Child Welfare: HHS Actions Would Help States Prepare Youth in the
Foster Care System for Independent Living (12-JUL-07,		 
GAO-07-1097T).							 
                                                                 
Congress passed the Foster Care Independence Act of 1999 (FCIA), 
which doubled annual federal funds for independent living	 
programs to $140 million. This testimony discusses (1) states'	 
FCIA funding allocations, (2) services provided and remaining	 
challenges, (3) state coordination of programs to deliver	 
services, and (4) the states and the Department of Health and	 
Human Services' (HHS) Administration for Children and Families'  
(ACF) progress toward meeting program accountability		 
requirements. This testimony is primarily based on our 2004	 
report on FCIA (05-25), with updated information from our 2007	 
testimony on state child welfare challenges (07-850T). To conduct
the 2004 work, we surveyed state independent living coordinators,
conducted 4 state site visits, and reviewed states' plans and	 
annual reports. Updated information from our 2007 testimony was  
taken primarily from a 2006 survey of state child welfare	 
directors.							 
-------------------------Indexing Terms------------------------- 
REPORTNUM:   GAO-07-1097T					        
    ACCNO:   A72526						        
  TITLE:     Child Welfare: HHS Actions Would Help States Prepare     
Youth in the Foster Care System for Independent Living		 
     DATE:   07/12/2007 
  SUBJECT:   Child care programs				 
	     Child welfare					 
	     Federal aid to states				 
	     Federal funds					 
	     Foster children					 
	     Intergovernmental relations			 
	     Program evaluation 				 
	     Refunds to government				 
	     Reporting requirements				 
	     State-administered programs			 
	     Strategic planning 				 
	     Surveys						 
	     HHS John H. Chafee Foster Care			 
	     Independence Program				 
                                                                 

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GAO-07-1097T

   

     * [1]Background
     * [2]FCIA Increased Independent Living Allocations for Most State
     * [3]States Expanded and Improved Services for Youth after FCIA,
     * [4]States Reported Increased Coordination with Federal and Stat
     * [5]States' and HHS's Actions in Response to FCIA Requirements H
     * [6]Concluding Observations
     * [7]GAO Contact and Staff Acknowledgments
     * [8]GAO's Mission
     * [9]Obtaining Copies of GAO Reports and Testimony

          * [10]Order by Mail or Phone

     * [11]To Report Fraud, Waste, and Abuse in Federal Programs
     * [12]Congressional Relations
     * [13]Public Affairs

Testimony

Before the Subcommittee on Income Security and Family Support, Committee
on Ways and Means, U.S. House of Representatives

United States Government Accountability Office
GAO

For Release on Delivery
Expected at 10:00 a.m. EDT
Thursday, July 12, 2007

CHILD WELFARE

HHS Actions Would Help States Prepare Youth in the Foster Care System for
Independent Living

Statement of Cornelia M. Ashby, Director
Education, Workforce, and Income Security Issues

GAO-07-1097T

July 12, 2007

Mr. Chairman and Members of the Subcommittee:

Thank you for inviting me here today to discuss the needs of youth who
leave the foster care system each year without the support of an adoptive
or other permanent home. As you are aware, almost 40 percent of the
estimated 513,000 children in foster care are age 13 or older, and over
24,000 youth left the foster care system in 2005 as emancipated youth
without a permanent living arrangement. Research studies have shown that
many of these young people face serious problems once on their own,
including homelessness, a lack of education and stable employment, and
difficulties obtaining medical and mental health services. In response to
concerns that youth leave foster care poorly prepared to live
self-sufficiently, in 1986 Congress created the Independent Living
Program, which was further strengthened with the passage of the Foster
Care Independence Act of 1999 (FCIA) and creation of the John H. Chafee
Foster Care Independence Program (Chafee Program). Under the new program,
overall federal funding doubled for independent living programs from $70
million to $140 million.^1 In addition to providing increased funding,
FCIA resulted in other significant changes for the independent living
program.

My testimony today will focus on four key issues as they relate to the
implementation of the Chafee Program:

           1. how states' funding allocations for independent living programs
           compare when considering the number of youth eligible for
           services,
           2. the extent to which states have expanded independent living
           services and age groups for youth in foster care after the passage
           of FCIA and what challenges remain,
           3. the extent to which states have used other federal and state
           programs to coordinate the delivery of independent living services
           to foster care youth, and
           4. how the states and the Department of Health and Human Services
           (HHS) have fulfilled the program accountability provisions of the
           law and assessed the effectiveness of independent living services.

^1The Chafee Program receives funding under Title IV-E of the Social
Security Act. Title IV-E authorizes the appropriation of federal funds to
states for the purpose of developing and operating foster care and
transitional independent living programs and providing payments to
adoptive parents of eligible foster children with special needs. In 2006,
the adoption program received approximately $1.8 billion, and the foster
care program received approximately $4.6 billion.

My comments are based on the findings of a report GAO issued in 2004,^2
with updated information from a May 2007 testimony on challenges facing
state child welfare systems.^3 The information reported in the 2004 report
was based on survey responses from independent living coordinators in all
50 states and the District of Columbia regarding their experiences in
developing and implementing their Chafee Programs in federal fiscal year
2003. Where appropriate, we compared those responses to information we
gathered on state independent living programs operating in federal fiscal
year 1998. We analyzed federal financial and foster care data. We also
analyzed Chafee Program plans from 49 states, the District of Columbia,
and Puerto Rico for 2001-2004, and 90 annual progress and services reports
for 2001 and 2002. We visited 4 states--Connecticut, Florida, Texas, and
Washington--and two local areas within each state, where we spoke with
state and local officials, caseworkers, youth, foster parents, and
contract providers. Finally, we interviewed HHS officials, federal
contractors, and child welfare experts, and reviewed relevant documents
and literature. We included updated information--taken primarily from our
2006 survey of state child welfare directors--from our 2007 testimony on
challenges states face in improving outcomes for children. In addition, we
included additional information from reports issued by the American Public
Human Services Association, the Congressional Research Service, and the
National Resource Center for Youth Services. We conducted our work in
accordance with generally accepted government auditing standards.

In summary,

           o States' funding allocations for independent living programs
           effectively ranged from a maximum of approximately $500 to $2,300
           for each foster care youth who was eligible for independent living
           services, according to data available at the time of our 2004
           report. Funding varied because of differences in states'
           eligibility requirements and the funding formula used to allocate
           funds.

           o Although our 2004 survey of state independent living
           coordinators showed that 40 states reported expanding existing
           independent living services to younger youth and 36 states
           reported serving youth older than they had previously served,
           states varied in their ability to engage youth and to provide key
           services. About one-third of reporting states were serving less
           than half of their eligible foster care youth population, while an
           equal percentage of states were serving three-fourths or more, and
           states we visited reported that gaps in the availability of
           critical services contributed to the differences in proportion of
           youth served. For example, securing safe and secure housing was
           identified as a challenge by youth and program officials in the 4
           states we visited, including limited affordable housing in costly
           urban areas and scarce rental housing in rural areas. In addition,
           our more recent survey of state child welfare directors in 2006
           showed that 31 states remained dissatisfied with housing for youth
           transitioning to independence, and similar numbers of states were
           dissatisfied with the availability of mental health, substance
           abuse, and dental health services.

