This is the accessible text file for GAO report number GAO-14-347 
entitled 'Foster Care: HHS Needs to Improve Oversight of Fostering 
Connections Act Implementation' which was released on May 29, 2014. 

This text file was formatted by the U.S. Government Accountability 
Office (GAO) to be accessible to users with visual impairments, as 
part of a longer term project to improve GAO products' accessibility. 
Every attempt has been made to maintain the structural and data 
integrity of the original printed product. Accessibility features, 
such as text descriptions of tables, consecutively numbered footnotes 
placed at the end of the file, and the text of agency comment letters, 
are provided but may not exactly duplicate the presentation or format 
of the printed version. The portable document format (PDF) file is an 
exact electronic replica of the printed version. We welcome your 
feedback. Please E-mail your comments regarding the contents or 
accessibility features of this document to Webmaster@gao.gov. 

This is a work of the U.S. government and is not subject to copyright 
protection in the United States. It may be reproduced and distributed 
in its entirety without further permission from GAO. Because this work 
may contain copyrighted images or other material, permission from the 
copyright holder may be necessary if you wish to reproduce this 
material separately. 

United States Government Accountability Office: 
GAO: 

Report to Congressional Requesters: 

May 2014: 

Foster Care: 

HHS Needs to Improve Oversight of Fostering Connections Act 
Implementation: 

GAO-14-347: 

GAO Highlights: 

Highlights of GAO-14-347, a report to congressional requesters. 

Why GAO Did This Study: 

Approximately 400,000 children were living in foster care in fiscal 
year 2012, according to the most recent data available. HHS oversees 
states' implementation of federal child welfare requirements under 
title IV-E of the Social Security Act. In 2008, the Fostering 
Connections Act amended title IV-E to improve the outcomes for 
children in foster care, such as maintaining family and school
connections. GAO was asked to review implementation of the act. 

GAO examined (1) steps states have taken to implement selected 
provisions of the act and challenges they have faced, and (2) the 
extent to which HHS has monitored states' efforts. GAO reviewed 
relevant federal laws, regulations, and guidance and surveyed 52 state 
child welfare agencies, achieving a 100 percent response rate. GAO 
also interviewed HHS officials and state and local child welfare and 
educational agency officials; caseworkers; court officials, and foster 
youth and parents in four states, selected to ensure variety of
program characteristics and geographic dispersion. 

What GAO Found: 

To implement the Fostering Connections to Success and Increasing 
Adoptions Act of 2008 (Fostering Connections Act), many states GAO 
surveyed (which included the District of Columbia and Puerto Rico) 
reported requiring caseworkers to employ multiple practices to improve 
outcomes for children in foster care; however, states continue to face 
challenges that can undermine progress. Among the practices that the 
Department of Health and Human Services (HHS) and others suggested 
states use, survey respondents reported requiring caseworkers to use 
group decision-making to maintain family connections, consult with 
schools, and facilitate adult connections for older youth. At the same 
time, a majority of surveyed states reported facing challenges,
especially related to foster placements (see figure below). 

Figure: Major Challenges Reported by States in GAO Survey Regarding 
Foster Placements: 

[Refer to PDF for image: horizontal bar graph] 

Lack of available placements for large sibling groups: 
Not a challenge: 0; 
Minor challenge: 9; 
Major challenge: 42. 

Lack of placement resources near current school: 
Not a challenge: 1; 
Minor challenge: 12; 
Major challenge: 38. 

Identifying appropriate housing for youth after transitioning from 
care: 
Not a challenge: 1; 
Minor challenge: 20; 
Major challenge: 31. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

Note: Responses do not sum to 52 if states selected “do not know/not 
applicable” or did not respond. 

[End of figure] 

Further, the Fostering Connections Act made additional children 
eligible for federal adoption assistance payments thereby potentially 
freeing up state funds previously used for this purpose. Although 
states are required to spend any resulting savings on child welfare 
services, only 21 states reported calculating these savings for fiscal 
year 2012, and 20 states reported difficulties performing the 
calculations. HHS has not provided states guidance in this area, and 
without it states may continue to struggle with the calculations, 
leading to potential lost program funding. 

HHS approved states' plans to implement the Fostering Connections Act;
however, the agency has not yet monitored states' actions. HHS 
regulations specify that states must undergo a complete review of 
child welfare programs every 5 years, yet HHS's last review cycle 
began in 2007—using a tool developed before the act was passed. 
Internal control standards emphasize using timely data for effective 
monitoring, but data collected by HHS do not reflect the act's 
provisions. In March 2014, HHS announced plans to begin a review cycle 
in fiscal year 2015, but details about how it would address changes
from the act were unavailable. Without adequate monitoring or updated 
data, HHS lacks information about the implementation of the act and 
the effectiveness of states' actions. 

What GAO Recommends: 

GAO recommends that HHS (1) provide guidance on how states could
calculate savings resulting from changes to federal adoption assistance
eligibility criteria, (2) systematically monitor states' 
implementation of the act, and (3) update data reporting requirements 
related to the act. HHS concurred with our recommendations. HHS also 
provided technical comments that were incorporated, as appropriate. 
The Department of Education had no comments. 

View [hyperlink, http://www.gao.gov/products/GAO-14-347]. For more 
information, contact Kay Brown at (202) 512-7215 or brownke@gao.gov. 

[End of section] 

Contents: 

Letter: 

Background: 

States Reported Implementing Suggested Practices but Continue to Face 
Challenges with Certain Requirements: 

States Reported Receiving Useful Technical Assistance from HHS, but 
HHS Has Not Yet Systematically Monitored State Implementation: 

Conclusions: 

Recommendations for Executive Action: 

Agency Comments and Our Evaluation: 

Appendix I: Findings on Family Connections Provisions: 

Appendix II: Findings on School Stability Provisions: 

Appendix III: Findings on Older Youth Provisions: 

Appendix IV: Scope and Methodology: 

Appendix V: Comments from the Department of Health and Human Services: 

Appendix VI: GAO Contact and Staff Acknowledgments: 

Table: 

Table 1: Selected Requirements and Options Established by the 
Fostering Connections Act Included in this Review: 

Figures: 

Figure 1: Top Three Practices Used by States to Implement Required 
Provisions Related to Family Connections: 

Figure 2: Top Three Practices Used by States to Implement Required 
Provisions Related to School Stability: 

Figure 3: Top Three Practices Used by States to Implement Required 
Provisions Related to Older Youth: 

Figure 4: States' Views on Usefulness of HHS Technical Assistance to 
Implement Fostering Connections Act Provisions: 

Abbreviations: 

ACF: Administration for Children and Families: 

AFCARS: Adoption and Foster Care Analysis and Reporting System: 

CFSR: Child and Family Services Review: 

GAP: Guardianship Assistance Program: 

HHS: Department of Health and Human Services: 

[End of section] 

United States Government Accountability Office: 
GAO:
441 G St. N.W. 
Washington, DC 20548: 

May 29, 2014: 

Congressional Requesters: 

At the end of fiscal year 2012, approximately 400,000 children were 
living in foster care, mostly as a result of having experienced 
neglect or abuse by their parents.[Footnote 1] Nearly half of these 
children were placed in non-relative foster family homes and more than 
a quarter were placed in a relative's home.[Footnote 2] Child welfare 
agencies generally try to place children with family members when 
possible; however, in many cases, agencies lack information on 
relatives' whereabouts. Even when relatives are available to care for 
the child, they may need financial help to do so. An experience in 
foster care may disrupt other family connections important to the 
child's well-being, such as ongoing relationships with siblings. 
Children in foster care face other challenges, such as lower academic 
achievement and higher dropout rates than their peers who are not in 
foster care. Moreover, youth who remain in foster care until adulthood 
are more likely to be homeless, unemployed, and incarcerated compared 
to the general population. 

The Fostering Connections to Success and Increasing Adoptions Act of 
2008 (Fostering Connections Act) made a number of changes to part E of 
title IV (title IV-E) of the Social Security Act, which authorizes 
federal support for state foster care and adoption assistance 
programs.[Footnote 3] According to its co-sponsors, the legislation 
was intended to address shortcomings in the existing foster care 
system that disconnected foster children from family and school, 
leaving them ill-prepared to transition out of care at age 18. The 
Department of Health and Human Services (HHS) is responsible for 
overseeing the states' implementation of federal requirements for 
child welfare services, including those established by the Fostering 
Connections Act. 

You asked us to review the implementation of the Fostering Connections 
Act. This report examines: (1) the actions states have taken to 
implement selected provisions of the Fostering Connections Act, and 
what challenges, if any, states face; and (2) how HHS has provided 
technical assistance to help states implement selected provisions of 
the Fostering Connections Act and the extent to which HHS has 
monitored implementation. 

We reviewed selected provisions of the Fostering Connections Act 
pertaining to family connections, school stability, support for older 
youth, and states' savings from the change in income eligibility 
criteria for adoption assistance payments,[Footnote 4] and used 
several methodologies to address our objectives.[Footnote 5] See 
appendixes I-III for more information on the specific provisions in 
this review. First, we reviewed relevant federal laws and regulations, 
HHS guidance to states, and other publications. Second, to obtain 
information on states' implementation of the selected provisions of 
the Fostering Connections Act, we conducted a survey of state child 
welfare agencies from the 50 states, the District of Columbia, and 
Puerto Rico, achieving a 100 percent response rate.[Footnote 6] The 
survey included questions about the practices states employed to 
implement the provisions, challenges they faced, and their use of HHS-
funded technical assistance. Third, we conducted site visits to four 
states and two localities in each state to obtain further information 
on implementation of these provisions from state and local child 
welfare agency officials and caseworkers, state and local educational 
agency officials, court officials, and current and former foster youth 
and foster parents. We selected the four states--California, 
Massachusetts, Texas, and Virginia--to represent a mix of factors 
including: type of child welfare agency (state-or county-
administered); number of children in foster care; amount of federal 
title IV-E funds received; whether the state had implemented either of 
two optional provisions in the Fostering Connections Act (establishing 
a title IV-E guardianship assistance program or extending eligibility 
for title IV-E assistance beyond age 18);[Footnote 7] and geographic 
dispersion. The localities were a mix of large cities, smaller cities, 
and rural areas. The results from the site visits are not 
generalizable, but provide illustrative examples of how states are 
implementing the provisions of the Fostering Connections Act. We also 
interviewed officials from HHS's Administration for Children and 
Families, including the four regional offices serving the states we 
visited, as well as selected HHS-funded technical assistance providers 
that have provided assistance to states to implement the Fostering 
Connections Act. A more detailed explanation of our methodology can be 
found in appendix IV. 

We conducted this performance audit from April 2013 to May 2014 in 
accordance with generally accepted government auditing standards. 
Those standards require that we plan and perform the audit to obtain 
sufficient, appropriate evidence to provide a reasonable basis for our 
findings and conclusions based on our audit objectives. We believe 
that the evidence obtained provides a reasonable basis for our 
findings and conclusions based on our audit objectives. 

Background: 

Title IV-E and the Fostering Connections Act: 

Title IV-E of the Social Security Act authorizes federal funding to 
states to help cover the costs of operating their foster care and 
adoption assistance programs. This funding primarily provides 
financial support for the care of eligible children who have been 
removed from their homes due to abuse or neglect, as well as to 
families who adopt eligible children with special needs from the 
foster care system. In 2008, the Fostering Connections Act was 
enacted, which amended title IV-E. According to two co-sponsors of the 
legislation, it was intended to address shortcomings in the existing 
foster care system that disconnected foster children from family and 
school, leaving them ill-prepared to transition out of care at age 
18.[Footnote 8] These shortcomings are rooted in longstanding 
challenges, such as finding appropriate foster homes; coordinating 
between child welfare agencies, schools, and other service providers; 
and ensuring housing for foster youth transitioning to independence. 
[Footnote 9] The Fostering Connections Act established requirements 
for states operating title IV-E programs as well as options states may 
elect to pursue to improve outcomes for youth in and leaving foster 
care. See table 1 for a complete list of the required and optional 
provisions included in our review. 

Table 1: Selected Requirements and Options Established by the 
Fostering Connections Act Included in this Review: 

Family connections: 

Summary of provision: Requires that the state exercise due diligence 
to identify and notify all grandparents and other adult relatives of a 
child within 30 days of the child's removal from the parents' custody; 
Requirement. 

Summary of provision: Requires states to make reasonable efforts to 
place siblings removed from their home in the same foster care, 
kinship guardianship, or adoptive placement, and to provide for 
frequent visitation or other ongoing interaction between siblings who 
are not placed together, unless it would be contrary to the safety or 
well-being of any of the siblings to do so; 
Requirement. 

Summary of provision: Authorizes HHS to share information from the 
Federal Parent Locator Service with child welfare agencies for title 
IV-E purposes[A]; 
Option. 

Summary of provision: Authorizes states to provide and receive federal 
reimbursement for some kinship guardianship assistance payments[B]; 
Option. 

Summary of provision: Authorizes states to waive, on a case-by-case 
basis, non-safety licensing standards for relative foster family homes; 
Option. 

School stability: 

Summary of provision: Requires that the state's title IV-E plan 
provide assurances that each school-age child eligible for a payment 
under the title IV-E plan is attending school full-time or has 
completed secondary school; 
Requirement. 

Summary of provision: Requires that each placement of a child in 
foster care takes into account the appropriateness of the current 
educational setting and the proximity to the school in which the child 
was enrolled at the time of placement; 
Requirement. 

Summary of provision: Requires that the child welfare agency 
coordinate with appropriate local educational agencies to ensure that 
the child remains in the school in which the child is enrolled at the 
time of each placement. If remaining in that school is not in the best 
interests of the child, the agencies must provide immediate and 
appropriate enrollment in a new school, along with the child's 
educational records; 
Requirement. 

Summary of provision: Authorizes the use of foster care maintenance 
payments to cover the cost of reasonable travel for the child to 
remain in the school in which the child was enrolled at the time of 
placement; 
Option. 

Older youth: 

Summary of provision: Requires that during the 90-day period prior to 
a child aging out of foster care, a caseworker assists and supports 
the child in developing a personalized transition plan[C]; 
Requirement. 

Summary of provision: Authorizes states to provide foster care, 
adoption assistance, and kinship guardianship payments for eligible 
youth age 18 and older (up to age 21) in certain circumstances; 
Option. 

Summary of provision: Authorizes states to extend eligibility for 
Chafee Foster Care Independence Program services to youth who exit 
foster care to adoption or kinship guardianship at age 16 or older[D]; 
Option. 

Summary of provision: Authorizes states to extend eligibility for 
education and training vouchers to youth who exit foster care to 
kinship guardianship at age 16 or older[E]; 
Option. 

Source: GAO analysis of selected provisions of the Fostering 
Connections to Success and Increasing Adoptions Act of 2008 (Fostering 
Connections Act), Pub. L. No. 110-351, 122 Stat. 3949 (codified as 
amended in scattered sections of 42 U.S.C.). 

Note: In this table, a provision is categorized as a "requirement" if 
a state must adopt it in order to be eligible for federal assistance 
under title IV-E. States may choose to adopt the provisions 
categorized as "options," but are not required to in order to be 
eligible for federal assistance under title IV-E. 

