Final Report - RI Department of Children, Youth & Families

CHAPTER 4: FINANCING THE SYSTEM OF CARE
Financing a comprehensive system of care for children, adolescents, and their families is one
of the most complex aspects of system reform. Funding for services for children and families
comes from a very broad range of federal, state, local, and private sector sources. In FY 2001
DCYF budget exceeded $200 million and these funds were augmented from a number of
other sources including but not limited to public and private insurance, federal government
grants and contracts, federal entitlements, state general funds, trust funds or other set-asides,
and local revenues.
On a State level, funding and supports were available from DHS in the form of RIte Care
capitation, fee for service Medicaid claims, and a variety of supports available under TANF.
DHS funding for programs for Families and Children in Medicaid alone exceeded $300
million in FY 2001 and covered 120,000 family members of whom over 80,000 were
children. LEAs also were a resource available for this system, particularly in their growing
role as Medicaid providers.
In this system of care, DHS and DCYF have a strong partnership. DCYF is responsible for
developing programs and services to meet the needs of its priority populations. DHS is the
designated single state agency with responsibility and accountability for the Medicaid State
Children’s Health Insurance (SCHIP) programs. The majority of DCYF children, youth, and
families are Medicaid/SCHIP eligible. Therefore, the opportunity exists to strategically
leverage DCYF’s and DHS’s authorities and resources to expand services. DHS is a funder
with a voice in program development. The responsibility for funding programs is
accompanied by participation in design, development, and measurement of program
effectiveness. Likewise, in this system, DHS does not establish programs that directly affect
DCYF children and families without DCYF’s full and equal participation. These two
departments operate as a strategic alliance.
The DHS plays an important role in partnering with DCYF and other state agencies to
maximize Medicaid support for eligible children and their families. They continue their work
with DCYF in developing opportunities for access to RiteCare coverage and their work with
DCYF and other state agencies developing opportunities for increased access to services
through programs like CEDARR 16 and the LCC’s. In this system, DHS ensures access to the
full range of medically necessary prevention and treatment services through contractual
language with RIteCare providers. DCYF funds provide non-Medicaid reimbursable services.
In the system design, the case rate supports the non-Medicaid reimbursable costs while the
Comprehensive Care Networks’ lead agencies bill Medicaid for reimbursable services with
DCYF providing the State Medicaid share.
For non-insurance government funding, the system creates a “state child and family budget”
that includes all non-insurance sources of federal and state revenue, clearly organizes the
resources to support the system, and recognizes that entitlement programs cannot be
capitated. The Child and Family Budget also reflects Federal grants to communities. The
system places an emphasis on attracting federal funds, maximizing federal financial
16 CEDARR stands for Comprehensive Evaluation Diagnosis Assessment Referral and Reevaluation and is a
collaborative effort of the following state agencies: DHS, DCYF, RIDE, DOH, and MHRH. DHS administers
the CEDARR program.
System of Care Task Force Report (January 2003) 37