           o Almost all states that we surveyed in 2004 reported an increase
           in coordination with some federal, state, and local programs, but
           linkages with other federal and state youth-serving programs were
           not always in place to increase services available across local
           areas. Many programs exist at the federal, state, or local level
           that can be used to provide or supplement independent living
           services, and each state reported in our survey using some of
           these programs to provide services. Despite these coordination
           efforts, some states may not make full use of the available
           resources. Inconsistent availability of information on the array
           of programs that were operating in each state and local area was
           cited as a challenge in promoting coordination in both our prior
           and more current work.

           o States and HHS have taken action to fulfill the accountability
           provisions of FCIA, but little information is available to assess
           the effectiveness of independent living services. At the time of
           our review in 2004, all states had developed their initial
           multiyear plans for their programs and submitted annual reports to
           the Administration for Children and Families (ACF), but using
           these plans and the reports to assess state performance was
           hindered by inconsistencies between the plans and reports, an
           absence of goals and baseline information to use in measuring
           progress, and incomplete information on outcomes for all youth who
           received services. Although in 2000 ACF began taking steps to
           develop an information system that will allow it to capture data
           on the characteristics, services, and outcomes of youth in
           independent living programs, it has not yet implemented the final
           regulations directing states to begin collecting data and tracking
           outcomes. ACF is also conducting an evaluation of selected
           independent living programs.

^2See GAO, Foster Youth: HHS Actions Could Improve Coordination of
Services and Monitoring of States' Independent Living Programs,
[14]GAO-05-25 (Washington, D.C.: Nov.18, 2004).

^3See GAO, Child Welfare: Additional Federal Action Could Help States
Address Challenges in Providing Services to Children and Families,
[15]GAO-07-850T (Washington, D.C.: May 15, 2007).

In our 2004 report, we recommended that the Secretary of HHS improve the
availability of information on the array of federal programs that could be
used to assist youth transitioning out of foster care. HHS did not comment
on this recommendation. Our 2007 testimony cites a similar recommendation
that HHS take action to improve awareness of and access to federal social
services by such means as modifying the Catalog of Federal Domestic
Assistance. HHS disagreed with this recommendation, stating that it was
insufficient to address the problem and incorrectly implied that
caseworkers were not already aware of existing resources. We continue to
support the recommendation based on the results of our work.

Our 2004 report also recommended that HHS improve existing processes for
monitoring states' progress in meeting the needs of current and former
foster care youth by developing a standard reporting format for state
plans and progress reports, and implementing a uniform process regional
offices can use to assess states' progress in meeting the needs of youth
in foster care and those recently emancipated from care. HHS continues to
disagree with our recommendation to provide a standard reporting format in
that it would be overly prescriptive and impose an unnecessary burden on
states. In addition, HHS reported that when standard data are available
through the National Youth in Transition Database, the agency would be
better positioned to determine how best to assess state performance. In
the continued absence of implementation of such a database, we continue to
support our recommendation to monitor state performance through
modification of existing state reporting requirements. HHS agreed with our
recommendation to implement a uniform process that regional offices can
use to assess states' progress, but has not yet done so.

Background

In 1986, Congress amended Title IV-E of the Social Security Act to
authorize federal funds targeted to assist youth aged 16 and over in
making the transition from foster care to living independent of the child
welfare system and created the Independent Living Program. This program
was designed to prepare adolescents in foster care to live
self-sufficiently once they exited the child welfare system. Several
amendments were made to the Independent Living Program over the years, but
the passage of FCIA and the creation of the Chafee Program represented the
most significant changes in the federal Independent Living Program since
its creation. FCIA doubled the federal funds available for independent
living programs to $140 million each year.^4 These funds are allocated to
states based on their share of the nation's foster care population.^5

In addition to providing increased funding, FCIA eliminated the minimum
age limit of 16 years and provided states with the flexibility to define
the age at which children in foster care are eligible for services to help
them prepare for independent living, as long as services are provided to
youth who are likely to remain in foster care until 18 years of age.

The law also provided several new services to help youth make the
transition to adulthood.

           o It allowed states to use up to 30 percent of their state
           allotment for room and board for former foster care youth up to
           age 21.

           o It allowed states the option to expand Medicaid coverage to
           former foster care adolescents between 18 and 21.

           o Title IV-E was amended again in 2002 to provide foster care
           youth vouchers for postsecondary education and training under the
           Education and Training Vouchers (ETV) program and authorized an
           additional $60 million for states to provide postsecondary
           education and training vouchers up to $5,000 per year per youth.
           Eligible participants include youth otherwise eligible for
           services under the states' Chafee Programs, youth adopted from
           foster care after attaining the age of 16, and youth participating
           in the voucher program on their 21st birthday (until they turn 23
           years old) as long as they are enrolled in a postsecondary
           education or training program and are making satisfactory progress
           toward completion of that program.

^4The actual amount divided among the states, the District of Columbia,
and Puerto Rico totaled $137.9 million. Under the law, 1.5 percent of the
$140 million is reserved for evaluation, technical assistance, performance
measurement, and data collection activities conducted by HHS. States must
provide matching contributions of 20 percent to receive Chafee Program
funds. The matching contribution may be in cash or in-kind contributions
of services, equipment, or property.

^5A hold-harmless clause in FCIA ensures that states with smaller
populations received either $500,000 or the amount of independent living
funds they received in federal fiscal year 1998, whichever amount is
greater.

In addition, the law required that states make every effort to coordinate
their Chafee Programs with other federal and state programs for youth,
such as the Runaway and Homeless Youth Program, abstinence education
programs, local housing programs, programs for disabled youth, and
school-to-work programs offered by high schools or local workforce
agencies. Further, states were required to coordinate their programs with
each Indian tribe in the state and offer the state's independent living
services to Indian children.

To receive funds under the Chafee Program, states were required to develop
multiyear plans describing how they would design and deliver programs and
to submit program certifications. The multiyear Chafee plans must include
a description of the state's program design, including its goals,
strategies, and its implementation plan for achieving the purposes of the
law. States were also required to certify that they would operate a
statewide independent living program that complied with the specific
aspects of the law, such as providing training to foster parents, adoptive
parents, workers in group homes, and case managers on issues confronting
adolescents preparing for independent living. Further, to receive annual
funds, ACF required states to submit annual reports that described the
services provided and activities conducted under their Chafee Programs,
including information on any program modifications and their current
status of implementation; provide a record of how funds were expended; and
include a description of the extent to which the funds assisted youth age
18 to 21 in making the transition to self-sufficiency.

FCIA also required that HHS develop and implement a plan to collect
information needed to effectively monitor and measure a state's
performance, including the characteristics of youth served by independent
living programs, the services delivered, and the outcomes achieved.
Further, FCIA required HHS to conduct evaluations of independent living
programs deemed to be innovative or of potential national significance
using rigorous scientific standards to the maximum extent practicable,
such as random assignment to treatment and control groups.