[A] The Federal Parent Locator Service is a computerized system 
administered by HHS's Office of Child Support Enforcement. In 
accordance with the Fostering Connections Act, HHS regulations permit 
this system to be used to locate relatives for title IV-E purposes. 45 
C.F.R. § 302.35(d)(2). 

[B] These payments are authorized to be made on behalf of eligible 
children to grandparents and other relatives who have assumed legal 
guardianship of the children for whom they have cared as foster 
parents and for whom they have committed to care on a permanent basis. 
Under title IV-E, legal guardianship means a judicially created 
relationship between child and caretaker which is intended to be 
permanent and self-sustaining as evidenced by the transfer to the 
caretaker of the following parental rights with respect to the child: 
protection, education, care and control of the person, custody of the 
person, and decision-making. 42 U.S.C. § 675(7). To receive funding, 
the child must meet title IV-E eligibility requirements and must live 
with the caregiver for at least 6 months, among other requirements. 

[C] The plan must include specific options on housing, health 
insurance, education, local opportunities for mentors and continuing 
support services, and workforce supports and employment services. HHS 
guidance also encourages the caseworker to include information in the 
plan relating to sexual health, services, and resources as well. The 
Patient Protection and Affordable Care Act added the requirement to 
include information in the plan about the importance of designating 
another individual to make health care treatment decisions on behalf 
of the child if the child becomes unable to participate in such 
decisions and the child does not have, or does not want, a relative 
who would otherwise be authorized under state law to make such 
decisions, and provides the child with the option to execute a health 
care power of attorney, health care proxy, or other similar document 
recognized under State law. Pub. L. No. 111-148, § 2955(a), 124 Stat. 
119, 352 (2010). 

[D] Under provisions unaffected by the Fostering Connections Act, this 
program may also serve youth who are likely to remain in foster care 
until age 18, and young adults between the ages of 18 and 21 who have 
"aged out" of the foster care system. These services may include help 
with education, employment, financial management, housing, emotional 
support, and connections to caring adults. 

[E] Youth who exited foster care to adoption at age 16 or older were 
already eligible for these education and training vouchers prior to 
the enactment of the Fostering Connections Act. 

[End of table] 

In addition, the Fostering Connections Act modified a requirement 
related to eligibility for adoption assistance. Specifically, the 
Fostering Connections Act changed the eligibility criteria for federal 
adoption assistance for children with special needs to eliminate 
income requirements for the family from which the child is removed. 
[Footnote 10] This change is being phased in over time based on the 
child's age at adoption (becoming applicable to children age 16 and 
older in fiscal year 2010, 14 and older in fiscal year 2011, 12 and 
older in fiscal year 2012, and so on until fiscal year 2018 when the 
criteria will apply to children of all ages). As a result, more 
children may be eligible for federal adoption assistance payments and 
states may no longer bear the entire cost of adoption assistance 
payments on behalf of eligible children with special needs removed 
from families that did not meet the previous income requirements. The 
Fostering Connections Act also required states to spend any savings in 
state expenditures resulting from the changes to the adoption 
assistance eligibility criteria on child welfare services that may be 
provided under title IV-E or IV-B (referred to in this report as 
"reinvesting savings"). As a result of a subsequent amendment, states 
are also required to document how such amounts are spent annually. 
[Footnote 11] 

Oversight and Monitoring: 

Promoting the well-being of children and families has traditionally 
been understood as a primary responsibility of state governments, and 
state and local governments are the primary administrators of child 
welfare programs designed to protect children from abuse or neglect. 
Most states administer their child welfare programs centrally, but in 
some states, county agencies administer their own child welfare 
programs with state supervision. At the federal level, HHS's 
Children's Bureau within the Administration for Children and Families 
(ACF) is responsible for administering and overseeing states' 
implementation of title IV-E, including the provisions added by the 
Fostering Connections Act.[Footnote 12] The ACF regional offices are 
responsible for reviewing and approving state title IV-E plans for 
states in their regions. Title IV-E plans include information on how 
states have implemented or plan to implement title IV-E, including the 
provisions of the Fostering Connections Act. In 2000, HHS issued 
regulations that established a systematic review process to monitor 
states' child welfare programs to determine whether the programs are 
in compliance with federal law, regulations, and the relevant approved 
state plan.[Footnote 13] These regulations specify that states must 
undergo a complete review of their child welfare programs--including 
title IV-E--every 5 years.[Footnote 14] This systematic review 
process, known as the Child and Family Services Review (CFSR), 
involves a statewide assessment, a case-file review, and stakeholder 
interviews. Two rounds of the CFSRs have been conducted to date--the 
second round started in 2007, before the enactment of the Fostering 
Connections Act. HHS also compiles, validates, and reports data on 
children in foster care and children who have been adopted from state 
child welfare agencies in the Adoption and Foster Care Analysis and 
Reporting System (AFCARS). Twice a year, states are required to submit 
data on the characteristics of children in foster care, foster 
parents, adopted children, and adoptive parents.[Footnote 15] 

Guidance and Technical Assistance for States: 

ACF is responsible for developing and distributing program guidance to 
all states, and issued a comprehensive Program Instruction to state 
child welfare agencies in July 2010, with guidance on implementing the 
various provisions of the Fostering Connections Act. Some of the 
provisions of the Fostering Connections Act are general in nature and 
allow states discretion in determining how to implement them. For 
example, one provision requires states to make reasonable efforts to 
place siblings who are removed from their home in the same foster care 
placement, but it does not define what constitutes "reasonable 
efforts."[Footnote 16] ACF's Program Instruction described ACF's 
expectations for implementation of selected provisions and in some 
cases encouraged states to consider certain practices that could 
facilitate implementation. For example, the guidance encouraged 
notification of relatives via several different methods such as in 
writing and orally, and also explained ACF's expectation that siblings 
not placed together should be in contact at least monthly. ACF issued 
subsequent Program Instructions on targeted issues and updated its 
online Child Welfare Policy Manual to provide additional guidance on 
implementing the act. 

States receive additional training and technical assistance through 
regional ACF offices and the Children's Bureau's Training and 
Technical Assistance Network. This network is comprised of 28 
technical assistance centers that provide training, technical 
assistance, research, information and referral, and consultation. 
Members of the network include 10 topic-oriented national resource 
centers; a Training and Technical Assistance Coordination Center; the 
Child Welfare Information Gateway, which provides information, 
resources, and tools covering child welfare topics; and 16 other 
organizations dedicated to providing states training and technical 
assistance. Several of these organizations, as well as other child 
welfare-focused organizations, have issued toolkits and other material 
suggesting practices for states to consider in implementing Fostering 
Connections Act provisions. 

States Reported Implementing Suggested Practices but Continue to Face 
Challenges with Certain Requirements: 

States Reported Requiring Caseworkers to Employ Multiple Practices to 
Implement the Fostering Connections Act: 

According to our survey, to implement the various provisions of the 
Fostering Connections Act, many states required child welfare workers 
to employ multiple practices suggested by HHS and other child welfare-
focused organizations. In general, these practices were not 
specifically required by the Fostering Connections Act, but 
stakeholder organizations recommended states consider them to ensure 
the act results in better outcomes for children and youth in foster 
care.[Footnote 17] To help ensure that certain requirements were 
implemented, most states reported that they required case workers to 
document certain key efforts. 

Family Connections: 

For the required family connections provisions, states reported 
formalizing prior efforts and requiring or recommending practices 
aimed at identifying relatives, notifying relatives of the need for 
foster care placement, and keeping siblings together or in contact. 
Figure 1 shows the top three practices states reported in our survey 
within each of these areas. (See appendix I for additional practices.) 
During our visits, states reported formalizing their prior efforts to 
identify and notify relatives. For example, according to officials, 
Massachusetts began requiring notification in writing, and California 
added a timeframe for notification to its state law. We also learned 
of specific ways that states are carrying out some of these practices. 
For example, in Virginia, state child welfare agency policy requires 
that a copy of a written notice to relatives be kept in the child's 
case file and that the date the written notice was sent and of any 
relatives' response be recorded in the state's child welfare agency 
data system. Reasons for not notifying specific relatives--such as 
involvement in domestic violence--must be documented as well. To 
ensure that siblings not placed together maintain contact, Texas 
officials explained that if siblings are placed more than 100 miles 
apart, the agency must ensure that the children have access to a phone 
and video-conferencing. Current and former foster youth we met with in 
Massachusetts said the state child welfare agency created a Sibling 
Bill of Rights, which has helped youth advocate for their right to 
remain in contact with siblings. 

Figure 1: Top Three Practices Used by States to Implement Required 
Provisions Related to Family Connections: 

[Refer to PDF for image: horizontal bar graph] 

Number of states: 

Identifying relatives: 

Efforts to identify relatives documented in the case file: 
Required statewide (e.g., in state law, regulation, or child welfare 
agency policy): 48; 
Not required, but recommended statewide (e.g., in written state child 
welfare agency practice guidance): 3. 

Group decision-making strategy used to identify relatives: 
Required statewide (e.g., in state law, regulation, or child welfare 
agency policy): 33; 
Not required, but recommended statewide (e.g., in written state child 
welfare agency practice guidance): 15. 

Identification of relatives begins prior to child's removal from home: 
Required statewide (e.g., in state law, regulation, or child welfare 
agency policy): 32; 
Not required, but recommended statewide (e.g., in written state child 
welfare agency practice guidance): 14. 

Notifying relatives: 

Efforts to notify relatives documented in the case file: 
Required statewide (e.g., in state law, regulation, or child welfare 
agency policy): 49; 
Not required, but recommended statewide (e.g., in written state child 
welfare agency practice guidance): 0. 

Notification to relatives provided in writing: 
Required statewide (e.g., in state law, regulation, or child welfare 
agency policy): 43; 
Not required, but recommended statewide (e.g., in written state child 
welfare agency practice guidance): 7. 

Notification to relatives provided both verbally and in writing: 
Required statewide (e.g., in state law, regulation, or child welfare 
agency policy): 20; 
Not required, but recommended statewide (e.g., in written state child 
welfare agency practice guidance): 24. 

Sibling placement: 

Visitation plan specifies that siblings should be in contact at least 
monthly[A]: 
Required statewide (e.g., in state law, regulation, or child welfare 
agency policy): 47; 
Not required, but recommended statewide (e.g., in written state child 
welfare agency practice guidance): 4. 

Ongoing efforts made to reunite siblings who are placed separately[A]: 
Required statewide (e.g., in state law, regulation, or child welfare 
agency policy): 42; 
Not required, but recommended statewide (e.g., in written state child 
welfare agency practice guidance): 6. 

Specified factors used to consider safety/well-being before placement 
with siblings: 
Required statewide (e.g., in state law, regulation, or child welfare 
agency policy): 37; 
Not required, but recommended statewide (e.g., in written state child 
welfare agency practice guidance): 6. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

[A] Unless it would be contrary to a child's safety or well-being. 

[End of figure] 

Among the optional family connections provisions, HHS data show that 
32 states have been approved to operate a title IV-E guardianship 
assistance program. Of these states, 21 had previously operated a 
guardianship assistance program using state funds or through a title 
IV-E waiver demonstration project. In response to our survey, 43 
states reported that they now allow waivers of non-safety licensing 
standards for relative foster family homes, up from 33 prior to the 
enactment of the Fostering Connections Act. In addition, 32 states 
reported requiring or recommending the use of the Federal Parent 
Locator Service to identify adult relatives. 

School Stability: 

States reported establishing new approaches to implement the school 
stability requirements. Figure 2 shows the top three practices 
reported in our survey. (See appendix II for additional practices.) 
During our visits, we learned that the state child welfare and 
educational agencies in Virginia drafted joint guidance for localities 
to guide implementation of the school stability provisions. The guide 
identified factors to consider in determining whether the school 
placement is in the best interest of the child and clarified 
responsibilities for funding transportation. We learned of a similar 
effort under way in Massachusetts. In three of the four states we 
visited--California, Texas, and Virginia--state law or agency policy 
requires school districts to designate "foster care liaisons" or 
points of contact at the district or school level who can assist 
caseworkers or foster parents with issues such as immediately 
enrolling foster youth in a new school in the event of a school change. 

Figure 2: Top Three Practices Used by States to Implement Required 
Provisions Related to School Stability: 

[Refer to PDF for image: horizontal bar graph] 

Number of states: 

Decisions about keeping child in the same school documented in writing: 
Required statewide (e.g., in state law, regulation, or child welfare 
agency policy): 34; 
Not required, but recommended statewide (e.g., in written state child 
welfare agency practice guidance): 16. 

Specific factors used to consider keeping child in the same school: 
Required statewide (e.g., in state law, regulation, or child welfare 
agency policy): 24; 
Not required, but recommended statewide (e.g., in written state child 
welfare agency practice guidance): 16. 

Schools consulted when considering if child should be kept in the same 
school: 
Required statewide (e.g., in state law, regulation, or child welfare 
agency policy): 22; 
Not required, but recommended statewide (e.g., in written state child 
welfare agency practice guidance): 15. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

[End of figure] 

In addition, 36 states reported using title IV-E foster care 
maintenance funds to pay for transportation so that children in foster 
care could remain in their schools--as authorized by the Fostering 
Connections Act. 

Older Youth: 

For the provisions related to older youth, states reported adding to 
existing policies to incorporate requirements related to the 
development of a transition plan in the 90-day period prior to a youth 
aging out of care. Figure 3 shows the top three practices reported by 
states in our survey. (See appendix III for additional practices.) 
Officials in Massachusetts reported that their existing policies 
already addressed many of the specific elements of transition plans 
required by the Fostering Connections Act. To carry out its planning 
practices, Texas requires in its manual for caseworkers that youth be 
provided a Youth Transition Portfolio at least 90 days before turning 
18. The portfolio is to contain key documents such as the birth 
certificate, Social Security card, immunization records, education 
records, additional health records, and an "Almost 18?" checklist that 
lists the 14 required items youth should receive. Texas child welfare 
agency policy also requires group decision-making meetings called 
Circles of Support to enable youth age 16 or older to develop a 
transition plan and to connect with supportive and caring adults who 
can help the youth after they leave foster care. 

Figure 3: Top Three Practices Used by States to Implement Required 
Provisions Related to Older Youth: 

[Refer to PDF for image: horizontal bar graph] 

Number of states: 

Youth input on 90-day transition plan is documented: 
Required statewide (e.g., in state law, regulation, or child welfare 
agency policy): 49; 
Not required, but recommended statewide (e.g., in written state child 
welfare agency practice guidance): 3. 

90-day transition plan includes ensuring youth has key documents: 
Required statewide (e.g., in state law, regulation, or child welfare 
agency policy): 49; 
Not required, but recommended statewide (e.g., in written state child 
welfare agency practice guidance): 3. 

