Apr. 20 Federal Update: ACF Issues Dear Colleague Letter Regarding Title IV-E Prevention Plan Amendments 

On April 13, the Administration for Children and Families (ACF) published a Dear Colleague letter with sample program language and program requirements for well-supported home visiting models. States and Tribes may incorporate these services into existing Title IV-E five-year prevention plans through the established plan amendment process.  

Integrating pre-reviewed language and requirements will accelerate approval for Title IV-E prevention purposes, streamlining review and facilitating more timely deployment. While not required, States and Tribes may also add information about state and tribal-specific implementation plans to add new home visiting services. 

ACF Announces 15 Jurisdictions Have Joined a Home for Every Child 

The Administration for Children and Families (ACF) recently announced that 14 states and the District of Columbia have joined A Home for Every Child, a bipartisan initiative to increase the number of licensed foster homes relative to the number of children in care. The states include Alabama, Arkansas, Delaware, Iowa, Kansas, Kentucky, Louisiana, Maryland, Mississippi, Missouri, Nebraska, Oklahoma, Tennessee, and Rhode Island. 

The Home for Every Child Initiative aims to: 

•  Safely lower the number of children entering foster care through effective prevention 
• Increase the number of foster homes through diligent recruitment, prioritizing kin 
• Improve retention of existing caregivers 

Nationwide, there are 57 licensed foster homes for every 100 children in care, a gap the initiative aims to close. Assistant Secretary Alex J. Adams stressed the importance of the metric for states to meaningfully pursue improving this ratio while tracking permanency outcomes, kinship placement rates, and prevention services. 

To advance a Home for Every Child and support collaboration with states, tribes, and grantees, ACF has announced key staff appointments. 

House Ways and Means Committee Hosts Roundtable to Discuss Bipartisan Foster Care Reform 

The United States House Committee on Ways & Means held a roundtable discussion with First Lady Melania Trump and foster youth to discuss modernizing the John H. Chafee Foster Care Program for Successful Transition to Adulthood. 

The discussion follows the introduction of six bipartisan bills to support current and former foster youth as they exit foster care and transition to adulthood and independence. As a whole, the legislation aims to improve state utilization of Chafee funds, strengthen coordination between child welfare and federal housing programs, expand access to education and workforce training opportunities, improve support for foster youth who are parents or soon-to-be parents, expand access to legal services, and modernize the purposes of the Chafee program.  

The Ways & Means Committee has published a brief summarizing the bills. 

HRSA Announces Critical Grant Funding to Expand Nutrition Services and Strengthen Rural Health Workforce 

The Health Resources and Services Administration (HRSA) announced more than $135 million in grant funding to expand nutrition services and strengthen the rural workforce, improve access to care, enhance preventive services, and reduce the burden of chronic disease. HRSA-funded health centers serve more than 32.4 million patients at over 16,000 sites nationwide, including one in five rural residents. 

Expanded Nutrition Services will receive $125 million to support more than 350 HRSA-funded health centers in expanding access to nutrition services and food-based interventions within primary care settings to prevent and manage chronic diseases. 

The Rural Residency Planning and Development Program will receive $11.25 million through as many as 15 grants of up to $750,000 each over three years. The funding will support new rural residency programs in high-need specialties, including psychiatry, family medicine, internal medicine, OB-GYN, general surgery, and preventive medicine.   

CMS Issues Guidance to Implement New Limits on Federal Medicaid and CHIP Funding Following H.R. 1 

The Centers for Medicare & Medicaid Services (CMS) issued letters to states, offering guidance as a key provision of the recent tax and reconciliation bill, H.R. 1, will take effect Oct. 1. The provision will limit states’ ability to claim federal matching funds for Medicaid and the Children’s Health Insurance Program (CHIP) for certain populations of immigrants. The guidance exempts green card holders, Cuban and Haitian entrants, and citizens of certain Pacific island nations. 

The guidance is expected to impact health care access for immigrants, especially as states will no longer receive full federal matching funds for the Medicaid or CHIP benefits of refugees, asylees, parolees, and victims of trafficking following H.R. 1. However, federal matching funds remain available for emergency Medicaid. States will also not be required to provide state-only coverage where federal funding is unavailable.  

The guidance outlines the required state actions to implement these changes, including eligibility redeterminations for current enrollees, updates to eligibility and verification systems, managed care and financial claiming procedures, and the submission of Medicaid and CHIP state plan amendments.  

Sector Updates from the Judiciary 

Federal Courts Determine Changes to Continuum of Care Grants Are Illegal 

The United States District Court for the District of Rhode Island determined that the sudden funding conditions attached to the Continuum of Care (CoC) program were illegally implemented. 

The CoC program is the largest resource for federal homelessness assistance funds. Research conducted by the National Alliance to End Homelessness (NAEH) estimates that the imposed limits to permanent housing would lead more than 170,000 individuals to experience homelessness. Additionally, surveys among grant recipients conducted by the NAEH detailed potential delays in program referrals, increased uncertainty for program participants, and exacerbated staffing challenges. 

U.S District Judge Mary McElroy similarly detailed the harm that the amended grant conditions would have and found that the notice announcing the funding opportunities, the new criteria used by HUD when deciding to issue grants, and the one-week application period for the grants were all unlawful. The court also ordered that the funding already approved by Congress must still be awarded.  

In addition to the lawsuit filed by a coalition of nonprofits and local governments, several states filed lawsuits challenging the sudden and extensive changes to the CoC program. The First Circuit Court of Appeals also prevented the Trump administration from imposing restrictions on homelessness funding. The First Circuit’s decision keeps an existing injunction in place, allowing billions of dollars in funding to continue to housing-first solutions while the lawsuit continues.

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