FCIA Increased Independent Living Allocations for Most States and Allocations
per Youth Vary by State

While overall federal funding for state independent living programs
doubled with the passage of FCIA, there were significant variations in the
changes to state allocations, and the maximum amount of funds available at
the time of our 2004 report for each eligible foster care youth ranged
between $476 and $2,300. Under the previous independent living program,
states received funds ranging from $13,000 in Alaska to more than $12
million in California. In the first year of funding under FCIA, Alaska and
8 other states received the guaranteed minimum of $500,000, while
California received more than $27 million (see table 1). Some states were
unable to spend all of their federal allocations in the first 2 years of
increased funding under the program. For example, in 2001, 20 states
returned nearly $10 million in federal funding to HHS, and in 2002, 13
states returned more than $4 million. ACF regional officials reported that
one reason for these unspent funds was that some states did not initially
have the infrastructure in place to quickly absorb the influx of funds.
Data provided in a July 2007 Congressional Research Service memo to
Congress showed that 9 states returned less than 1 percent of total Chafee
funding in 2004 (see app. I).

Table 1: Changes in Funding Allocations across States since the Passage of
FCIA

                                                            Percentage change 
State                1998 allocation 2001 allocation  over 1998 allocation 
District of Columbia      $1,091,992      $1,091,992                     0 
Louisiana                  1,358,131       1,358,131                     0 
New Jersey                 2,297,848       2,297,848                     0 
New York                  11,585,958      12,313,109                     6 
Pennsylvania               4,638,225       5,304,231                    14 
Alabama                    1,038,490       1,288,304                    24 
Virginia                   1,361,561       1,698,102                    25 
Maine                        565,888         737,309                    30 
West Virginia                521,302         740,816                    42 
Mississippi                  514,444         747,127                    45 
Wisconsin                  1,554,305       2,252,837                    45 
Michigan                   4,171,796       6,109,567                    46 
New Hampshire                320,326         500,000                    56 
Ohio                       2,860,992       4,693,625                    64 
Kentucky                     791,557       1,332,019                    68 
Vermont                      295,633         500,000                    69 
Minnesota                  1,142,066       2,102,991                    84 
Oregon                       930,799       1,723,115                    85 
South Carolina               579,606       1,085,860                    87 
Rhode Island                 314,840         612,710                    95 
Indiana                    1,019,970       2,088,263                   105 
Montana                      244,190         504,007                   106 
Connecticut                  754,518       1,567,892                   108 
Colorado                     825,854       1,785,766                   116 
California                12,481,777      27,570,079                   121 
Kansas                       717,477       1,583,555                   121 
Missouri                   1,295,026       2,940,120                   127 
New Mexico                   207,149         500,000                   141 
Delaware                     203,034         500,000                   146 
Washington                   825,168       2,030,990                   146 
Texas                      1,841,708       4,600,585                   150 
Arkansas                     270,940         682,373                   152 
Iowa                         449,966       1,134,717                   152 
Maryland                   1,238,095       3,143,032                   154 
North Carolina             1,045,349       2,650,713                   154 
Georgia                    1,098,852       2,803,131                   155 
South Dakota                 193,430         500,000                   158 
North Dakota                 192,058         500,000                   160 
Utah                         202,348         531,358                   163 
Nebraska                     435,562       1,293,213                   197 
Oklahoma                     620,076       1,910,598                   208 
Tennessee                    777,838       2,523,776                   224 
Illinois                   2,817,094       9,413,899                   234 
Nevada                       153,647         517,800                   237 
Massachusetts                635,852       2,610,972                   311 
Idaho                        107,004         500,000                   367 
Arizona                      347,763       1,677,998                   383 
Florida                      987,045       8,016,425                   712 
Wyoming                       44,585         500,000                 1,021 
Hawaii                        17,834         514,994                 2,788 
Alaska                        13,032         500,000                 3,737 

Source: GAO analysis of HHS data.

Notes: As required by FCIA, no state received less than its federal fiscal
year 1998 allotment under the Title IV-E Independent Living Program.
Federal fiscal year 2001 was the first year states received full funding
under FCIA.

Allocations do not account for unobligated or unliquidated funds.

Puerto Rico is not included in this analysis because the territory did not
receive independent living funds in 1998. The 2001 allocation to Puerto
Rico totaled $1,814,052.

At the time of our 2004 report, we could not determine the exact amount of
funding states had available to spend on each youth eligible for
independent living services because of the lack of data on eligible youth
emancipated from foster care. However, available data at that time on
youth in foster care suggest that states may have different amounts of
funds available for services to youth in foster care. We compared each
state's 2004 FCIA allocation with its 2002 population of eligible youth in
foster care.^6 This comparison showed that maximum funding for independent
living services ranged from $476 per foster care youth in West Virginia to
almost $2,300 per foster care youth in Montana.^7 These differences were
due in part to the new provision that allowed states to define the age
ranges within which youth were eligible for independent living services.
For example, 4 states reported in our survey offering independent living
services to youth at age 12, while 27 states reported offering services at
age 14.^8 In addition, the funding formula is based on the total number of
all children in foster care. However, some states have a larger share of
youth eligible for independent living services than other states, even
when their eligibility age range is the same. For example, of the 15
states reporting in our survey that youth are eligible for services
between the ages of 14 and 21, 3 states had 25 percent or less of their
foster care population within this age range, while in 3 other states,
this age range accounted for over 40 percent of the total foster care
population.^9

^6We calculated this figure using financial data from HHS on the FCIA
funding allocations in federal fiscal year 2004 and Adoption and Foster
Care Analysis and Reporting System (AFCARS) data from federal fiscal year
2002 because funding allocations are calculated using foster care
population data from AFCARS 2 years prior to the funding year. These
calculations also included states' 20 percent match requirement. However,
states may use other funds to pay for services, and these calculations do
not reflect any additional funding. To determine the eligible population
for each state, we used the age ranges that states reported in our 2004
survey and AFCARS data on the numbers of youth in each age group. For
example, Alabama reported in our survey serving youth between 14 and 21
with independent living services. According to data the state reported to
AFCARS, 2,081 youth in this age range were in care in Alabama in federal
fiscal year 2002. However, this calculation excludes youth emancipated
from foster care, since AFCARS does not capture this information.

^7Nationwide, the average funding for independent living services
available per eligible youth in foster care was about $1,090 in federal
fiscal year 2004.

^8According to results from our 2004 survey, 4 states began services at
age 12, 7 states began services at age 13, 27 states began services at age
14, 9 states began services at age 15, and 4 states began services at age
16.

^9These calculations are based on AFCARS data, which do not include
emancipated youth.

States Expanded and Improved Services for Youth after FCIA, but Reported That
Gaps in Critical Services Remain

In our 2004 survey, 40 states reported expanding services to youth younger
than they had previously served, and 36 states reported serving older
youth, but states reported service gaps in critical areas, such as mental
health and housing. The number of states that reported providing core
independent living services, such as independent living skills
assessments, daily living skills training, and counseling to youth younger
than 16 more than doubled after FCIA. Similarly, more states reported
offering these supports and services to youth who were emancipated from
foster care.