90-day transition plan includes efforts to ensure youth has adult 
connections: 
Required statewide (e.g., in state law, regulation, or child welfare 
agency policy): 36; 
Not required, but recommended statewide (e.g., in written state child 
welfare agency practice guidance): 13. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

[End of figure] 

HHS data show that 19 states have approved plan amendments to 
implement the option to extend title IV-E assistance to eligible youth 
ages 18 to 21. Of these states, 9 had previously extended the age for 
foster care with other funding sources, at least under limited 
circumstances. 

In addition to providing information on specific practices, states 
reported that the legislative and regulatory actions they took, if 
any, to implement the selected Fostering Connections Act provisions 
varied. For each of the selected provisions in our review, some states 
reported making changes to their laws and regulations to implement the 
provision, while others reported that their state laws and regulations 
were already consistent with the act.[Footnote 18] For example, three 
of the four states we visited reported that they enacted or revised 
laws or regulations to implement some of the family connections 
provisions. State officials indicated that these laws or regulations 
largely made minor changes to existing child welfare policy in this 
area. For instance, officials in California explained that county 
child welfare agencies were already required by state law to look for 
family members and consider them for placement prior to the Fostering 
Connections Act, but the state amended its law to conform to the 
requirements of the act, such as by adding a timeframe--child welfare 
workers are to identify and notify relatives within 30 days of a 
child's removal from the home. In addition, in response to our survey, 
many states indicated that their existing laws or regulations were 
consistent with the Fostering Connections Act and that no changes were 
needed.[Footnote 19] Some states reported that they have undertaken 
efforts that are reflected in agency policy or practice guidance, but 
did not change their laws or regulations. For example, in our survey, 
Massachusetts reported making no changes to laws or regulations to 
implement the school stability requirements, but officials we 
interviewed there told us about new school stability efforts reflected 
in joint agency guidance from the state's child welfare and 
educational agencies. Similarly, Texas officials reported adding a 
Circles of Support transition planning meeting in the 90 days before 
youth turn 18 or exit care without revising state law or regulation. 

States Reported Challenges, Especially Related to Lack of Available 
Foster Placements: 

Most states reported in our survey that they face major challenges, 
some of which are rooted in difficulties finding sufficient or 
appropriate living placements for foster youth or appropriate housing 
for youth after transitioning from foster care, along with other 
challenges. 

Family Connections: 

States reported major difficulties identifying appropriate placements 
for sibling groups, specifically finding available placements for 
large sibling groups (42 states), or sibling groups with exceptional 
needs (30 states) or with a wide age range (18 states). Although 
states do not collect uniform data on sibling placement, caseworkers 
and youth we met with in one state and foster parents in another 
reported that siblings are frequently separated. One director of a 
local child welfare agency we interviewed explained that some foster 
families and treatment facilities specify an age range for children 
they are willing to accept, and siblings may not fall within these age 
ranges. A case worker in another state explained that some families do 
not want to take older siblings who are more likely to have a higher 
level of trauma than younger children. In addition, 15 states 
identified competing priorities--specifically the tension among the 
priorities to place siblings together, keep a child at their school of 
origin, and place a child with a family member--as a major challenge. 
Local child welfare agency officials in two of the localities we 
visited told us they tend to give higher priority to placement with a 
family member than to placement near the school of origin. Fewer 
states (no more than 15) reported major challenges related to 
identifying or notifying relatives within 30 days of a child's 
removal. Child welfare officials we interviewed in all four of the 
states we visited indicated that they had prioritized identifying 
relatives for placements prior to enactment of the Fostering 
Connections Act. 

School Stability: 

States reported that finding foster placements was a major impediment 
to implementing the school stability provisions as well. Specifically, 
finding foster placements near a student's current school was 
identified as a major challenge by 38 states. Officials or child 
welfare workers we interviewed in six of the eight localities we 
visited--representing both urban and rural areas--told us that 
children are frequently placed in homes that are far from their 
current school. Child welfare workers in urban locations reported that 
in some cases older youth may be able to take public transportation 
back to their school. However, it is more difficult to transport 
younger children since they are more dependent on the foster parent 
for transportation in these cases, and foster parents may not be able 
to provide transportation due to their work schedules. Issues with 
arranging transportation back to the child's school of origin upon 
placement outside of the district--both determining what entity should 
be responsible for transportation costs and identifying funds for 
transportation--were each raised as a major challenge by 20 states. 
Former and current foster youth we spoke with in three different 
states reported frequent school changes upon placements, and discussed 
the detrimental effects of these changes on their academic progress 
and social development. For example, new schools may not recognize 
credits they have earned elsewhere, and it can be emotionally 
difficult to leave old friends behind and make new ones. Further, 19 
states reported in our survey that the lack of a requirement for 
educational agencies to coordinate with child welfare agencies is a 
major challenge they face in ensuring school stability for foster 
youth.[Footnote 20] In our site visits, we also heard concerns about 
coordination from child welfare and school officials in five of the 
eight localities we visited. 

Older Youth: 

Thirty-one states reported identifying appropriate housing for youth 
after they transition out of foster care as a major challenge. Finding 
appropriate housing for older youth who remain in foster care beyond 
age 18 was also cited as a challenge by the two states we visited that 
had extended foster care. Officials from one locality noted that young 
adults may voluntarily leave foster care and re-enter the program, but 
finding housing for these youth can be a challenge. Child welfare 
workers in another locality explained that finding a home that 
welcomes older youth with behavioral problems is especially 
problematic. In discussions with former and current foster youth, we 
heard examples of youth who were homeless and living in shelters upon 
transitioning out of care. In addition, 21 states reported additional 
difficulties with transition planning; that is, with both identifying 
and engaging supportive adults from the youth's life in the transition 
planning efforts, and the same number of states reported a lack of 
staff training or time to effectively engage youth in their transition 
planning. Some case workers we interviewed also explained that 
sometimes youth left care unexpectedly which made it difficult to 
complete the 90-day transition plan. 

These challenges to maintaining family connections, ensuring school 
stability, and assisting older youth are not new; states have faced 
many of them since before the Fostering Connections Act was enacted. 
We heard examples of new approaches to try to address these 
challenges, such as the use of social media to locate relatives and 
telecommunications options to keep siblings connected. (See apps. I-
III for additional examples of state practices.) However, many 
challenges remain unresolved, hindering states' abilities to 
effectively meet the needs of children in foster care. 

Only Twenty-One States We Surveyed Reported Calculating Savings From 
Adoption Assistance Income Eligibility Changes for Fiscal Year 2012: 

Regarding implementation of the Fostering Connections Act provision 
directing states to reinvest any savings due to the elimination of 
income eligibility criteria for adoption assistance payments, only 21 
states we surveyed reported performing calculations of these savings 
from this change for fiscal year 2012, and 20 states reported 
performing the calculations for fiscal year 2011.[Footnote 21] Three 
states reported they were developing a methodology to calculate the 
savings. States that did calculate savings reported using these funds 
for a range of services, including state-funded subsidy payments, post-
adoption staff and services, mental health services, and other child 
welfare uses. 

Twenty states--representing both states that did report calculating 
savings and those that did not--reported facing difficulties with 
calculating the amount of savings from the change in eligibility 
criteria for adoption assistance payments.[Footnote 22] Specifically, 
eight of these states reported facing challenges with identifying 
children who are eligible for title IV-E payments as a result of the 
change in income eligibility criteria. An organization that has worked 
with states on this calculation explained that some states do not 
track the reason for ineligibility, so they are unable to determine 
whether a currently eligible child had previously been ineligible for 
title IV-E payments due to their birth family's income. Six states 
reported challenges either calculating the savings manually or 
identifying a mechanism to automate the calculations. Four states 
reported challenges with developing a methodology to determine 
savings, and three states discussed the challenge of calculating the 
savings given the gradual phasing-in of more eligible youth by age or 
other changes in the eligible population. Few states identified 
challenges related to reinvesting the savings. Specifically, three 
states reported difficulty in planning for the use of the funds given 
the uncertainty about how much the state will have to spend each year. 
Two other states reported facing challenges obtaining approval within 
the state for their spending plans. 

HHS officials attributed the low number of states that reported 
calculating savings in our survey to the lack of a reporting 
requirement, confusion over the requirement for states to document and 
use any savings, and the low number of youth eligible under the new 
eligibility criteria to date. While the Fostering Connections Act did 
not specifically require states to report the amount saved as a result 
of the eligibility changes, the Child and Family Services Improvement 
and Innovation Act, enacted in 2011,[Footnote 23] required states to 
document how any savings were spent. Further, according to the 
officials, the calculations are complicated--requiring states to 
determine which youth would have been eligible for federal adoption 
assistance payments under the old criteria as well as the new. 
Officials also suggested that states have likely seen limited savings 
to date due to the fact that the requirement has only applied to older 
children so far. The revised eligibility criteria will apply to 
children ages 8 and older in fiscal year 2014 and to children of all 
ages by fiscal year 2018. In addition, HHS officials noted that this 
provision is not a "maintenance of effort" requirement that would 
require states to spend a specified level of funding for child welfare 
services. Specifically, it does not address when these funds must be 
expended or whether they must be in addition to other state funds used 
for these purposes in any specific period. Therefore, it is possible 
for a state to document that any calculated adoption savings were used 
for child welfare purposes while also reducing state funding for these 
purposes--which would not increase total child welfare spending. 

HHS has not provided specific guidance on how states should calculate 
the savings, even though in 2008 the Congressional Budget Office 
estimated that enacting this provision could result in savings of over 
$1 billion to states from fiscal years 2009 to 2018. In its 2010 
Program Instruction on implementing the Fostering Connections Act, HHS 
stated that title IV-E agencies have the flexibility to determine the 
methodology for calculating savings. HHS officials explained they have 
not issued further guidance to states on performing the calculations 
because they have tried to implement this provision in a way that is 
not burdensome to states. In 2013, the Office of Management and Budget 
did, however, issue a revision to its single audit compliance 
supplement that included some guidance to assist auditors in 
evaluating states' compliance with this requirement.[Footnote 24] HHS 
officials informed us that state's assurances of these savings 
calculations are monitored using the single audit process, which is 
performed annually by state auditors. In the absence of guidance to 
states from HHS on how to perform these calculations, states may 
continue to struggle with finding ways to calculate savings resulting 
from increased federal reimbursement and thus may be missing an 
opportunity to reinvest additional funds into their child welfare 
programs. 

States Reported Receiving Useful Technical Assistance from HHS, but 
HHS Has Not Yet Systematically Monitored State Implementation: 

HHS Has Provided Broad Guidance as well as Tailored Assistance, Which 
Most States Found Useful: 

To support states in their implementation of the Fostering Connections 
Act, HHS provided broad guidance and technical assistance to all 
states, including written communications, information posted on 
various websites, and webinars. Written communications included 
Program Instructions and Information Memoranda to state agencies that 
clarify and explain procedures and methods for operationalizing 
program policies, activities, or priorities, and in some cases 
encouraged states to consider certain practices. In addition, the 
Training and Technical Assistance Coordination Center created two-page 
briefs for states that describe available training and technical 
assistance related to the key provisions of the Fostering Connections 
Act. As for websites, the Children's Bureau and technical assistance 
network organizations' websites provide comprehensive information, 
including toolkits and resource listings to help states review their 
policies and practices related to the Fostering Connections Act. For 
example, the Child Welfare Information Gateway website, one of the 
websites HHS maintains, has a specific section dedicated to the 
Fostering Connections Act that links to text of the legislation and 
other relevant resources. Lastly, according to HHS data, from 2008 to 
2013, HHS conducted approximately 53 webinars to assist states in 
implementing the Fostering Connections Act through several national 
resource centers and the Child Welfare Information Gateway. 

In addition to such broad guidance, HHS has also provided tailored 
assistance to states that requested it. According to HHS 
documentation, from fiscal year 2011 through March 2013, nearly all 
states requested tailored assistance to help them implement the 
Fostering Connections Act. This assistance may be in the form of 
consultation, problem solving, or discussions with individual states. 
Additionally, on some issues, the national resource centers provided 
assistance to multiple states at once. For example, the National 
Resource Center for Permanency and Family Connections worked with HHS 
and the Department of Education to convene a national meeting on child 
welfare, education, and the courts to encourage cross-system efforts 
to address educational stability issues and to showcase collaborative 
projects and initiatives at state and local levels that support 
educational well-being outcomes. In addition, the National Resource 
Center for Youth Development organized a number of efforts to help 
states implement the extension of foster care beyond age 18, including 
the development of a virtual meeting place for states that have 
implemented the extension to share information and ask questions. 

Overall, most states found the assistance they received from HHS and 
its technical assistance network useful. Nearly every state reported 
in our survey that they found HHS's Program Instructions and 
Information Memoranda (47), as well as regional office assistance 
(42), useful. One state official told us that the ongoing assistance 
via teleconferences and site visits from their regional HHS officials 
has been extremely helpful. In addition, a majority of states (40) 
reported that they found publications, such as practice briefs, 
toolkits, and other articles, useful. See figure 4 for state views on 
the usefulness of HHS technical assistance. 

Figure 4: States' Views on Usefulness of HHS Technical Assistance to 
Implement Fostering Connections Act Provisions: 

[Refer to PDF for image: horizontal bar graph] 

Number of states: 

HHS Guidance (Information Memoranda and Program Instructions): 
Very useful: 30; 
Somewhat useful: 17. 

Technical assistance provided by HHS (e.g. regional offices): 
Very useful: 16; 
Somewhat useful: 26. 

Publications: 
Very useful: 15; 
Somewhat useful: 25. 

Other teleconferences, webinars, and webcasts (aside from peer-to-peer 
supports): 
Very useful: 12; 
Somewhat useful: 27. 

Peer-to-peer supports (e.g., facilitated calls and workgroups with 
other states): 
Very useful: 10; 
Somewhat useful: 27. 

In-person convenings: 
Very useful: 15; 
Somewhat useful: 16. 

Technical assistance provided by National Resource Centers or regional 
implementation centers[A]: 
Very useful: 14; 
Somewhat useful: 15. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

[A] Nineteen states reported in our survey that they did not use HHS 
technical assistance centers. According to HHS officials, however, 
nearly all states used the national resource centers. The officials 
suggested that state responses to the use of national resource centers 
in our survey may not reflect this because the respondent may not have 
been familiar with that particular aspect of the state's activities. 

[End of figure] 

HHS Has Not Yet Systematically Monitored State Implementation of the 
Fostering Connections Act: 

To date, HHS's main oversight of state implementation of the Fostering 
Connections Act has consisted of reviewing states' title IV-E plans to 
ensure they comply with federal requirements; however, the agency has 
not yet systematically reviewed actual state implementation of the 
act. To review title IV-E plans, HHS staff in regional offices assess 
state laws, regulations, policies, and procedures for consistency with 
federal child welfare requirements, including those established by the 
Fostering Connections Act. A state's title IV-E plan must be amended 
or updated as necessary to comply with any new federal requirements, 
such as changes to the law. According to HHS, fifty states (including 
the District of Columbia) currently have approved title IV-E plans 
reflecting all mandatory provisions of the Fostering Connections Act 
(and other title IV-E requirements).[Footnote 25] According to 
officials in HHS regional offices that we interviewed, HHS's other 
oversight activities include reviewing quarterly expenditure data and 
ongoing discussions with state child welfare officials through 
conference calls, site visits, technical assistance, and joint 
planning with state officials around their plans for delivering and 
improving child welfare services.[Footnote 26] Additionally, HHS 
officials in one regional office told us that they may follow up on 
specific issues brought to their attention by advocates. While these 
oversight activities allow HHS to have some knowledge about state 
implementation of the Fostering Connections Act, at the time of our 
interviews, officials at all four HHS regional offices we spoke to 
told us that since the Fostering Connections Act was enacted, they 
have not comprehensively evaluated compliance with title IV-E plans 
within states after they have been approved. 

