PA | 115 | 2051 |
| Noem, Kristi L. | N000184 | 8147 | H | R | COMMMEMBER | SD | 115 | 2060 |
| Black, Diane | B001273 | 8153 | H | R | COMMMEMBER | TN | 115 | 2063 |
| DelBene, Suzan K. | D000617 | 8374 | H | D | COMMMEMBER | WA | 115 | 2096 |
| Walorski, Jackie | W000813 | H | R | COMMMEMBER | IN | 115 | 2128 | |
| Holding, George | H001065 | H | R | COMMMEMBER | NC | 115 | 2143 | |
| Wenstrup, Brad R. | W000815 | H | R | COMMMEMBER | OH | 115 | 2152 | |
| Rice, Tom | R000597 | H | R | COMMMEMBER | SC | 115 | 2160 | |
| Smith, Jason | S001195 | H | R | COMMMEMBER | MO | 115 | 2191 | |
| Curbelo, Carlos | C001107 | H | R | COMMMEMBER | FL | 115 | 2235 | |
| Bishop, Mike | B001293 | H | R | COMMMEMBER | MI | 115 | 2249 | |
| LaHood, Darin | L000585 | H | R | COMMMEMBER | IL | 115 | 2295 | |
| Doggett, Lloyd | D000399 | 8181 | H | D | COMMMEMBER | TX | 115 | 303 |
| Johnson, Sam | J000174 | 8159 | H | R | COMMMEMBER | TX | 115 | 603 |
| Levin, Sander M. | L000263 | 7997 | H | D | COMMMEMBER | MI | 115 | 683 |
| Lewis, John | L000287 | 7902 | H | D | COMMMEMBER | GA | 115 | 688 |
| Neal, Richard E. | N000015 | 7967 | H | D | COMMMEMBER | MA | 115 | 854 |
| Blumenauer, Earl | B000574 | 8116 | H | D | COMMMEMBER | OR | 115 | 99 |
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