Many states also began to offer the new services to support youth that
emancipated from foster care. These services include the Education and
Training Vouchers, Medicaid health insurance, and assistance with room and
board.

           o ETV: All states, the District of Columbia, and Puerto Rico began
           receiving funds under the ETV program to assist youth seeking
           postsecondary education, but 26 states did not spend all of the
           funding received (see app. II). A report from the National
           Resource Center for Youth Development showed that states provide a
           range of benefits to youth eligible for ETVs.^10 Over 90 percent
           of 38 state independent living coordinators responding to a survey
           reported offering financial support to youth for room and board,
           school supplies, equipment and uniforms, school-related fees, and
           transportation costs. Eighty-four percent of states made payments
           for child care for the dependents of youth, and 60 percent of
           state reported making payments for college or university health
           plans on behalf of youth.^11 States were challenged to spend all
           of their funding allotment. Mississippi returned almost all of its
           2004 ETV funds, and 14 other states returned over 20 percent of
           their funding allotment.^12

           o Medicaid: Recent information from the American Public Human
           Services Association shows that all states are now using or
           planning to use the Chafee option or other means to extend
           Medicaid coverage to youth. In our 2004 survey, 31 of 50 state
           independent living coordinators had reported offering Medicaid
           benefits to at least some emancipated youth to help them maintain
           access to health care benefits while they transitioned to
           independence. In 2007, the American Public Human Services
           Association reported that 22 states planned or have already
           started using the Chafee option to offer Medicaid coverage to
           youth who age out of foster care.^13 The study also found that the
           remaining 28 states and the District of Columbia were reported to
           be using other methods, such as the State Children's Health
           Insurance Program or the Medicaid waiver demonstration program, to
           extend coverage to youth.

           o Housing assistance: In our 2004 survey, 46 states reported that
           they offered assistance with room and board to youth who had been
           emancipated from foster care, and the 4 states we visited reported
           offering a range of housing supports to assist youth. At the time
           of our visit, Connecticut provided several housing options to meet
           the needs of youth at varying levels of independence, including
           group homes, supervised apartment sites, and unsupervised
           apartment sites with periodic visits from case managers. While 3
           other states we visited offered a more limited supply of housing
           options, all provided some type of housing subsidy or placement.

           o Existing services: Chafee Program funds were also used to
           improve the quality of existing independent living services and
           refocus the attention of their programs, according to state
           officials we visited. For example, local officials in Florida said
           that prior to FCIA, training in daily living skills was provided
           haphazardly, and in many cases unqualified staff taught classes
           even though such training was considered a core component of their
           independent living program. At the time of our visit, Florida
           officials said that the state redesigned staff training, improved
           instructor quality, and was better prepared to provide youth with
           the skills necessary to live independently outside of the foster
           care system.

^10See Michelle L. Kessler, Educating Youth in Care: The First Year of
Education and Training Vouchers (Tulsa, Oklahoma: 2004).

^11Of the 38 responding states, 54 percent also indicated that they pay
for other tangible benefits such as tutoring, Internet access, computers,
books, medications required to allow youth to be successful with their
studies, payment for housing over the holidays and vacations when dorms
are closed, preparatory tests, and study materials.

^12Overall, more than 14 percent of 2004 ETV funding was returned to the
U.S. Treasury. As states have 2 years to spend these funds, information on
later years is not currently available.

^13Arizona, California, Florida, Indiana, Iowa, Kansas, Massachusetts,
Mississippi, Nevada, New Jersey, Oklahoma, Rhode Island, South Carolina,
South Dakota, Texas, Utah, and Wyoming reported enacting the Chafee
Medicaid option. Maryland, Missouri, New Mexico, North Carolina, and
Wisconsin reported planning to pursue the use of the Chafee Medicaid
option. See American Public Human Services Association, Medicaid Access
for Youth Aging Out of Foster Care (Washington, D.C.: 2007).

States differed in the proportion of eligible youth served under their
respective independent living programs. In our 2004 survey, 40 states
reported serving about 56,000 youth--or approximately 44 percent of youth
in foster care who were eligible for independent living services in these
states.^14 About one-third of reporting states were serving less than half
of their eligible foster care youth population, while an equal percentage
of states were serving three-fourths or more. While states expanded
eligibility to younger youth, most services continued to be directed at
youth age 16 and older in most of the states we visited.

Certain gaps in the availability of critical services were reported, which
may have contributed to the challenge of serving higher numbers of
eligible youth.^15 States also reported that these challenges were more
prominent in rural areas. Service gaps included the following:

           o Mental health services: Youth in foster care often require
           mental health services continuing beyond emancipation. However,
           states continue to be challenged in providing youth with a smooth
           transition between the youth and adult mental health systems. Of
           the 4 states we visited in 2004, 3 cited difficulties due to more
           stringent eligibility requirements in the adult system, different
           levels of services, and long waiting lists for services.
           Challenges with mental health services remained in 2006, when 32
           state child welfare directors responding to our survey reported
           dissatisfaction with the level of mental health services.^16

           o Mentoring services: Research studies indicate that the presence
           of positive adult role models is critical for youth in foster care
           because family separations and placement disruptions have been
           found to hinder the development of enduring bonds. Although the
           majority of states reported in our 2004 survey that they offered
           mentoring programs to youth, officials in the states we visited
           cited challenges in providing all youth with access to mentoring
           programs to establish and maintain such relationships.^17 For
           example, in Connecticut, one program director reported challenges
           recruiting adults to serve as mentors, especially men willing to
           make a 1-year commitment to an adolescent boy. In addition, some
           state and local officials and service providers seemed unclear on
           what should be included in a high-quality mentoring program and
           how to identify qualified service providers.

           o Securing safe and suitable housing: Providing appropriate
           housing also remains a critical service gap. Youth we spoke with
           across the 4 states we visited in 2004 said that locating safe and
           stable housing after leaving foster care was one of their primary
           concerns in their transition to independence, and state officials
           reported challenges meeting youths' housing needs. Youth reported
           difficulties renting housing because of a lack of an employment
           history, a credit history, or a cosigner. State and local
           officials in the states we visited said the availability of
           housing resources for foster youth during their initial transition
           from foster care depended on where they lived, and in some cases
           the benefits provided did not completely meet the needs of youth,
           or were available only to certain youth. For example, at the time
           of our visit, local officials in Washington reported that housing
           subsidies may not completely offset expenses for youth in
           expensive urban areas, like Seattle, and that rental housing in
           some rural areas was scarce. This service gap was identified by
           states again in our 2006 survey, as 31 state child welfare
           directors reported dissatisfaction with the level of housing for
           foster youth transitioning to independence.

           o Youth and foster family engagement: State and local officials,
           as well as service providers in the 4 states we visited said that
           it was difficult to get some youth to participate in the
           independent living programs and that foster parents were sometimes
           reluctant partners. While youth were generally offered incentives,
           such as cash stipends, to participate in daily living skills
           training or other activities, officials emphasized that
           participation is voluntary and it is critical for foster parents
           to support and encourage youth participation in the program.^18

^14We were unable to identify comparable data on the proportion of
eligible youth in foster care that received independent living services
prior to the passage of FCIA.

^15State and local administrators reported some similar gaps in our 1999
report. They noted that their independent living programs fell short in
key areas, including gaps in employment, daily living skills, and housing
services. See GAO, Foster Care: Effectiveness of Independent Living
Services Unknown, HEHS-00-13 (Washington, D.C.: Nov. 5, 1999).