HHS's last 5-year round of the CFSR process to comprehensively monitor 
state child welfare programs began in 2007, before the enactment of 
the Fostering Connections Act. HHS regulations provide that states 
must undergo a complete review of child welfare programs--including 
title IV-E--every 5 years, and HHS implements this requirement using 
the CFSR process. In March 2014, HHS announced plans to conduct the 
next round of CFSRs beginning in fiscal year 2015. This announcement 
addresses process changes, such as not requiring stakeholder 
interviews if HHS determines that data provided by the state 
sufficiently demonstrate state compliance in a particular area. While 
the assessment instrument used by HHS for previous CFSRs may be broad 
enough to capture some of the new provisions of the Fostering 
Connections Act, such as placement with siblings or school stability, 
HHS has not completed the assessment instrument for the forthcoming 
round, so it is not clear what indicators would be used to assess 
compliance with these provisions. Additionally, the previous CFSR 
instrument does not address other provisions that involve specific 
deadlines, such as the requirement that child welfare agencies 
identify and notify relatives within 30 days after a child's removal 
from his home or that youth develop a transition plan 90 days prior to 
aging out of foster care. HHS officials told us that they are 
currently revising this instrument in preparation for the next round 
of CFSRs and expected it to be finalized in the summer of 2014. 

HHS officials told us that the next round of the CFSRs, which should 
have started in 2012, was delayed because the agency was considering 
how to best address comments they solicited in 2011 on improving the 
CFSR process and what changes, if any, they would need to make to the 
regulations to monitor implementation of the Fostering Connections 
Act.[Footnote 27] In the meantime, officials in one regional office 
told us that with this delay in the CFSR process, there is no other 
mechanism in place for HHS to systematically examine actual state 
practices. Our previous work found that regional HHS staff considered 
the CFSR an important complement to a state's planning documents--it 
enables HHS staff to determine both whether states are providing the 
services they report in their planning documents and whether those 
services are adequate and appropriate to meet the needs of the state's 
children and families.[Footnote 28] Officials in all four regional 
offices we spoke with told us that a systematic monitoring effort, 
like the CFSR, could help states improve their programs. An official 
in one regional office added that states can also gain the support 
needed to make improvements by showing results from systematic 
monitoring reviews. 

HHS also lacks adequate data to assess if states are complying with 
the policies they outlined in their title IV-E plans or the 
effectiveness of states' actions. Internal control standards state 
that management should obtain data on a timely basis for effective 
monitoring.[Footnote 29] Effective control structures depend on data 
analysis to determine whether agencies are effectively using resources 
and whether the agency is in compliance with applicable laws and 
regulations. However, HHS has not yet updated information collection 
requirements for case level data it collects from states on children 
in foster care through the Adoption and Foster Care Analysis and 
Reporting System (AFCARS). These data do not reflect the new 
provisions added by the Fostering Connections Act, such as those on 
sibling placement and school stability. HHS officials told us that 
they are beginning the process of revising AFCARS completely and plan 
to publish a notice of proposed rulemaking in the spring of 2014. 
AFCARS data are used to inform oversight activities conducted by HHS, 
including the CFSR process. These data will not be revised in time for 
the upcoming fiscal year 2015 CFSR process, which relies heavily on 
AFCARS for the development of statewide performance indicators. 
Meanwhile, officials in two states we visited told us that they were 
in the process of updating their state data systems and it would be 
helpful for them to know what kind of data HHS would like them to 
collect before making a costly and time-intensive investment in 
overhauling their system. Additionally, while some states may 
voluntarily collect information about the outcomes of their programs, 
many do not.[Footnote 30] This lack of data further hinders HHS's 
ability to evaluate implementation of the Fostering Connections Act. 

We found examples of potential uneven implementation of state policies 
in the four states we visited.[Footnote 31] For example, regarding the 
Fostering Connections Act school stability provisions, officials in 
one state we visited reported that while the state policy requires 
child welfare agencies and schools to jointly determine whether 
changing schools would be in a child's best interest, local agencies 
likely varied in the extent to which they collaborated and some may 
not be doing so at all. A local school official in another state 
observed that whether or not these best interest determinations happen 
may depend on individual caseworkers. Additionally, practices varied 
within the states we visited pertaining to the requirement that 
caseworkers support youth in developing a transition plan in the 90 
days before they age out of care. All four of the states we visited 
had updated their policies to reflect the new requirement, but local 
officials in one office indicated that they did not always complete 
plans for all youth before they age out of care. Caseworkers in 
another state told us that while they aim to engage youth in the 90-
day transition plan, the meeting held to fulfill the requirement may 
not include the youth in many cases. 

The experiences of the 29 current and former foster youth we met with 
also indicate that family connections, school stability, and 
transitions for older youth may still be a concern for some youth. 
[Footnote 32] For example, while nine of the youth we met with 
reported being placed together with their siblings or were in frequent 
contact, five youth said they had no contact with their siblings or 
had only sporadic contact.[Footnote 33] One young woman said that 
being able to see her sister was treated as a privilege rather than a 
right, and that the privilege was taken away, for example, when she 
did not perform well in school. In terms of school stability, nearly 
all of the youth we met with experienced multiple school changes and 
one youth reported missing a month of school upon entering foster care 
while waiting for records to be transferred to a new school. The youth 
we met with also had mixed experiences with transition planning. Ten 
of the youth felt they had benefited from their transition plans and 
group decision-making meetings, but eight said they did not recall 
having a transition plan or being actively involved in developing it. 
A systematic monitoring effort by HHS could help identify and address 
some of these problems. 

Conclusions: 

The Fostering Connections Act made changes to address shortcomings in 
the foster care system, and states have reported implementing numerous 
practices aimed at achieving improved outcomes for children and their 
families. More than 5 years after its enactment, however, HHS has not 
yet monitored states' implementation of the act in a systematic way. 
States reported facing major challenges with meeting requirements for 
sibling placement, educational stability, and several other provisions 
in the act. These challenges--some of them longstanding barriers--are 
complex, and failure to overcome them could hamper progress toward 
meeting the goals of the Fostering Connections Act. HHS has an 
important role in helping assess what states have done and what else 
is needed to improve outcomes for children in foster care. While HHS 
has plans under way to begin monitoring through a new round of CFSRs 
in fiscal year 2015, HHS has not specified how it will address changes 
made by the Fostering Connections Act. Without monitoring state 
implementation of these new provisions, it will be difficult for HHS 
to have sufficient information to determine how these approaches are 
working and whether changes to state or federal policies or federal 
guidance and assistance are needed to improve outcomes for children in 
foster care. At the same time, HHS has not yet updated data reporting 
requirements to reflect the new provisions of the Fostering 
Connections Act. These data are a fundamental element of the CFSR 
process, yet they will not be relevant to the changes made by the 
Fostering Connections Act for the next round of reviews. Without these 
data, it will be difficult for HHS to have adequate information to 
evaluate implementation and assess states' progress towards meeting 
the needs of children in and transitioning out of foster care. 
Additionally, for states that have already begun revamping their own 
state data systems, incorporating federal requirements at a later date 
can lead to additional delay or expense. Lastly, only 21 states 
reported calculating their savings from the federal adoption 
assistance income eligibility changes for fiscal year 2012, despite 
the Fostering Connections Act requirement that states spend these 
savings on their child welfare programs. Although states we surveyed 
reported challenges performing these calculations, HHS has not issued 
guidance to states on how to perform them. The amount states save 
could grow more significant as the expanded eligibility criteria are 
phased in to include all youth by fiscal year 2018. The state funds 
freed up as a result of more children becoming eligible for federal 
funding could help states address the persistent challenges they face 
serving children in foster care. In the absence of further guidance, 
states may continue to struggle with calculating savings and miss an 
opportunity to take advantage of increased federal funds to add to 
limited state resources. 

Recommendations for Executive Action: 

To ensure implementation of the Fostering Connections Act and improve 
outcomes for children in foster care, we recommend the Secretary of 
Health and Human Services take the following three actions. 

To maximize the amount of funds states are reinvesting into child 
welfare services, the Secretary of Health and Human Services should 
provide guidance on how states could calculate savings from the 
changes to the federal adoption assistance income eligibility criteria. 

To help identify areas where states may need additional support or 
guidance in their efforts to provide children in foster care with 
services and assistance under title IV-E, as amended by the Fostering 
Connections Act, the Secretary of Health and Human Services should 
proceed with and expeditiously finalize plans to: 

* systematically monitor state practices for compliance with policies 
outlined in their title IV-E plans that cover the new provisions 
established by the Fostering Connections Act, and: 

* update AFCARS to collect relevant data from states about provisions 
established by the Fostering Connections Act. 

Agency Comments and Our Evaluation: 

We provided a draft of this report to HHS and the Department of 
Education for review and comment. HHS provided formal comments that 
are reproduced in appendix V. HHS also provided technical comments 
that we incorporated, as appropriate. Education did not have comments. 

HHS concurred with our recommendations and outlined steps it is taking 
to implement them. HHS stated that it is committed to continuing to 
support states in providing high quality child welfare services and to 
engaging in monitoring activities that hold the states accountable 
both for compliance with the law and for improved outcomes for 
children and families. 

In response to our recommendation to provide guidance on how states 
could calculate savings from the changes to the federal adoption 
assistance income eligibility criteria, HHS said the department will 
gather examples of how savings are being calculated and documented by 
some states and develop a document to provide as technical assistance 
to other states. HHS further stated that the department's 
implementation of this provision to date has been driven by a desire 
to avoid imposing an undue administrative burden on states and the 
challenge of specifying a methodology for calculating savings that 
would work in all state settings. HHS said that state officials have 
signed assurances as part of their title IV-E plan submissions to 
calculate and reinvest these savings. HHS also stated that independent 
auditors are responsible for identifying an appropriate finding in 
single audit reports for any states that have not taken steps to 
calculate and account for these savings. HHS said it will work to 
assure that all needed corrective actions are taken to resolve any 
such finding in a state's single audit. 

In response to our recommendation to expeditiously finalize plans to 
systematically monitor state practices for compliance with policies 
outlined in their title IV-E plans that cover the new provisions 
established by the Fostering Connections Act, HHS stated that the CFSR 
process is designed to provide federal oversight of states' compliance 
with provisions of titles IV-B and IV-E, and the amendments made by 
the Fostering Connections Act to titles IV-B and IV-E will be 
reflected in the revised CFSR protocol. HHS said it is in the process 
of finalizing the instruments and measures that will be used during 
the round of reviews expected to begin in fiscal year 2015 and they 
will be shared with the public when finalized. We continue to 
encourage HHS to ensure that the new provisions introduced by the 
Fostering Connections Act are incorporated into these instruments and 
measures and that the department moves quickly to complete the 
instruments and begin the third round of CFSR reviews. 

In response to our recommendation that HHS expeditiously finalize 
plans to update AFCARS to collect relevant data from states about 
provisions established by the Fostering Connections Act, HHS stated 
that ACF has announced its intent to begin the regulatory process to 
make changes to AFCARS by issuing a Notice of Proposed Rulemaking, 
projected to be published in the spring of 2014. HHS did not discuss 
how these changes would incorporate the provisions in the Fostering 
Connections Act nor provide an estimate as to when these changes will 
be completed. We encourage HHS to make every effort to expedite these 
changes within the rulemaking process. As it is, the next round of 
CFSRs will proceed without the benefit of updated data from AFCARS 
relevant to the amendments made by the Fostering Connections Act. 
Without these data, it will be difficult for HHS to have adequate 
information to assess states' progress in implementing the Fostering 
Connections Act. 

We are sending copies of this report to the Secretaries of Health and 
Human Services and Education, and interested congressional committees. 
In addition, the report is available at no charge on the GAO website 
at [hyperlink, http://www.gao.gov]. 

If you or your staff members have any questions about this report, 
please contact me at (202) 512-7215 or brownke@gao.gov. Contact points 
for our Offices of Congressional Relations and Public Affairs may be 
found on the last page of this report. GAO staff who made key 
contributions to this report are listed in appendix VI. 

Signed by: 

Kay E. Brown, Director: 
Education, Workforce, and Income Security Issues: 

List of Requesters: 

The Honorable Sander Levin: 
Ranking Member: 
Committee on Ways and Means: 
House of Representatives: 

The Honorable Lloyd Doggett: 
Ranking Member: 
Subcommittee on Human Resources: 
Committee on Ways and Means: 
House of Representatives: 

The Honorable Jim McDermott: 
Ranking Member: 
Subcommittee on Health: 
Committee on Ways and Means: 
House of Representatives: 

[End of section] 

Appendix I: Findings on Family Connections Provisions: 

Relative identification and notification: 

States took steps to formalize or modify prior policies, and
some states experienced challenges finding relatives. 

What the act says: 

As amended by the Fostering Connections to Success and
Increasing Adoptions Act of 2008 (Fostering Connections Act), title
IV-E of the Social Security Act requires that the state exercise due
diligence to identify and notify all grandparents and other adult
relatives of a child, subject to certain exceptions, within 30 days
of the child's removal from the parents' custody and of the relatives' 
options to become a placement resource for the child. 42 U.S.C. § 
671(a)(29). 

Legislative/regulatory action: 

States reported taking the following legislative or regulatory action to
implement the relative identification and notification requirement: 16 
states enacted or revised a law: AR, CA, CO, FL, GA, HI, IN, IA, ME, 
MD, MN, MT, OK, TX, UT, and WI. 

23 states issued or revised a regulation: AL, AZ, CO, CT, ID, LA, MS, 
MO, NE, NH, NJ, NM, NY, NC, ND, OH, OK, OR, PR, TN, VA, WA, and WI. 

13 states made no changes: 
(The existing law or regulation was already consistent with the 
federal requirement) AK, DE, DC, KS, MA, MI, NV, PA, RI, SC, SD, VT, 
and WY. 

Note: Responses sum to 52 but not all states are represented as some 
states reported taking both legislative and regulatory action. Because 
states generally had discretion in how to implement this provision, 
some states may have used means other than law or regulation. 

Table: Practices reported by states in a nationwide survey: 

Relative identification and notification practices that states 
reported being required or recommended statewide: 

Relative identification practices: 

Efforts to identify relatives are documented in the case file: 
48 required; 
3 recommended. 

A group decision-making strategy is used to identify relatives (e.g., 
team decision-making or family group decision-making): 
33 required; 
15 recommended. 

Identification of relatives begins prior to a child's removal from the 
home: 
32 required; 
14 recommended. 

Local, state, or federal information management systems are used to 
identify relatives (e.g., Statewide Automated Child Welfare 
Information System or Department of Motor Vehicle records): 
31 required; 
15 recommended. 

Federal Parent Locator Service is used to identify adult relatives 
(other than non-custodial parents): 
17 required; 
15 recommended. 

Private subscription services are used (e.g., Lexis-Nexis): 
10 required; 
25 recommended. 

Relative notification practices: 

Efforts to notify relatives are documented in the case file: 
49 required; 
0 recommended. 

Notification to relatives is provided in writing: 
43 required; 
7 recommended. 

Notification to relatives is provided both verbally and in writing: 
20 required; 
24 recommended. 

Notification to relatives is provided in languages other than English, 
if needed: 
20 required; 
20 recommended. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

[End of table] 

Practices in selected states: 

States we visited reported refining their relative identification and
notification practices in response to the Fostering Connections Act. For
example, according to state officials, Massachusetts began requiring 
notification in writing, and California added a timeframe to its state 
law. Officials in multiple locations emphasized the importance of 
engaging relatives as early as possible, in some cases before a child 
is formally removed from the home. Three of the four states used 
family team meetings to discuss potential relative placement options. 
While all four of the states we visited used technology-—such as Lexis-
Nexis or the Federal Parent Locator Service—-to locate relatives,
caseworkers we interviewed in Texas indicated that a child's parents 
remain the first and primary source of information about relatives. 
Caseworkers also reported using social media to locate relatives. 
Officials and caseworkers in three of the four states reported that 
they use both written notification and a telephone call to notify 
relatives. 

Selected state challenges: 

Officials and caseworkers reported that parents may not be forthcoming 
with information on relatives, particularly related to non-custodial 
fathers. One state noted that the 30-day timeframe can be challenging 
if a child is not already known to the agency at the time of removal. 
An official in one local office that serves a large immigrant 
community noted that identifying relatives outside of the country may 
take longer. 

Figure: Challenges reported by states in a nationwide survey: 

[Refer to PDSF for image: horizontal bar graph] 

Number of states: 

Insufficient staff resources to conduct or follow up on searches: 
Not a challenge: 13; 
Minor challenge: 21; 
Major challenge: 15. 

Parent hesitation to identify relatives: 
Not a challenge: 2; 
Minor challenge: 35; 
Major challenge: 13. 

Lack of technology to search for relatives: 
Not a challenge: 30; 
Minor challenge: 12; 
Major challenge: 7. 

Caseworker concerns about compromising parents' confidentiality: 
Not a challenge: 19; 
Minor challenge: 25; 
Major challenge: 5. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

Note: Responses do not sum to 52 if states selected “do not know/not 
applicable” or did not respond. 

[End of figure] 

Data collection: 

Federal: HHS does not collect nationwide data on relative identification
and notification efforts. States do report data to HHS on the 
percentage of children in foster care whose most recent placement is 
in a relative foster family home, which one state noted using as a 
proxy measure for relative identification and notification efforts. 
HHS data indicate that this figure has increased somewhat in recent 
years (see table below). 

Table: Percentage of children in foster care whose most recent 
placement setting was a relative foster family home: 

Fiscal year 2008: 24%; 
Fiscal year 2009: 24%; 
Fiscal year 2010: 26%; 
Fiscal year 2011: 27%; 
Fiscal year 2012: 28%. 

Source: HHS, Adoption and Foster Care Analysis and Reporting System 
(AFCARS). 

[End of table] 

State: In our survey, 23 states reported that they use quantitative
indicators or data to assess their state's performance related to the
relative identification and notification requirements. Seven states 
indicated that they collected specific data on these requirements. 
Eight states indicated that their measures relate to the placement of 
children with relatives, as discussed above, rather than 
identification and notification efforts specifically, and eight states 
did not provide details on what they collect. Additionally, two states 
that captured relevant data, such as the number of relatives 
identified or the timeliness of relative search efforts, reported that 
these data are not yet regularly reviewed. 

[End of section] 

Sibling Placement: 

States required practices aimed at keeping siblings together or in 
contact, but the lack of appropriate placements for sibling groups was 
a major challenge. 

What the act says: 

Requires states to make reasonable efforts to place siblings removed 
from their home in the same foster care, kinship guardianship, or 
adoptive placement, and to provide for frequent visitation or other 
ongoing interaction between siblings who are not placed together, 
unless it would be contrary to the safety or well-being of any of the 
siblings to do so. 42 U.S.C. § 671(a)(31). 

Legislative/regulatory action: 

States reported taking the following legislative or regulatory action to
implement the federal sibling placement requirement: 12 states enacted 
or revised a law: AK, FL, GA, MN, NV, NJ, ND, OK, PA, TX, VA, and WI. 

21 states issued or revised a regulation: AL, AZ, AR, CT, HI, ID, LA, 
ME, MD, MS, NE, NM, ND, OH, OK, OR, PR, RI, TN, UT, and WI. 

17 states made no changes:
(The existing law or regulation was already consistent with the 
federal requirement) CA, CO, DE, DC, IN, IA, KS, MA, MO, MT, NH, NY, 
NC, SC, SD, WA, and WY. 

Note: Responses do not sum to 52 because not all states may have 
responded to the question, and some states may have taken both 
legislative and regulatory action. Because states generally had 
discretion in how to implement this provision, some states may have 
used means other than law or regulation. 

Table: Practices reported by states in a nationwide survey: 

Sibling placement practices that states reported being required or 
recommended statewide: 

Number of states: 

When siblings cannot be placed together, a visitation plan is created 
that specifies that siblings should be in contact at least monthly[A]: 
47 required; 
4 recommended. 

Ongoing efforts are made to reunite siblings placed separately[A]: 
42 required; 
6 recommended. 

Child welfare staff use specified factors to consider whether 
placement with siblings would be contrary to a child's safety or well-
being: 
37 required; 
6 recommended. 

When siblings cannot be placed together, efforts are made to place 
them in close proximity to facilitate contact[A]: 
31 required; 
20 recommended. 

A group decision-making strategy is used to make sibling placement 
decisions (e.g., team decision-making or family group decision-making): 
26 required; 
20 recommended. 

Children placed in care are included in decisions about sibling 
placements when appropriate: 
23 required; 
25 recommended. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

Note: The Fostering Connections Act generally does not require states 
to adopt particular practices. 

Totals may not sum to 52 if some states do not require or recommend 
the practice. 

[A] Unless it would be contrary to a child's safety or well-being. 

[End of table] 

Through our survey, individual states also provided the following 
examples of practices that worked well in their efforts to meet the 
federal requirement: placement of siblings with relatives; allowing 
some flexibility around rules such as the number of children allowed 
in a foster home or sharing a bedroom; temporary use of emergency 
placements to maintain sibling groups until a suitable permanent 
placement is located; and increasing priority and awareness within the 
agency around sibling placement. In particular, one state noted that 
having youth alumni share their experiences with caseworkers has had 
an impact on making sibling placement a priority. 

Practices in selected states: 

States that we visited revised existing policies related to sibling 
placement. For example, officials in Massachusetts said that their
sibling placement practices have been in place since the 1980s, but
were put into state law in 2008. Officials in Texas said they launched 
a major initiative that included training staff on the importance of 
sibling connections. Texas officials also reported expanding the use of
telecommunication options to keep siblings connected. Officials in 
three of the four states we visited noted that placing siblings with
relatives is a key strategy that can address several challenges, such
as difficulty finding placements for siblings with a wide range in age. 

Selected state challenges: 

The lack of available placements for sibling groups was a challenge 
identified in all four states we visited. One local office noted that
this can be particularly challenging in high-cost urban areas where
potential resource families have limited space. Additionally, siblings
may have different needs that may require separate housing, as when
one sibling has severe behavioral issues that require a higher level of
care. Caseworkers in two states noted that groups in which siblings
have different fathers can complicate placement with relatives. One 
group of foster parents we interviewed reported that the child welfare 
agency does not do enough to facilitate visitation between separated 
siblings, which is left to the foster parents to arrange. 

Figure: Challenges reported by states in a nationwide survey: 

[Refer to PDF for image: horizontal bar graph] 

Number of states: 

Lack of available placements for large sibling groups: 
Not a challenge: 0; 
Minor challenge: 9; 
Major challenge: 42. 

Exceptional needs of one or more siblings: 
Not a challenge: 2; 
Minor challenge: 19; 
Major challenge: 30. 

Sibling groups with a wide range in age: 
Not a challenge: 6; 
Minor challenge: 26; 
Major challenge: 18. 

Coordinating placement when siblings are removed from the home at 
different times: 
Not a challenge: 7; 
Minor challenge: 29; 
Major challenge: 15. 

Competing placement priorities (i.e., placement with a relative 
compared to proximity to school): 
Not a challenge: 10; 
Minor challenge: 26; 
Major challenge: 15. 

State law, regulation, or policy limiting the number of foster 
children allowed in a home: 
Not a challenge: 29; 
Minor challenge: 20; 
Major challenge: 2. 

Defining who is a sibling: 
Not a challenge: 43; 
Minor challenge: 7; 
Major challenge: 0. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

Note: Responses do not sum to 52 if states selected “do not know/not 
applicable” or did not respond. 

[End of figure] 

Data collection: 

Federal: 

* HHS does not collect nationwide data on sibling placement or
visitation. 

State: 

* Twenty-five states reported in our survey that they use quantitative
indicators or data to assess their state's performance related to the
federal sibling placement requirements. Of these, 15 indicated that
their statewide data systems can track whether siblings are placed
together. 

* One state we visited tracks the share of sibling groups in which all
siblings are placed together; some siblings are together and others are
separated; and all siblings are separated. These data can be
compared across regions of the state. 

[End of section] 

Waivers of non-safety licensing standards: 

More states currently allow waivers for relative foster family homes 
compared to 2008, but some officials reported a burdensome process: 

What the act says: 

Authorizes states to waive, on a case-by-case basis, non-safety
licensing standards for relative foster family homes. States have
the discretion to determine what constitutes a non-safety standard.
42 U.S.C. § 671(a)(10). 

Pre-existing guidance from HHS permits states to grant “variances,”
alternative equivalent methods of meeting licensing standards, on a
case-by-case basis. According to HHS, the legislative change 
encouraged more states to actively engage relatives and to increase
the percentage of relative foster family homes that are licensed. 

Legislative/regulatory action: 

States reported taking the following legislative or regulatory action to
implement the option to waive nonsafety licensing standards for 
relative foster family homes: 

13 states enacted or revised a law: AR, CA, CO, DC, GA, IN, LA, ME, 
MN, NJ, ND, TX, and WI. 

18 states issued or revised a regulation: AL, AZ, CO, CT, HI, LA, MD, 
MS, MO, NE, NV, ND, OH, OK, OR, TN, UT, and WI. 

18 states made no changes: (The existing law or regulation was already
consistent with the federal requirement) AK, DE, FL, ID, IA, KS, MA, MT,
NH, NY, NC, PA, RI, SC, SD, VT, WA, and WY. 

Note: Responses do not sum to 52 because not all states may have 
responded to the question, and some states may have taken both 
legislative and regulatory action. Because states generally had 
discretion in how to implement this provision, some states may have 
used means other than law or regulation. 

Note to table at right: The following states reported that they allow 
waivers of non-safety licensing standards for relative foster family 
homes but such standards are not defined in state law, regulations, or 
agency policy: Arizona, Arkansas, Hawaii, Indiana, Louisiana, 
Michigan, Nevada, North Carolina, Texas, Utah, Vermont, Virginia, and 
Washington. 

States that allow waivers: 

In response to our survey, 43 states reported they now allow waivers of
non-safety licensing standards for relative foster family homes, up 
from 33 prior to the enactment of the Fostering Connections Act. Of 
these 43 states, 19 reported allowing local or county offices to 
approve waivers. Most states that allow these waivers reported that 
they define “non-safety” or list specific standards that may be waived 
in state law, regulation, or agency policy. 

Table: States that reported defining “non-safety” or listing specific 
standards that may be waived: 

Alaska: 
In agency policy. 

California: 
In regulation; 
In agency policy. 

Colorado: 
In regulation. 

Connecticut: 
In regulation; 
In agency policy. 

District of Columbia: 
In regulation. 

Georgia: 
In agency policy. 

Idaho: 
In regulation; 
In agency policy. 

Illinois: 
In agency policy. 

Iowa: 
In regulation. 

Kansas: 
In regulation; 

Maine: 
In agency policy. 

Massachusetts: 
In agency policy. 

Minnesota: 
In agency policy. 

Mississippi: 
In agency policy. 

Missouri: 
In regulation; 
In agency policy. 

Montana: 
In regulation; 
In agency policy. 

Nebraska: 
In agency policy. 

New Hampshire: 
In state law; 
In regulation; 
In agency policy. 

New Jersey: 
In agency policy. 

New York: 
In agency policy. 

North Dakota: 
In agency policy. 

Ohio: 
In regulation. 

Oklahoma: 
In agency policy. 

Oregon: 
In regulation; 
In agency policy. 

Pennsylvania: 
In regulation. 

Rhode Island: 
In regulation. 

Tennessee: 
In agency policy. 

West Virginia: 
In agency policy. 

Wisconsin: 
In state law; 
In regulation; 

Wyoming: 
In agency policy. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

[End of table] 

Practices in selected states: 

All four of the states we visited allowed waivers of non-safety
licensing standards for relative foster family homes, but use of
waivers varied. Officials in Massachusetts and California noted that 
they had been approving waivers of non-safety standards before the 
Fostering Connections Act, and approve waivers, for example, related 
to square footage or sleeping arrangements. Officials in one 
California county explained that about half of the county's placements 
are with relatives, and that the majority of these required some kind 
of waiver. While waivers for relatives are allowed in Texas and 
Virginia, officials in those states said that they are not frequently 
used in part because of the lower number of relative foster family 
homes pursuing licensure. 

Selected state challenges: 

Local officials or caseworkers in three of the four states we visited
told us that the process for getting a waiver approved can be 
burdensome or lengthy. Some indicated that this can lead to not 
pursuing waivers in some cases. Caseworkers in one state told us that 
many relative homes remain unlicensed in part because of the difficult 
process, but that many of these families are struggling and need the 
financial assistance that being licensed would provide. One official 
in another state said that caseworkers in some local offices may not 
try to get relative homes licensed because of local office attitudes 
against families being paid to care for their relatives. 

Figure: Challenges reported by states in a nationwide survey: 

[Refer to PDF for image horizontal bar graph] 

Number of states: 

Working across states when a relative family moves or is located in a 
different state: 
Not a challenge: 9; 
Minor challenge: 19; 
Major challenge: 12. 

Limited staff resources to process applications: 
Not a challenge: 16; 
Minor challenge: 19; 
Major challenge: 7. 

Family preference to remain unlicensed: 
Not a challenge: 16; 
Minor challenge: 15; 
Major challenge: 7. 

Disagreement between state licensing authority and child welfare 
agency: 
Not a challenge: 32; 
Minor challenge: 2; 
Major challenge: 2. 