^16Child welfare directors in many states were also dissatisfied with the
level of substance abuse services (31) and dental care services (29).
Dissatisfaction with physical health services and access to Medicaid was
cited by 10 states.

^17Forty-five states reported having mentoring services for youth in
foster care, and 39 states reported having mentoring services for
emancipated youth.

^18The National Resource Center for Youth Services--under contract with
HHS--reported in 2004 on a study conducted by the Casey Family Services,
which found that not all young adults accepted supports extended to them.
In a sample of 115 alumni of foster care, only 41 percent incurred
expenses for services after age 19. Some youth are simply ready to end
their relationship with the child welfare system when they are legally
able. Others, however, may not incur expenses for services because they
are not aware of the benefits that are available. See Kessler, Educating
Youth in Care.

States Reported Increased Coordination with Federal and State Programs to
Provide Independent Living Services to Youth, but Barriers Hinder Linkages
across Programs

After FCIA, 49 states reported increased coordination with a number of
federal, state, and local programs that can provide or supplement
independent living services, but officials from the 4 states we visited
reported several barriers in developing the linkages necessary to access
services under these programs across local areas. States we surveyed
reported working with a range of service provides, such as Job Corps,
workforce boards, and local housing agencies.^19

States we visited used different strategies to develop linkages among
state youth programs. Three of the states we visited reported establishing
state-level work groups that included representatives from the independent
living program and other state agencies to bring agency officials together
to discuss the needs of youth in foster care and possible strategies for
improving service delivery. For example, Florida's legislature mandated a
state-level work group to facilitate information sharing at the state
level among various agencies, such as the State Departments of Children
and Families and Education, the Agency for Workforce Innovation, and the
Agency for Health Care Administration. Additional strategies states
developed to establish linkages with other federal, state, or local
programs included establishing liaisons between agencies or programs or
through less formal collaborative arrangements. Officials also reported
developing linkages with other private resources in their communities,
such as business owners, to provide services to youth in the independent
living program.

Despite states' efforts, we continued to find in our 2006 survey that
states were least likely to address challenges in providing services such
as mental health that are typically provided outside of the child welfare
system by other agencies. Officials in the 4 states we visited in 2004
reported several barriers that hinder their ability to establish linkages
with other agencies and programs, including the lack of information on the
array of programs available in each state or local area and differences in
program priorities. Officials from 3 states said that they relied on local
officials to identify potential partners and initiate and maintain
coordination efforts, and while individuals in some local areas may have
developed successful collaborations with service providers in their area,
these relationships have not always been expanded statewide. To some
extent, this has been due to the fact that state and local child welfare
officials differ in their awareness of resources available from other
agencies. Some gaps in awareness may be partly due to turnover rates for
caseworkers reported by the states we visited.^20 Caseworkers' lack of
knowledge about available programs may have contributed to foster parents
and youth reporting that they were unaware of the array of services
available from other federal, state, or local programs. In addition,
officials cited barriers to establishing linkages with other federal and
state programs because of different program priorities. Differences in
performance goals among programs can affect the ability of independent
living staff to obtain services for foster youth from other agencies. In
North Carolina, state officials we visited in 2006 said that about 70
percent of children and families in the child welfare system received
services from multiple public agencies, and the Catalog of Domestic
Assistance (CFDA)--a repository of information on all federal assistance
programs--lists over 300 federal programs that provide youth and family
services. In October 2003, the White House Task Force for Disadvantaged
Youth recommended that the CFDA be modified to provide a search feature
that can be used to identify locations where federally funded programs
were operating.^21

^19Job Corps is an education and vocational training program administered
by the U.S. Department of Labor to service youth ages 16 through 24 years.
The Workforce Investment Act established workforce investment boards. Each
state workforce investment board is responsible for developing statewide
workforce policies and overseeing its local workforce investment boards.
The local workforce investment boards, in turn, are responsible for
developing local workforce policies and overseeing operations.

^20See also GAO, Child Welfare: HHS Could Play a Greater Role in Helping
Child Welfare Agencies Recruit and Retain Staff, [16]GAO-03-357
(Washington, D.C.: Mar. 31, 2003).

^21A similar model may be found on an HHS Web link,
[17]http://ask.hrsa.gov/pc/ , where users can enter a ZIP code to find the
closest community health center locations offering medical, mental,
dental, and other health services on a sliding fee scale.

States' and HHS's Actions in Response to FCIA Requirements Have Not Yet
Established Accountability for Independent Living Programs

All states developed multiyear plans as required under FCIA and submitted
annual progress reports to ACF for their independent living programs, but
the absence of standard comprehensive information within and across state
plans and reports precludes using them at the state and federal levels to
monitor how well the programs are working to serve foster care youth. HHS
has not yet implemented its plan to collect information to measure states'
program performance, and while some states reported collecting some data,
states have experienced difficulties in contacting youth to determine
their outcomes. HHS has begun to evaluate selected independent living
programs.

           o State plans and annual reports: All states developed state plans
           as required by FCIA that described independent living services
           they planned to provide to foster care youth and submitted annual
           reports to ACF, but for several reasons, these plans and reports
           cannot be used to assess states' independent living programs.
           While ACF officials stated that the plans and annual reports
           served as the primary method the agency used to monitor states'
           use of the Chafee Program funds, ACF did not require states to use
           a uniform reporting format, set specific baselines for measuring
           progress, or report on youths' outcomes. As a result, each state
           developed plans and reports that varied in their scope and level
           of detail, making it difficult to determine whether states had
           made progress in preparing foster youth to live
           self-sufficiently.^22

           On the basis of our review of plans from all 50 states and the
           District of Columbia covering federal fiscal years 2001 through
           2004, and annual reports for 45 states from federal fiscal years
           2001 and 2002, we found the following:

                        o Few states both organized the information in their
                        plans to address the purposes of FCIA and presented
                        specific strategies they would use to meet these
                        purposes.
                        o The plans vary in their usefulness in establishing
                        outcomes the states intended to achieve for youth.
                        o Annual reports for all 45 states contained
                        information that did not directly relate to
                        information in their state plan, making it unclear
                        whether the differences were due to service changes
                        or missing information.
                        o Of the 90 annual progress reports we reviewed, 52
                        reports did not include clear data that could be used
                        to determine progress toward meeting the goals of the
                        states' independent living programs.
								
^22We previously reported similar problems using state reports for federal
monitoring of independent living programs prior to FCIA and had
recommended that HHS establish a uniform set of data elements and a
standard reporting format for state reporting on independent living
programs. See GAO-HEHS-00-13.

           ACF officials said that they recognize the limitations of these
           documents as tools to monitor states' use of independent living
           program funds, but explained that they rely on states' to
           self-certify that their independent living programs adhere to FCIA
           requirements. Staff in ACF's 10 regional offices conduct direct
           oversight of the program by reviewing the plans and reports,
           interpreting guidance, and communicating with the states. However,
           officials in three offices reported during our 2004 review that
           their review of the documents was cursory and that the plans and
           annual reports do not serve as effective monitoring tools. In
           addition, ACF officials reported that the Child and Family
           Services Review (CFSR) used to evaluate the states' overall child
           welfare systems could serve as a tool to monitor independent
           living programs, but the CFSR is limited in the type and amount of
           data collected on youth receiving independent living services.
           o National Youth in Transition Database: ACF has not completed
           efforts to develop a plan to collect data on youths'
           characteristics, services, and outcomes in response to the FCIA
           requirement, and some states that are attempting to collect
           information on youths' outcomes are experiencing difficulties. In
           2000, ACF started to develop the National Youth in Transition
           Database (NYTD) to collect information needed to effectively
           monitor and measure states' performance in operating independent
           living programs. The agency issued proposed rules on July 14,
           2006, but as of July 2007, final rules governing the system have
           not been issued.^23

           The proposed rules include an approach to collect information on
           all youth who received independent living services, youth who are
           in foster care at age 17, and follow-up information on youth at
           ages 19 and 21. For any youth who receives independent living
           services from either the child welfare agency or another source
           supported by federal Chafee funds, the state must report a series
           of data elements, including the type of independent living
           services received, such as housing education or health education
           and risk prevention. These data are to be collected on an ongoing
           basis for as long as the youth receives services.

^23Chafee National Youth in Transition Database, 71 Fed. Reg. 40,346 (July
14, 2006) (to be codified at 45 C.F.R. pt. 1356).

           In order to develop a system to identify youth outcomes, HHS
           proposes establishing information on a baseline population of
           youth at age 17. All youth who turn 17 years old while in foster
           care would be surveyed on a series of outcomes, such as their
           current employment status. States would be required to conduct
           follow-up surveys with the youth at ages 19 and 21. HHS would
           allow the states to pull a sample from this baseline population
           with which to conduct these follow-up surveys. For example,
           California had over 7,500 youth in care in 2004 who were 17 years
           old. On the basis of the proposed sampling methodology, the state
           would be allowed to survey a minimum of 341 19-year-olds in the
           follow-up effort.

           According to results from our survey, in federal fiscal year 2003,
           30 states attempted to contact youth who had been emancipated from
           foster care for initial information to determine their status,
           including education and employment outcomes. Of those states, most
           reported that they were unsuccessful in contacting more than half
           of the youth. Further, 21 states reported attempting to follow up
           with emancipated youth after a longer period of time had elapsed
           but had trouble reaching all the youth. Similarly, officials in
           the states we visited reported that collecting outcome data is
           especially challenging since there is little they can do to find
           youth unless the youth themselves initiate the contact. Further,
           some officials were concerned about the value of the outcome data
           since they believe that youth who are doing well are more likely
           to participate in the follow-up interviews, thus skewing the
           results. When HHS issued the proposed rule, it provided strategies
           states could use to conduct the follow-up component of the NYTD
           requirements. For example, the document recommends letting the
           youth know up-front that the agency will be contacting them in the
           future; suggests keeping a "case file" that tracks any activity,
           such as reasons why a letter was returned; and suggests that the
           agency establish a toll-free phone line.

           o Mutltistate evaluations: At the time of our 2004 review, ACF
           expected to complete the evaluations of four approaches to
           delivering independent living services by December 2007. However,
           it is unclear if that deadline will be achieved at this point. As
           required by FCIA, these evaluations are expected to use rigorous
           scientific standards, such as an experimental research design that
           randomly assigns youth in independent living programs to different
           groups: one that is administered the experimental treatment and
           one that is not. HHS initiated this effort in 2001 with a
           nationwide review of potentially promising approaches to
           delivering independent living services. HHS contracted with a
           research institute to conduct a nationwide search to identify
           independent living programs that meet the criteria of the
           evaluation^24 and to conduct 5-year evaluations of the selected
           programs.^25 On the basis of the search and the established
           criteria, HHS selected four programs for the evaluation (see table
           2).

^24In the nationwide search, HHS contractors sought programs that met four
criteria for a rigorous research study: Programs should be directed, at
least in part, at youth leaving foster care or expected to remain in
foster care until adulthood; be innovative, of national significance, and
capable of expanding into new geographic areas; be willing and capable of
participating in experiments involving random assignment of youth to
treatment services or the alternative services; and have an adequate
sample size and should have a need for the services greater than what is
currently available so an experiment would not reduce the total number of
youth serviced by the program. Many programs could not support a
randomized study because their youth population was not large enough to
ensure youth did not go without services.

^25HHS contracted with the Urban Institute and its partners--the Chapin
Hall Center for Children and the National Opinion Research Center.

Table 2: Programs Included in the Multisite Evaluation of Foster Youth
Programs

                                                     Number of                               
                                             Age         youth  Length of                    
                                              of  (control and  service     Key outcome of   
Site          Program      Type of service focus experimental)  provision   interest         
Los Angeles   Community    Classroom-based    17           450  5 weeks (10 Education,       
County,       College Life and                                  workshops)  employment,      
California    Skills (LST) experiential                                     housing          
              Training     life skills                                      stability,       
                           training, teen                                   avoidance of     
                           support group,                                   risk behaviors   
                           and exposure to                                                   
                           community                                                         
                           college                                                           
                           opportunities                                                     
Los Angeles   Early Start  Structured      14-15           450  6 months of Education,       
County,       to           tutoring and                         tutoring on employment, and  
California    Emancipation mentoring                            average,    interpersonal    
              Preparation  curriculum for                       mentoring   and relationship 
              (ESTEP)      youth 1-3 years                      continues   skills           
                           behind grade                         less                         
                           level in                             intensively                  
                           reading and                          after                        
                           math skills                          tutoring                     
                                                                ends, for 3                  
                                                                months on                    
                                                                average                      
Kern County,  Employment   Employment         16           250  Ongoing     Employment and   
California    program      skills                               through age economic         
                           training, job                        21          self-sufficiency 
                           referral, and                                                     
                           employment                                                        
                           support                                                           
                           provided                                                          
                           through county                                                    
                           Temporary                                                         
                           Assistance to                                                     
                           Needy Families                                                    
                           agency                                                            
Massachusetts Adolescent   Intensive,         17           250  Mean of 1   Employment,      
              Outreach     individualized                       year        housing          
              Program      life skills                                      stability,       
                           mentoring and                                    service linkages 
                           casework                                                          

Source: HHS.

In the report issued in 2004, we made recommendations to HHS (1) to make
information available to states and local areas about other federal
programs that may assist youth in their transition to self-sufficiency and
provide guidance on how to access services under these programs and (2) to
develop a standard reporting format for state plans and progress reports
and implement a uniform process regional offices can use to assess states'
progress in meeting the needs of youth in foster care and those recently
emancipated from care. These recommendations have not been implemented.

Concluding Observations

Preparing youth to successfully transition to independence is a daunting
task that requires coordinated and continuous services across many social
service systems including child welfare, health, education, and housing.
The Chafee Program has provided a single funding stream that can be used
to meet service needs across these social systems. However, this funding
alone is not sufficient to overcome state challenges in meeting the varied
service needs of emancipating youth. The child welfare system must work
with housing agencies to remove barriers faced by youth with no employment
history or cosigner, and with health agencies, to ensure a smooth
transition between the youth and adult mental health systems. In addition,
states continue to have difficulty building adequate service capacity for
housing and mental health in all locales, and child welfare staff still
struggle to identify the myriad of public and private sector programs that
exist to assist youth. Our November 2004 report and our May 2007 testimony
present recommendations we made to HHS to make information available to
states and local areas about other federal programs that may assist youth
in their transition to self-sufficiency.