Lack of clarity over what may be considered a non-safety licensing 
standard: 
Not a challenge: 25; 
Minor challenge: 17; 
Major challenge: 1. 

State laws that limit which requirements can be waived: 
Not a challenge: 28; 
Minor challenge: 13; 
Major challenge: 1. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

[End of table] 

Data collection: 

Federal: HHS does not routinely collect nationwide data on waivers of
non-safety licensing standards for relative foster family homes. In 
2011, as required by the Fostering Connections Act, HHS submitted a 
one-time report to Congress on children placed in relative foster 
family homes and the use of licensing waivers. That report noted that 
this was the first time that states were asked to provide this 
information, and some states do not routinely collect these data in 
their automated systems. The report contained information on types of 
non-safety licensing standards waived:[Footnote 1] 

* the majority of waivers approved pertained to a child's sleeping
arrangements or the space requirements in the home (e.g. bedroom
space, square footage); 

* waivers allowed a foster family home to parent more children and
children of different ages than would normally be allowable under state
licensing rules; 

* many waivers provided relatives with exemptions from pre-license and
ongoing foster parent training requirements, or extensions to complete
foster parent training. 

Footnotes: 

[1] HHS report does not provide the number of states that allow each 
of these types of waivers. 

[End of section] 

Title IV-E Guardianship Assistance Program: 

32 states operated a federally-subsidized kinship guardianship 
assistance program; state budget constraints were a major factor for 
many that did not: 

What the act says: 

Authorizes states to provide and receive federal reimbursement for
some kinship guardianship assistance payments and establishes certain 
eligibility requirements. A child may be eligible for a payment if, 
among other conditions, the state agency determines that: 

* the child has been eligible for foster care maintenance payments 
while residing for at least 6 continuous months in the home of the 
prospective relative guardian, and; 

* returning home or adoption are not appropriate permanency
options for the child. 42 U.S.C. §§ 671(a)(28), 673(d). 

States operating programs: 

According to HHS, the 32 states listed below have opted to run a
title IV-E guardianship assistance program (GAP) as of February
2014. Of these, 21 states ran GAP programs with state funds or
through a title IV-E waiver demonstration project prior to the
Fostering Connections Act. 

16 states previously operated a state-funded program: AK, CA,
CT, DC, HI, ID, ME, MD, MA, NE, NJ, NY, OK, PA, RI, and WA. 

5 states previously operated a program through a title IV-E 
waiver demonstration project: IL, MT, OR, TN, and WI. 

11 states did not previously operate a program: AL, AR, CO,
IN, LA, MI, MO, SD, TX, VT, and WV. 

3 states indicated that they plan to implement a title IV-E GAP
program in 2014: NC, SC, and UT. 

Table: Practices reported by states in a nationwide survey: 

Number of states: 

The child welfare agency informs relative foster parents considering 
guardianship that financial assistance is available: 
31 required; 
1 recommended. 

A consistent definition of “relative” is used for both the title IV-E 
GAP program and for initial relative identification and notification: 
26 required; 
3 recommended. 

A group decision-making strategy is used when considering relative 
guardianship (e.g., team decision-making, family group decision-
making): 
17 required; 
8 recommended. 

Guardianships in place prior to the state's implementation of a title 
IV-E GAP program are eligible for assistance payments: 
15 required; 
1 recommended. 

Relative foster parents are provided written materials describing the 
differences between foster care, guardianship, and adoption: 
15 required; 
10 recommended. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

Note: The Fostering Connections Act generally does not require states 
to adopt particular practices. Totals may not sum to 32 if some states 
do not require or recommend the practice. 

[End of table] 

Through the survey, individual states also provided the following 
examples of practices that worked well in their efforts to implement a 
title IV-E GAP program: 

* providing training on program processes and the benefits to children
and families; 

* having a specialized staff position to support guardianship efforts; 

* having a state “mailbox” for local offices to submit case-specific
questions; and; 

* agency culture that supports relative placements and recognizes the
need for ongoing assistance to ensure that relative placements remain
stable. 

Four states also noted that experience operating a state-funded
guardianship assistance program prior to the Fostering Connections Act
helped them to implement their programs. 

Practices in selected states: 

Two of the states we visited, California and Massachusetts, operated a 
state-funded guardianship assistance program prior to enactment of the 
Fostering Connections Act. Officials in Massachusetts reported that 
their program has remained largely the same. In California, officials 
said some changes to program rules made in response to the Act-—such
as reducing the number of months (from 12 to 6) a child must be
placed with a relative before guardianship could be granted—-have led 
to more children exiting foster care to guardianship. Texas 
implemented a guardianship assistance program for the first time in 
2010, and officials reported that they have actively recruited kinship 
families and use specialized kinship workers to talk with families 
about guardianship as an option. Virginia does not operate a 
guardianship assistance program. 

Selected state challenges: 

State officials in two of the states we visited that operate the program
said that the requirement that relative families become licensed and 
that the child be eligible for foster care payments for 6 months prior 
to guardianship can delay or impede permanency. Officials in one state 
said that getting older youth to participate can be difficult in part 
because exiting foster care to guardianship could limit access to the 
services that are available to older youth who remain in care, such as 
education and training vouchers. Officials in Virginia and Texas said 
that some stakeholders in their states are not in favor of providing 
financial assistance to relative guardians. 

Figure: Challenges reported by states in a nationwide survey: 

[Refer to PDF for image horizontal bar graph] 

Number of states: 

Need for relative guardians to have been licensed foster parents: 
Not a challenge: 9; 
Minor challenge: 10; 
Major challenge: 11. 

Eligibility requirement of 6 continuous months in foster care prior to 
title IV-E GAP: 
Not a challenge: 14; 
Minor challenge: 9; 
Major challenge: 8. 

Program limited to title IV-E eligible children: 
Not a challenge: 16; 
Minor challenge: 5; 
Major challenge: 5. 

Level of understanding of guardianship assistance among potential 
guardians: 
Not a challenge: 7; 
Minor challenge: 18; 
Major challenge: 4. 

Amount of time/resources available to train staff on title IV-E GAP: 
Not a challenge: 10; 
Minor challenge: 17; 
Major challenge: 3. 

Funding costs related to establishing guardianship: 
Not a challenge: 20; 
Minor challenge: 8; 
Major challenge: 3. 

Coordinating with Medicaid office to enroll children receiving title 
IV-E GAP: 
Not a challenge: 24; 
Minor challenge: 6; 
Major challenge: 0. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

Note: Responses are from the 32 states that operated a GAP program. 
Responses do not sum to 32 if states selected “do not know/not 
applicable” or did not respond. 

[End of figure] 

In addition, 13 states reported that state budget constraints for the 
state match portion of payments was a major factor in their states' 
decision not to establish a GAP program to date. 

Data collection: 

Federal: HHS collects data from states on the number of children served
through title IV-E GAP programs as part of states' quarterly financial
reporting (see table below). 

Table: Number of children served through title IV-E GAP programs: 

Number of states claiming federal GAP reimbursement: 
Fiscal year 2009: 1; 
Fiscal year 2010: 4; 
Fiscal year 2011: 13; 
Fiscal year 2012: 27. 

Average monthly number of children receiving assistance under
GAP: 
Fiscal year 2009: 103; 
Fiscal year 2010: 3,618; 
Fiscal year 2011: 3,552; 
Fiscal year 2012: 15,969. 

Source: HHS. 

Note: The latest available expenditure data were for fiscal year 2012; 
as of 2014, 32 states had title IV-E GAP programs. 

[End of table] 

[End of Appendix I] 

Appendix II: Findings on School Stability Provisions: 

School Stability: 

Steps taken to implement school stability requirements increased 
attention to foster youth education, but placement and transportation 
issues remained: 

What the act says: 

Requires that (1) each foster care placement take into account the
appropriateness of the educational setting and the proximity to the 
school in which the child is enrolled at the time of placement; and (2)
the child welfare agency coordinate with local educational agencies to
ensure that the child remains in that school. If remaining in that
school is not in the best interests of the child, the agencies must
provide immediate enrollment in a new school, along with the child's
educational records. 42 U.S.C. § 675(1)(G). Requires states to
provide assurances that each school-age child eligible for a IV-E
payment is attending school fulltime or has completed secondary
school. 42 U.S.C. § 671(a)(30). 

Legislative/regulatory action: 

States reported taking the following legislative or regulatory actions 
to implement 42 U.S.C. § 675(1)(G): 

18 states enacted or revised a law: CA, DC, FL, GA, IN, IA, LA,
MD, MI, MN, MO, NV, NJ, OK, TX, UT, VA, and WA. 

18 states issued or revised a regulation: AL, AZ, AR, CT, KS, LA, ME, 
MD, MS, NE, NM, NY, ND, OH, OK, RI, TN, and WV. 

15 states made no changes: (The existing law or regulation was already
consistent with the federal requirement) AK, CO, DE, HI, MA, MT, NC, NH,
OR, PA, SC, SD, VT, WI, and WY. 

Note: Responses do not sum to 52 because not all states may have 
responded to the question, and some states may have taken both 
legislative and regulatory action. Because states generally had 
discretion in how to implement this provision, some states may have 
used means other than law or regulation. 

Table: Practices reported by states in a nationwide survey: 

School stability practices that states reported being required
or recommended statewide: 

Number of states: 

Decision about whether remaining in the same school is in the child's 
best interest is documented in writing: 
34 required; 
16 recommended. 

Child welfare staff use specified factors when considering whether it 
is in the child's best interest to change schools: 
24 required; 
16 recommended. 

Child welfare staff consult with schools in considering whether it is 
in the child's best interest to change schools: 
22 required; 
15 recommended. 

Child welfare staff take into account the preference of the child 
(when age-appropriate) in considering whether it is in the child's 
best interest to change schools: 
16 required; 
27 recommended. 

Child welfare staff utilize technology such as Geographic Information 
Systems (GIS) to identify potential living placements close to the 
child's current school: 
9 required; 
12 recommended. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

Note: The Fostering Connections Act generally does not require states 
to adopt particular practices. Totals may not sum to 52 if some states 
do not require or recommend the practice. 

[End of table] 

Through the survey, individual states also provided the following 
examples of practices that worked well to implement federal school 
stability requirements: designating education and foster care liaisons 
who serve as a point of contact in their respective agencies and 
collaboration between the state-level agencies, including courts. Some 
of these collaborations led to inter-agency agreements or joint 
guidance. 

In addition, 36 states reported using title IV-E foster care maintenance
funds to pay for transportation for children in foster care to remain 
in their schools, as authorized under the Fostering Connections Act. 
Other funding sources used for transportation to allow students to 
remain in their schools included title IV-E administrative funds, 
state funds, and McKinney-Vento Act funds for homeless youth. 
[Footnote 1] 

Footnote: 

[1] The McKinney-Vento Homeless Assistance Act of 1987 (McKinney-Vento 
Act) requires state and local educational agencies to address access 
to education for homeless children, including children awaiting foster 
care placement. If a child is eligible for services under the McKinney-
Vento Act, local educational agencies are required to provide or arrange
transportation. 

Practices in selected states: 

Three states that we visited engaged in new efforts to improve school 
stability, such as collaborations between their state child welfare 
and educational agencies to jointly develop policies and procedures to 
implement the requirements. Some of these policies called for 
dedicated points of contact in the respective agencies, shared 
decision-making to determine which school is in a child's best 
interest, and timeframes and procedures for school enrollment. 
Officials in Virginia noted that their school stability policies for 
foster youth were modeled after McKinney-Vento Act policies for homeless
youth. Officials across the four states we visited noted that the 
Fostering Connections Act has increased attention to school stability 
for foster youth. 

Selected state challenges: 

The lack of placements near the school a child was attending before
entering foster care or changing placements was reported to be a
challenge in all four states we visited. In cases where the placement 
is reasonably close to the school, officials noted some financial and 
logistical barriers, such as reliance on taxis or caseworkers to provide
transportation. Foster youth with special education needs presented 
particular transportation and enrollment challenges, which sometimes 
delayed their starting classes. In addition, interaction between child 
welfare and educational agencies can vary considerably at the local 
level, where efforts sometimes depend on the individuals involved. 

Figure: Challenges reported by states in a nationwide survey: 

[Refer to PDF for image horizontal bar graph] 

Number of states: 

Lack of placement resources near current school: 
Not a challenge: 1; 
Minor challenge: 12; 
Major challenge: 38. 

Determining what entity should be responsible for transportation costs: 
Not a challenge: 10; 
Minor challenge: 20; 
Major challenge: 20. 

Lack of funds for transportation costs: 
Not a challenge: 14; 
Minor challenge: 15; 
Major challenge: 20. 

No requirement for educational agencies to coordinate with child 
welfare agencies: 
Not a challenge: 12; 
Minor challenge: 18; 
Major challenge: 19. 

Difficulty accessing and transferring student records: 
Not a challenge: 10; 
Minor challenge: 28; 
Major challenge: 12. 

School resistance to enrolling student: 
Not a challenge: 11; 
Minor challenge: 33; 
Major challenge: 7. 

School residency requirements delay enrollment: 
Not a challenge: 16; 
Minor challenge: 26; 
Major challenge: 7. 

Lack of clarity on who is responsible for child's education decisions: 
Not a challenge: 19; 
Minor challenge: 26; 
Major challenge: 6. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

Note: Responses do not sum to 52 if states selected “do not know/not 
applicable” or did not respond. 

[End of figure] 

Data collection: 

Federal: HHS does not collect nationwide data on school stability or
attendance. 

State: 

* Twelve states reported in our survey that they use quantitative
indicators or data to assess their state's performance related to 
federal school stability requirements. For example, one state reported 
tracking the distance between the removal home and the school placement.
Seven states that do not currently track data on school stability
reported that they are working to do so. 

* Estimates of the number of youth who are able to remain in their same
school when changing placements varied widely across officials,
caseworkers, and youth we interviewed, but most estimated that a
significant number of youth were changing schools. Caseworkers in
one state reported that the default option is for youth to change
schools. 

[End of Appendix II] 

Appendix III: Findings on Older Youth Provisions: 

90-day transition plan: 

States added to existing policies for ongoing planning to address new 
requirements, but faced challenges related to housing and engaging 
youth: 

What the act says: 

Requires that during the 90-day period prior to a child attaining 18
years of age, or such greater age as the state may elect, up to 21 
years of age (“aging out of care”), a caseworker assists and supports
the child in developing a transition plan that is personalized at the
direction of the child, and includes specific options on housing, health
insurance, education, local opportunities for mentors and continuing 
support services, work force supports, and employment services. A 
subsequent amendment also requires that the plan include certain 
information about designating a health care proxy or power of 
attorney. 42 U.S.C. § 675(5)(H). 

Legislative/regulatory action: 

States reported taking the following legislative or regulatory action to
implement the 90-day transition plan requirement: 13 states enacted or 
revised a law: CA, FL, GA, IN, KS, MN, NE, NV, OK, PA, TN, VA, and WI. 

27 states issued or revised a regulation: AL, AZ, AR, CO, DE, ID, IA, 
LA, ME, MD, MA, MS, MO, NE, NH, NM, NY, ND, OH, OK, OR, PR, RI, SC, 
UT, WV, and WI. 