HHS did not comment on our 2004 recommendation, but disagreed with our
recent recommendation to improve awareness of and access to various social
services funded by the federal government. HHS stated that the
recommendation was insufficient to address the need for additional
services, and incorrectly implied that local child welfare agencies were
not already aware of and using such resources. We acknowledged that
increasing awareness of existing federal resources is not the only action
needed, but in the course of our work across the years, continue to find
that caseworkers are sometimes unaware of the full array of federal
resources, such as health and housing, available in their locale, or had
not coordinated with other agencies to use them. We continue to support
the view that federal action, such as modifying the CFDA, would allow
caseworkers and others to more easily identify services and service
providers funded by federal agencies in closest proximity to the youth and
families they serve.

How well the Chafee Program has worked to improve outcomes for emancipated
youth among states is still unknown 8 years after the passage of FCIA, and
HHS has not yet implemented its information system that is intended to
meet FCIA requirements for collecting and monitoring a state's
performance. Given the significant variation in the number of youth served
and services provided across states, an interim system for measuring state
progress would seem to be warranted. However, while HHS has an oversight
process to measure outcomes of state child welfare systems as a whole,
this process no longer includes measures required by FCIA. Similarly,
while ACF's regional offices conduct much of the federal oversight for the
Chafee Program, the oversight tools currently in place do not provide
standard information needed to measure and compare performance across
states. Our 2004 report included a recommendation to develop a standard
reporting format for state plans and progress reports and implement a
uniform process regional offices can use to assess states' progress in
meeting the needs of youth in foster care and those recently emancipated
from care. These recommendations have not been implemented.

HHS continues to disagree with our recommendation to develop a standard
reporting format for state plans and progress reports, stating that such
action would be overly prescriptive and impose an unnecessary burden on
states. However, as reflected in our 2004 report, we continue to believe
that strengthening the state reporting process is needed to provide some
assurance of program accountability at the state and federal levels. HHS
had agreed with our recommendation to establish a uniform process regional
offices can use to assess states' progress and said that in 2005, ACF
would develop and provide a review protocol to be used in regional office
desk reviews of states' annual progress reports. However, ACF officials
reported that they have not yet implemented such a review protocol.

Mr. Chairman, this concludes my statement. I will be pleased to respond to
any questions you or other members of the subcommittee may have.

GAO Contact and Staff Acknowledgments

For further information, please contact Cornelia Ashby or Kay Brown at
(202) 512-7215. Individuals making key contributions to this testimony
include Lacinda Ayers and Sara L. Schibanoff.

Appendix I: Fiscal Year 2004 Chafee Foster Care Independence Program:
Final Funds Allotted, Expended, and Returned to Federal Treasury, by State

                                                   Dollar                     
                                                   amount       Percentage of 
                                              returned to  allotment returned 
                  Dollar amount Dollar amount    the U.S.         to the U.S. 
State              allocated      expended    Treasury            Treasury 
Alabama           $1,536,181    $1,536,181          $0                  0% 
Alaska               550,782       550,782           0                   0 
Arizona            1,606,959     1,606,959           0                   0 
Arkansas             764,776       764,776           0                   0 
California        26,112,429    26,112,429           0                   0 
Colorado           2,184,770     2,184,770           0                   0 
Connecticut        1,519,750     1,519,750           0                   0 
Delaware             500,000       500,000           0                   0 
District of        1,092,276     1,092,276           0                     
Columbia                                                                 0 
Florida            8,265,302     8,265,302           0                   0 
Georgia            3,120,798     3,120,798           0                   0 
Hawaii               703,523       703,523           0                   0 
Idaho                500,000       500,000           0                   0 
Illinois           6,316,656     6,316,656           0                   0 
Indiana            2,184,711     1,987,583     197,128                 9.0 
Iowa               1,336,412     1,336,412           0                   0 
Kansas             1,549,330     1,549,330           0                   0 
Kentucky           1,741,339     1,741,339           0                   0 
Louisiana          1,358,484     1,358,484           0                   0 
Maine                771,350       771,350           0                   0 
Maryland           3,048,143     2,635,510     412,633                13.5 
Massachusetts      3,242,220     2,859,297      62,350                 1.9 
Michigan           5,235,404     5,235,404           0                   0 
Minnesota          2,063,393     2,063,393           0                   0 
Mississippi          758,148       758,148           0                   0 
Missouri           3,303,069     3,303,069           0                   0 
Montana              500,000       500,000           0                   0 
Nebraska           1,586,304     1,586,304           0                   0 
Nevada               500,000       498,650       1,350                 0.3 
New Hampshire        500,000       500,000           0                   0 
New Jersey         2,844,433     2,844,433           0                   0 
New Mexico           500,000       500,000           0                   0 
New York          11,588,972    11,588,972           0                   0 
North Carolina     2,405,731     2,249,851     155,880                 6.5 
North Dakota         500,000       457,425      42,575                 8.5 
Ohio               5,310,180     5,310,180           0                   0 
Oklahoma           2,230,667     2,230,667           0                   0 
Oregon             2,216,643     2,216,643           0                   0 
Pennsylvania       5,341,822     5,279,535      62,287                 1.2 
Puerto Rico        2,124,039     2,124,039           0                   0 
Rhode Island         611,725       611,725           0                   0 
South Carolina     1,238,495     1,238,495           0                   0 
South Dakota         500,000       500,000           0                   0 
Tennessee          2,353,574     2,353,574           0                   0 
Texas              5,413,220     5,412,566         654            0 (0.01) 
Utah                 500,000       500,000           0                   0 
Vermont              500,000       500,000           0                   0 
Virginia           1,710,740     1,710,740           0                   0 
Washington         2,332,664     2,332,664           0                   0 
West Virginia        769,310       769,310           0                   0 
Wisconsin          1,955,276     1,955,276           0                   0 
Wyoming              500,000       498,996       1,004                 0.2 
Total           $137,900,000  $136,643,566    $935,861                     
                            ^a.                                    0% (.001%) 

Source: Subcommittee on Income Security and Family Support, Committee on
Ways and Means, House of Representatives via the Congressional Research
Service presentation of HHS data, July 2007.

aThe total mandatory funds for this program are $140 million. However, the
statute provides that a certain percentage of those funds be set aside for
HHS to conduct (or fund) research, evaluation, and technical assistance.