11 states made no changes: (The existing law or regulation was already
consistent with the federal requirement) AK, CT, DC, MI, MT, NJ, NC, SD,
TX, WA, and WY. 

Note: Responses do not sum to 52 because not all states may have 
responded to the question, and some states may have taken both 
legislative and regulatory action. Because states generally had 
discretion in how to implement this provision, some states may have 
used means other than law or regulation. 

Table: Practices reported by states in a nationwide survey: 

90-day transition plan practices that states reported being required 
or recommended statewide: 

Number of states: 

Youth input on the 90-day transition plan is documented: 
49 required; 
3 recommended. 

The 90-day transition plan includes ensuring that youth have key 
documents (e.g. birth certificate, Social Security card, and 
immunization records): 
49 required; 
3 recommended. 

The 90-day transition plan includes intensive efforts to ensure young 
people have adult connections (if not yet established): 
36 required; 
13 recommended. 

A document is developed for the 90-day transition plan that is 
separate from other transition planning efforts (e.g., plans developed 
in connection with permanency hearings): 
35 required; 
5 recommended. 

A transition planning specialist or outreach worker assists youth with 
90-day transition plan: 
28 required; 
16 recommended. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

Note: The Fostering Connections Act generally does not require states 
to adopt particular practices. 

[End of table] 

Totals may not sum to 52 if some states do not require or recommend 
the practice. Through the survey, individual states also provided the 
following examples of practices that worked well in efforts to meet 
the federal 90-day transition plan requirement: prior transition 
planning efforts that lay the groundwork for the 90-day plan; 
Permanency Roundtables, which seek to build stronger connections with 
friends and family and increase older youth adoptions and 
reunifications; specialized units that handle older youth cases and 
receive training on the unique aspects of serving older youth in
care; partnering with the courts to train court staff in their roles 
and child welfare agency practice; and a dedicated transition planning 
website. 

Practices in selected states: 

All four states we visited reported adapting their existing transition
planning policies to implement the 90-day plan requirement. In all four
states, transition planning begins by age 16, and in some cases as 
early as age 14. Officials in Massachusetts reported that their 
existing policies addressed many of the specific elements required by
the Fostering Connections Act. One local agency director noted that 
the additional checkpoint 90 days before youth exit care is valuable 
because youth may be more focused on their future than at earlier 
planning stages. Examples of how agencies seek to ensure that 
transition plans are youth-driven included seeking youth input on the 
transition plan template and other written materials; encouraging 
youth to actively participate in their court hearings; and allowing 
youth to select who is included in transition planning meetings. 

Selected state challenges: 

According to some experts, child welfare officials may think the 90-
day transition plan is redundant in light of their existing transition
planning efforts. Caseworkers in Virginia and Texas reported that
identifying housing and lifelong connections with a supportive adult
could be particularly difficult. Caseworkers in Massachusetts also 
reported that some youth are eager to exit care and may be more 
difficult to engage in planning. In addition, officials in three 
states said some youth exit care unexpectedly before a plan is 
completed. 

Figure: Challenges reported by states in a nationwide survey: 

[Refer to PDF for image horizontal bar graph] 

Number of states: 

Identifying appropriate housing for youth after transitioning from 
foster care: 
Not a challenge: 1; 
Minor challenge: 20; 
Major challenge: 31. 

Identifying/engaging supportive adults from the youth's life in the 
transition planning: 
Not a challenge: 0; 
Minor challenge: 29; 
Major challenge: 21. 

Lack of staff training or time to effectively engage youth in their 
transition planning: 
Not a challenge: 8; 
Minor challenge: 23; 
Major challenge: 21. 

Difficulty arranging for stakeholders to meet for transition planning: 
Not a challenge: 16; 
Minor challenge: 24; 
Major challenge: 10. 

Source: GAO survey of the state child welfare agencies of all 50 
states, the District of Columbia, and Puerto Rico. 

Note: Responses do not sum to 52 if states selected “do not know/not 
applicable” or did not respond. 

[End of figure] 

Data collection: 

Federal: 

* HHS does not collect nationwide data on the 90-day transition plan
requirement. 

* In 2010, HHS began collecting information through the National
Youth in Transition Database on each youth who receives independent 
living services.[Footnote 1] States are required to collect 
demographic and outcome information and follow youth over time. 
While the database does not contain information on the 90-day
transition plan, it does contain data elements on services that youth
receive and their outcomes related to many of the elements that are
required in the plan, such as housing, education, and employment. 

State: 

* Twenty states reported on our survey that they use quantitative
indicators or data to assess their state's performance related to the 
90-day transition plan requirement. These indicators included whether
and when the transition plan was completed. For example, one state
tracks the number of plans completed in each jurisdiction and the
number of youth requiring the plan. Three states also generate reports
of youth that have not completed plans and can alert caseworkers to
do so. 

Footnote: 

[1] The federal government provides funding for states to establish 
and implement independent living services to assist youth age16 and 
older in making the transition from foster care to independent living. 
Allowable services include education and employment assistance, 
instruction in daily living skills, and other support services. 

[End of section] 

Extension of Federal Foster Care Payments Beyond Age 18: 

19 states extended payments to youth age 18 and older; budget 
constraints were a major factor for other states: 

What the act says: 

Authorizes states to provide foster care, adoption assistance, and
kinship guardianship payments for eligible youth 18 and older (up to
age 21) when certain employment, education, or training requirements
are met. 42 U.S.C. §§ 675(8)(B), 672(c)(2), 673(a)(4). 

Authorizes states to extend eligibility for Chafee Foster Care
Independence Program services to youth who exit foster care to
adoption or kinship guardianship at age 16 or older. 42 U.S.C. §
677(a)(7). Also authorizes states to extend eligibility for education
and training vouchers to youth who exit foster care to kinship
guardianship at age 16 or older. 42 U.S.C. § 677(i)(2). 

States that extend federal foster care payments: 

9 states previously extended the age for foster care payments
using other funding sources: AR, DC, IL, MD, MA, MN, NY, WA, and TX. 

States reported taking the following legislative or regulatory action to
implement the option to extend the age for federal foster care 
payments: 

11 states enacted or revised a law: CA, IN, MD, MA, MI, MN, NE, ND, 
TN, TX, and WA. 

9 states issued or revised a regulation: AL, AR, ME, MD, NE, ND, OR, 
WA, and WV. 

3 states made no changes: DC, IL, and NY. 

Note: Responses do not sum to 19 because some states may have taken 
both legislative and regulatory action. Because states generally had 
discretion in how to implement this option, some states may have used
means other than law or regulation. 

Table: Program components reported by states in nationwide survey: 

Program components for 19 states that have HHS-approved plans to 
provide federal title IV-E foster care maintenance payments for 
eligible youth age 18 and older: 

Alabama: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Empty]; 
Payments can be made directly to certain youth: [Empty]. 

Arkansas: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Check]; 
Payments can be made directly to certain youth: [Empty]. 

California: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Check]; 
Payments can be made directly to certain youth: [Check]. 

District of Columbia: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Empty]; 
Voluntary placement agreements are made with youth: [Empty]; 
Payments can be made directly to certain youth: [Empty]. 

Illinois: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Empty]; 
Payments can be made directly to certain youth: [Check]. 

Indiana: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Empty]; 
Payments can be made directly to certain youth: [Check]. 

Maine: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Check]; 
Payments can be made directly to certain youth: [Check]. 

Maryland: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Empty]; 
Payments can be made directly to certain youth: [Empty]. 

Massachusetts: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Check]; 
Payments can be made directly to certain youth: [Check]. 

Michigan: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Check]; 
Payments can be made directly to certain youth: [Check]. 

Minnesota: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Check]; 
Payments can be made directly to certain youth: [Check]. 

Nebraska: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Check]; 
Payments can be made directly to certain youth: [Check]. 

New York: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Empty]; 
Payments can be made directly to certain youth: [Empty]. 

North Dakota: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Empty]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Check]; 
Payments can be made directly to certain youth: [Empty]. 

Oregon: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Empty]; 
Youth age 18 and older may leave and re-enter care: [Empty]; 
Voluntary placement agreements are made with youth: [Empty]; 
Payments can be made directly to certain youth: [Empty]. 

Tennessee: 
Extend eligibility under all 5 conditions[A]: [Empty]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Check]; 
Payments can be made directly to certain youth: [Check]. 

Texas: 
Extend eligibility under all 5 conditions[A]: [Check]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Check]; 
Payments can be made directly to certain youth: [Empty]. 

Washington: 
Extend eligibility under all 5 conditions[A]: [Empty]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Check]; 
Payments can be made directly to certain youth: [Check]. 

West Virginia: 
Extend eligibility under all 5 conditions[A]: [Empty]; 
Supervised independent living options available: [Check]; 
Youth age 18 and older may leave and re-enter care: [Check]; 
Voluntary placement agreements are made with youth: [Check]; 
Payments can be made directly to certain youth: [Check]. 

Sources: HHS data and GAO survey of the state child welfare agencies 
of all 50 states, the District of Columbia, and Puerto Rico. 

[A] States may choose to extend eligibility for a youth who meets the 
state's age limit and is: (1) completing secondary education or a 
program leading to an equivalent credential; (2) enrolled in an
institution which provides post-secondary or vocational education; (3) 
participating in a program or activity designed to promote or remove 
barriers to employment; (4) employed for at least 80 hours per month; 
or (5) incapable of doing any of the above described activities due to 
a medical condition, which incapability is supported by regularly 
updated information in the case plan of the child. 42 U.S.C. § 
675(8)(B)(iii). Tennessee does not extend eligibility to youth under 
conditions 3 and 4. Washington and West Virginia do not extend 
eligibility to youth under conditions 3, 4, or 5. 

[End of table] 

Additionally, 43 states extended eligibility for Chafee Foster Care
Independent Living Program services and 47 extended eligibility for
education and training vouchers. States reported varying case review 
requirements for youth receiving extended care payments. According to 
HHS guidance, reviews could be done either by a court or a panel of 
appropriate persons. For example, one state reported requiring an 
administrative hearing and a permanency review each year, while 
another reported it requires only a court review. 

Practices in selected states: 

At the time of our site visits, two of the four states we visited 
provided federal title IV-E foster care maintenance payments for 
eligible youth who were 18 or older (California and Texas) and
Massachusetts was approved to do so as of February 2014. According
to state officials, Texas and Massachusetts used state funds to 
provide extended services to youth 18 or older prior to the enactment
of the Fostering Connections Act, whereas California's program did
not begin until after the act went into effect. A large group of 
stakeholders including advocates, foundations, and government
administrators collaborated extensively for nearly 5 years to
implement extended federal foster care payments to youth up to age
21 in California. After extending care, officials in California reported
that they worked closely with foster youth and advocates to develop
policies and train staff in child welfare agencies on how to work
with older youth. 

Selected state challenges: 

Officials in California and Texas told us that designing a program
that provided young adults autonomy while at the same time met program 
requirements was a challenge. For example, some youth no longer wanted 
to participate in court hearings. Finding appropriate housing for 
youth was a significant challenge in California. Additionally, states
faced logistical challenges such as scheduling in-person visits with
youth who no longer resided in the state. 

Challenges reported by states in a nationwide survey: 

In response to our survey, 12 of the states that extend federal foster 
care payments provided comments on challenges they faced regarding
extending federal foster care payments to youth beyond age 18. These
challenges included: 

* finding appropriate housing options, 

* the cost associated with providing effective supportive services, 

* the additional demand on caseworker's time, and, 

* developing a program that meets the specific needs of older youth. 

Experts we spoke to also told us that states faced challenges marketing
the program to youth and designing policies to meet the needs of older
youth, such as appropriate policies that allow youth to re-enter into 
foster care after they have left. 

Additionally, 17 states that did not extend federal foster care 
payments to older youth cited budget constraints as the major factor 
for not providing extended services. Other major factors included 
needing to change a state law and concerns about title IV-E 
administrative requirements. 

Data collection: 

Federal: HHS collects demographic information about youth above age
18 from states that have extended care through the Adoption and Foster
Care Analysis and Reporting System. According to our survey, of the 19
states that extend services beyond age 18, 13 reported using data to
assess performance of extending such care. These states reported using
case management data, data on enrollment and discharges, and
educational status of eligible youth. 

The number of older youth receiving title IV-E payments has risen since
2010 (see table below). 

Table: Youth age 18 and older receiving a monthly title IV-E foster 
care maintenance payment: 

Number of older youth: 
Fiscal year 2008: 3,292; 
Fiscal year 2009: 2,986; 
Fiscal year 2010: 2,677; 
Fiscal year 2011: 4,306; 
Fiscal year 2012: 4,997. 

Source: HHS, Adoption and Foster Care Analysis and Reporting System 
(AFCARS). Data as of November 2013. 

Note: The numbers reported here may underestimate the number of youth 
receiving title IV-E foster care payments, as states are currently 
transitioning to report this expanded population of youth receiving 
title IV-E to AFCARS and not all have completed needed updates to 
their reporting. 

[End of table] 

[End of Appendix III] 

Appendix IV: Scope and Methodology: 

This report addresses (1) actions states have taken to implement 
selected provisions of the Fostering Connections Act and what 
challenges, if any, states face, and (2) how HHS has provided 
technical assistance to help states implement select provisions of the 
Fostering Connections Act and the extent to which HHS has monitored 
implementation. We surveyed state child welfare agencies, conducted 
site visits, and reviewed relevant federal laws and regulations, HHS 
guidance provided to states, and other research publications. We also 
interviewed officials from HHS's Administration for Children and 
Families, selected HHS-funded technical assistance providers that have 
provided assistance to states to implement the Fostering Connections 
Act, and other child welfare experts. 

The provisions we selected to include in our review pertain to family 
connections, school stability, support for older youth, and states' 
calculation of savings from the changes in income eligibility for 
adoption assistance payments.[Footnote 34] We excluded selected 
provisions of the Fostering Connections Act on tribal foster care and 
adoption assistance, as well as on health oversight and coordination 
plan requirements from this review because they were already being 
studied in other reviews conducted by GAO or the HHS Office of 
Inspector General, and based on input from child welfare experts. 

Survey of State Child Welfare Officials: 

To learn about actions states have taken to implement selected 
provisions of the Fostering Connections Act, we conducted a web-based 
survey of state child welfare officials in the 50 states, the District 
of Columbia, and Puerto Rico. For selected provisions, we asked 
officials if their state required or recommended certain practices; if 
their state enacted or revised laws or regulations to implement the 
provision; the degree to which they experienced certain challenges; 
whether they collected data in connection with the provision; and what 
type of technical assistance they received from HHS. 

Our survey population was state child welfare agencies. Because our 
survey covered a range of topics, we recognized that multiple 
officials within a state's child welfare agency may have needed to 
contribute to a state's survey response. To identify an appropriate 
point of contact within each state agency, we obtained a list of state 
child welfare directors from HHS. We contacted each director and 
proposed as a point of contact the individual identified by HHS as the 
state's foster care manager, but allowed the director to designate a 
different individual. We ultimately instructed respondents to consult 
with others who were familiar with their state's implementation of 
selected provisions, if doing so would provide more accurate responses. 