Appendix II: Fiscal Year 2004 Chafee Education and Training Vouchers:
Funds Allotted, Expended, and Returned to Federal Treasury, by State

                                              Dollar amount     Percentage of 
                                                returned to         allotment 
                  Dollar amount Dollar amount      the U.S.   returned to the 
State              allocated      expended      Treasury     U.S. Treasury 
Alabama             $501,312      $501,312            $0                0% 
Alaska               179,694       158,938        20,756              11.6 
Arizona              524,273       524,273             0                 0 
Arkansas             249,575       249,575             0                 0 
California         8,519,233     8,452,447        66,786               0.8 
Colorado             712,785       712,785             0                 0 
Connecticut          495,822       495,822             0                 0 
Delaware              73,625        73,625             0                 0 
District of          270,123       270,123             0                 0 
Columbia                                                                   
Florida            2,696,572     2,106,077       590,495              21.9 
Georgia            1,018,431     1,018,431             0                 0 
Hawaii               229,526       228,762           764               0.3 
Idaho                103,074        71,429        31,645              30.7 
Illinois           2,060,822     2,060,822             0                 0 
Indiana              712,952       712,952             0                 0 
Iowa                 436,007       436,007             0                 0 
Kansas               505,472       232,828       272,644              53.9 
Kentucky             568,115       383,562       184,553              32.5 
Louisiana            400,401       400,401             0                 0 
Maine                251,655       224,651        27,004              10.7 
Maryland             994,722       546,876       447,846              45.0 
Massachusetts      1,057,781     1,057,781             0                 0 
Michigan           1,708,505       841,705       866,800              50.7 
Minnesota            673,186       633,908        39,278               5.7 
Mississippi          247,412         1,795       245,617              99.3 
Missouri           1,077,913       304,222       773,691              71.8 
Montana              157,066       157,066             0                 0 
Nebraska             517,535       517,535             0                 0 
Nevada               138,764       138,764             0                 0 
New Hampshire        103,241       103,241             0                 0 
New Jersey           928,002       928,002             0                 0 
New Mexico           159,478       133,294        26,184              16.4 
New York           3,454,364     3,317,873       136,491               4.0 
North Carolina       785,079       785,079             0                 0 
North Dakota         100,579        44,943        55,636              55.3 
Ohio               1,741,616     1,282,013       459,603              26.4 
Oklahoma             727,760       692,465        35,295               4.9 
Oregon               723,184       424,309       298,875              41.3 
Pennsylvania       1,742,780     1,640,714       102,066               5.9 
Puerto Rico          693,152       497,325       195,827              28.3 
Rhode Island         199,577       199,577             0                 0 
South Carolina       404,061       404,061             0                 0 
South Dakota         115,969        72,411        43,558              37.6 
Tennessee            767,858       637,334       130,524              17.0 
Texas              1,766,074       803,113       962,961              54.5 
Utah                 150,993       150,993             0                 0 
Vermont              120,794       120,794             0                 0 
Virginia             558,132       312,991       245,141              43.9 
Washington           761,037       761,037             0                 0 
West Virginia        250,989       250,989             0                 0 
Wisconsin            637,913       554,677        83,236              13.1 
Wyoming               87,518        87,518             0                 0 
Total            $44,062,503   $37,719,227    $6,343,276             14.4% 

Source: Subcommittee on Income Security and Family Support, Committee on
Ways and Means, House of Representatives via the Congressional Research
Service presentation of HHS data, July 2007.

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Highlights of [25]GAO-07-1097T , a testimony before the Subcommittee on
Income Security and Family Support, Committee on Ways and Means, House of
Representatives

July 12, 2007

CHILD WELFARE

HHS Actions Would Help States Prepare Youth in the Foster Care System for
Independent Living

Congress passed the Foster Care Independence Act of 1999 (FCIA), which
doubled annual federal funds for independent living programs to $140
million. This testimony discusses (1) states' FCIA funding allocations,
(2) services provided and remaining challenges, (3) state coordination of
programs to deliver services, and (4) the states and the Department of
Health and Human Services' (HHS) Administration for Children and Families'
(ACF) progress toward meeting program accountability requirements. This
testimony is primarily based on our 2004 report on FCIA (05-25), with
updated information from our 2007 testimony on state child welfare
challenges (07-850T). To conduct the 2004 work, we surveyed state
independent living coordinators, conducted 4 state site visits, and
reviewed states' plans and annual reports. Updated information from our
2007 testimony was taken primarily from a 2006 survey of state child
welfare directors.

[26]What GAO Recommends

We recommended that HHS improve access to federal program information. HHS
did not comment on this recommendation in 2004, but disagreed with a
similar recommendation in our 2007 testimony. We also recommended that HHS
improve its state monitoring processes. HHS agreed to develop uniform
monitoring tools, but disagrees that standard state reports are necessary.

States' funding allocations for independent living programs effectively
ranged from a maximum of approximately $500 to $2,300 for each foster care
youth who was eligible for independent living services, according to data
available at the time of our 2004 report. Funding varied because of
differences in states' eligibility requirements and the funding formula
used to allocate funds.

Although our 2004 survey of state independent living coordinators showed
that 40 states reported expanding existing independent living services to
younger youth and 36 states reported serving youth older than they had
previously served, states varied in their ability to engage youth and to
provide key services. About one-third of reporting states were serving
less than half of their eligible foster care youth population, while an
equal percentage of states were serving three-fourths or more. Our 2006
survey of state child welfare directors showed that critical gaps remain
in providing services such as mental health and housing for youth
transitioning to independence. Mental health barriers included differences
in eligibility requirements and level of services between the youth and
adult systems, and long waiting lists. Housing barriers included limited
affordable housing in costly urban areas, scarce rental housing in rural
areas, and problems obtaining a rental lease due to the lack of youth
employment and credit history or a co-signer to guarantee payment.

Almost all states that we surveyed in 2004 reported an increase in
coordination with some federal, state, and local programs, but linkages
with other federal and state youth-serving programs were not always in
place to increase services available across local areas. Many programs
exist at the federal, state, or local level that can be used to provide or
supplement independent living services, and each state reported in our
survey using some of these programs to provide services. Despite these
coordination efforts, some states may not make full use of the available
resources. Inconsistent availability of information on the array of
programs that were operating in each state and local area was cited as a
challenge in promoting coordination in both our prior and more current
work.

States and HHS have taken action to fulfill the accountability provisions
of FCIA, but 8 years later, little information is available to assess
program outcomes. All states developed multiyear plans for their programs
and submitted annual reports, but using these documents to assess state
performance was hindered by inconsistencies between the plans and reports,
an absence of goals and baseline information to measure progress, and
incomplete information on outcomes for the youth serviced. ACF started
developing an information system in 2000 to monitor state performance, but
final regulations directing states to begin collecting data and tracking
outcomes are still pending. ACF is also conducting evaluations of selected
independent living programs, but results are not yet available.

References

Visible links
  14. http://www.gao.gov/cgi-bin/getrpt?GAO-05-25
  15. http://www.gao.gov/cgi-bin/getrpt?GAO-07-850T
  16. http://www.gao.gov/cgi-bin/getrpt?GAO-03-357
  17. http://ask.hrsa.gov/pc/
  18. http://www.gao.gov/
  19. http://www.gao.gov/
  20. http://www.gao.gov/fraudnet/fraudnet.htm
  21. file:///home/webmaster/infomgt/d071097t.htm#mailto:[email protected]
  22. file:///home/webmaster/infomgt/d071097t.htm#mailto:[email protected]
  23. file:///home/webmaster/infomgt/d071097t.htm#mailto:[email protected]
  24. http://www.gao.gov/cgi-bin/getrpt?GAO-07-1097T
  25. http://www.gao.gov/cgi-bin/getrpt?GAO-07-1097T
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