To draft the closed-ended questions on the questionnaire, we drew from 
HHS guidance to states, as well as materials put forth by national 
resource centers in the Training and Technical Assistance Network and 
other organizations. After we drafted the questionnaire, we sought 
feedback from knowledgeable stakeholder organizations, HHS, and from 
an independent GAO survey professional, and made revisions based on 
their comments. We conducted six pretests by phone with state child 
welfare agency officials to check that (1) the questions were clear 
and unambiguous, (2) terminology was used correctly, (3) the 
questionnaire did not place an undue burden on agency officials, (4) 
the information could feasibly be obtained, and (5) the survey was 
comprehensive and unbiased. We selected pre-test states to ensure a 
mix of state-and county-based administration of the child welfare 
program and coverage of states that both did and did not implement two 
of the optional provisions of the Fostering Connections Act ((1) that 
authorized states to establish a title IV-E guardianship assistance 
program and (2) that authorized states to extend eligibility for title 
IV-E assistance beyond age 18). 

We administered our web-based questionnaire through a secure server. 
When we completed the final survey questions and format, we sent an e-
mail announcement of the survey to respondents on October 30, 2013. 
They were notified that the questionnaire was available online and 
were given unique passwords and usernames on November 4, 2013. We sent 
follow-up e-mail messages on November 14, November 22, and December 4, 
2013, to those who had not yet responded. We also contacted non-
respondents by telephone, starting November 18, 2013. The 
questionnaire was available online until the final response was 
submitted on January 13, 2014. Questionnaires were completed by state 
child welfare agency officials in all 50 states, the District of 
Columbia, and Puerto Rico, for a response rate of 100 percent. 

Because this was not a sample survey, it has no sampling errors. 
However, the practical difficulties of conducting any survey may 
introduce errors, commonly referred to as non-sampling errors. For 
example, difficulties in interpreting a particular question, sources 
of information available to respondents, or entering data into a 
database or analyzing them can introduce unwanted variability into the 
survey results. We took steps in developing the questionnaire, 
collecting the data, and analyzing them to minimize such non-sampling 
error. In addition, for questions related to implementation of two 
optional provisions, title IV-E guardianship assistance program and 
extension of eligibility for title IV-E assistance beyond age 18, we 
compared survey responses to data provided by HHS on states that have 
been approved to implement these options. In the few cases where the 
data did not match, we considered HHS the definitive source and 
adjusted the survey data accordingly. 

Site Visits to Selected States: 

We conducted site visits to four states to obtain information on 
implementation of the selected provisions from state and local child 
welfare agency officials, state and local educational agency 
officials, child welfare case workers, court officials, and current 
and former foster youth, and foster parents. We selected the four 
states--California, Massachusetts, Texas, and Virginia--to represent a 
mix of factors including: type of child welfare agency (state or 
county administered); number of children in foster care; amount of 
title IV-E funds received; whether the state has established a title 
IV-E guardianship assistance program; whether the state has extended 
eligibility for federal title IV-E assistance to youth beyond age 18; 
and geographic dispersion. We visited two localities in each state. 
Across the four states, we visited a mix of large cities, smaller 
cities, and rural areas. In all four states, we met with officials 
from the state child welfare agency, the state educational agency, and 
in three states, we met with court officials. In each of the eight 
localities, we met with officials in the local child welfare and 
educational agencies. We held discussion groups with a total of 29 
current and former foster youth in three states, and in two states, we 
held discussion groups with a total of 11 foster parents to obtain 
their perspectives on implementation of the provisions. We also met 
with officials either in person or by phone from four regional HHS 
offices that oversee the states we visited to learn about 
implementation and to discuss oversight and any technical assistance 
the regional offices provided to the states. Although we cannot 
generalize our findings beyond these states and localities, these 
visits provided us with illustrative examples of how states are 
implementing the provisions of the Fostering Connections Act. 

[End of Appendix IV] 

Appendix V: Comments from the Department of Health and Human Services: 

Department of Health & Human Services: 
Office of The Secretary: 
Assistant Secretary for Legislation: 
Washington, DC 20201: 

May 15 2014: 

Kay E. Brown, Director: 
Education, Workforce and Income Security Issue: 
U.S. Government Accountability Office: 
441 G Street NW: 
Washington, DC 20548: 

Dear Ms. Brown: 

Attached are comments on the U.S. Government Accountability Office's 
(GAO) report entitled, "Foster Care: HHS Needs to Improve Oversight of 
Fostering Connections Act Implementation" (GAO-14-347). 

The Department appreciates the opportunity to review this report prior 
to publication. 

Sincerely, 

Signed by: 

Jim R. Esquea: 
Assistant Secretary for Legislation: 

Attachment: 

General Comments Of The Department Of Health And Human Services (HHS) 
On The Government Accountability Office's (GAO) Draft Report Entitled, 
"Foster Care: HHS Needs To Improve Oversight Of Fostering Connections 
Act Implementation" (GAO-14-347): 

The Department appreciates the opportunity to review and comment on 
this draft report. 

HHS is committed to continuing to support states in providing high 
quality child welfare services and to engaging in monitoring 
activities that hold states accountable both for compliance with
the law and for improved outcomes for children and families. 

GAO Recommendation: To maximize the amount of funds states are 
reinvesting into child welfare services, the Secretary of Health and 
Human Services should provide guidance on how states could calculate 
savings from the changes to the federal adoption assistance income
eligibility criteria. 

HHS Response: HHS's implementation of this provision has been driven 
by two primary factors: 1) a desire to avoid imposing an undue 
administrative burden on states; and 2) the diversity of state 
eligibility tracking, accounting and financial systems, that makes any 
federally imposed methodology for calculating savings unlikely to work 
in all state settings. We believed allowing states flexibility to 
develop a methodology appropriate to their individual state system
would be an efficient and effective means to implement the provision. 
To further strengthen oversight of the provision, we also initiated 
the change in the OMB compliance supplement for state auditors that 
was referenced in GAO's report. It is the responsibility of independent
auditors to identify an appropriate finding in single audit reports 
for any state that has not taken the necessary steps to calculate and 
account for any savings derived from the changes to the federal 
adoption income eligibility criteria. ACF will then work to assure 
that all needed corrective actions are taken to resolve such a finding. 

As part of their title IV-E plan submissions, state officials have 
signed an assurance stating: 

"I hereby assure that the State agency administering the title IV-E 
programs will spend an amount equal to the amount of savings (if any) 
in State expenditures under title IV-E resulting from the application 
of section 473(a)(2)(A)(ii) to all applicable children for a fiscal
year to provide to children or families any service (including post 
adoption services) that may be provided under this part or part B and 
will document how such amounts are spent, including on post-adoption 
services." 

We understand state feedback to GAO regarding guidance on the 
calculation of savings to be a request for technical assistance rather 
than an ACF imposed methodology. We will accommodate that request. ACF 
will gather examples of how savings are being calculated and 
documented by some states and develop a document to provide technical 
assistance to show other states how they can calculate these savings, 
in compliance with the law. 

GAO Recommendation: The Secretary of Health and Human Services should 
proceed with and expeditiously finalize plans to systematically 
monitor state practices for compliance with policies outlined in their 
title IV -E Plans that cover the new provisions established by the 
Fostering Connections Act. 

HHS Response: As indicated in the report, in March 2014, ACF announced 
that we are initiating a third round of reviews under the Child and 
Family Services Reviews (CFSR) regulations, beginning in Federal 
Fiscal Year 2015. The CFSR process is designed to meet the statutory 
requirement to provide federal oversight of states' compliance with 
provisions of titles IV-B and IV-E of the Social Security Act and to 
strengthen child welfare programs for improved child and family 
outcomes. Given that Fostering Connections amended provisions of 
titles IV-B and IV-E of the Social Security Act, those amendments will 
be reflected in the revised review protocol. We are in the process of 
finalizing the instruments and measures that will be used during this 
round of reviews and as these are finalized they will be shared with 
the public. 

GAO Recommendation: The Secretary of Health and Human Services should 
proceed with and expeditiously finalize plans to update AFCARS to 
collect relevant data from states about provisions established by the 
Fostering Connections Act. 

HHS Response: Changes to AFCARS must be made through the regulatory 
process. As noted in the report, ACF has announced our intent to issue 
a Notice of Proposed Rulemaking (NPRM) to revise the Adoption and 
Foster Care Analysis and Reporting System (AFCARS). The NPRM is 
currently under review with the Office of Management and Budget and 
projected to be published in the spring of2014. 

[End of Appendix V] 

Appendix VI: GAO Contact and Staff Acknowledgments: 

GAO Contact: 

Kay E. Brown, (202) 512-7215, brownke@gao.gov: 

Staff Acknowledgments: 

In addition to the contact named above, Sara Schibanoff Kelly 
(Assistant Director), Kate Blumenreich, Hedieh Fusfield, Michael Pahr, 
and Rosemary Torres Lerma made key contributions to this report. Also 
contributing to this report were James Bennett, Richard Brown, David 
Chrisinger, Sarah Cornetto, David Dornisch, Jennifer Gregory, and 
Almeta Spencer. 

[End of section] 

Footnotes: 

[1] These are the most recent data available. See U.S. Department of 
Health and Human Services, The AFCARS Report, Preliminary FY 2012 
Estimates as of July 2013, No. 20, HHS (Washington, D.C.: Nov. 2013). 

[2] The remaining children and youth were in one of the following 
settings: pre-adoptive home; group home; institution; supervised 
independent living; trial home visit; or runaway. 

[3] Pub. L. No. 110-351,122 Stat. 3949 (codified as amended in 
scattered sections of 42 U.S.C.). The Fostering Connections Act also 
amended other parts of the Social Security Act, including part B of 
title IV, which authorizes federal funding for certain child welfare 
services. For this review, we focused primarily on title IV-E of the 
Social Security Act. 

[4] The Fostering Connections Act changed the eligibility criteria for 
federal adoption assistance for children with special needs to 
eliminate income requirements for the family from which the child is 
removed. See section 402 of the Fostering Connections Act, amending 42 
U.S.C. § 673. 

[5] We excluded selected provisions of the Fostering Connections Act, 
including those on tribal foster care and adoption assistance, as well 
as on health oversight and coordination plan requirements, from this 
review because they were already being studied in other reviews 
conducted by GAO or the HHS Office of Inspector General, and based on 
input from child welfare experts. 

[6] For the purposes of this report, we refer to the survey as a state 
survey. However, it also includes responses from the District of 
Columbia and Puerto Rico. When referring to states we surveyed 
throughout this report, this includes the District of Columbia and 
Puerto Rico. 

[7] Title IV-E assistance includes foster care, adoption assistance, 
and kinship guardianship payments. 

[8] 154 Cong. Rec. 19, 459-61 (2008) (statements of Rep. McDermott and 
Rep. Weller). 

[9] See GAO, Child Welfare: Improving Social Service Program, 
Training, and Technical Assistance Information Would Help Address Long-
standing Service-Level and Workforce Challenges, [hyperlink, 
http://www.gao.gov/products/GAO-07-75] (Washington, D.C.: Oct. 6, 
2006). 

[10] See section 402 of the Fostering Connections Act, amending 42 
U.S.C. § 673. Children are eligible for federal adoption assistance 
payments if they meet the statutory definition of special needs and 
certain other criteria. Before the Fostering Connections Act was 
enacted, one of these criteria specified that, in addition to meeting 
other eligibility requirements, the child must have been removed from 
a home that met income qualifications for assistance under the Aid to 
Families with Dependent Children program as of July 16, 1996. The 
Personal Responsibility and Work Opportunity Reconciliation Act of 
1996 replaced the Aid to Families with Dependent Children program with 
the Temporary Assistance for Needy Families program. However, this 
income eligibility criterion was not changed until the Fostering 
Connections Act eliminated it. 

[11] Child and Family Services Improvement and Innovation Act. Pub. L. 
No. 112-34, § 106(c). 125 Stat. 369, 377 (2011). 

[12] ACF is also responsible for administering title IV-B programs, 
but the focus of this report is title IV-E. 

[13] Title IV-E Foster Care Eligibility Reviews and Child and Family 
Services State Plan Reviews, 65 Fed. Reg. 4020 (Jan. 25, 2000) 
(codified at 45 C.F.R. pts. 1355-57). These regulations were issued, 
in part, to comply with section 1123A of the Social Security Act, 
which requires HHS to issue regulations for the review of state child 
welfare programs, including those under title IV-E. The statute 
requires that HHS's regulations specify certain features of these 
reviews, such as the timetable for reviews, the federal requirements 
subject to review, and the criteria used to measure whether states are 
in substantial conformity with their plans and federal requirements. 
Section 1123A also requires HHS to follow certain procedures for 
programs found not to be in substantial conformity. 42 U.S.C. § 1320a-
2a. 

[14] 45 C.F.R. § 1355.32(b) (for states found to be in substantial 
conformity). According to the regulations, states found not to be in 
substantial conformity will be required to develop a program 
improvement plan and begin a full review two years after approval of 
the program improvement plan. 

[15] See 45 C.F.R. § 1355.40 and 45 C.F.R. pt.1355, app. A-E for HHS's 
AFCARS data collection requirements. 

[16] See section 206 of the Fostering Connections Act, amending 42 
U.S.C. § 671(a)(31). 

[17] States reported on specific practices we asked about in our 
survey. States could be employing other practices for which we did not 
obtain information. 

[18] Changes to state statutes or regulations are not necessarily an 
indication of state compliance with the Fostering Connections Act 
because states generally had discretion in how to implement the 
provisions. While legislative and regulatory actions may provide one 
indication of state efforts to implement selected provisions of the 
Fostering Connections Act, these steps may not necessarily indicate a 
substantial change in state policy or practice. We did not 
independently review state laws and regulations or assess their 
compliance with federal requirements. 

[19] The number of states reporting that existing laws and regulations 
were consistent with the act and no changes were needed varied by 
provision. Appendixes I-III contain this information for selected 
provisions. 

[20] On January 14, 2013, the President signed into law the 
Uninterrupted Scholars Act which, among other provisions, authorizes 
disclosure of education records without parental consent to child 
welfare agencies that have a right of access to a student's case plan 
and are legally responsible for the care and protection of the 
student. Pub.L. No. 112-278, 126 Stat. 2480 (2013) (amending 20 U.S.C. 
§ 1232g). For more information on data sharing practices among human 
services programs, see GAO, Human Services: Sustained and Coordinated 
Efforts Could Facilitate Data Sharing While Protecting Privacy, 
[hyperlink, http://www.gao.gov/products/GAO-13-106] (Washington, D.C.: 
Feb. 8, 2013). 

[21] Seventeen states reported they did not calculate savings from the 
eligibility change for 2011, eleven states responded that they did not 
know the amount saved and how funds were reinvested, and 4 states did 
not respond. For 2012, 16 states reported they did not calculate 
savings from the eligibility change, 11 states responded that they did 
not know the amount saved and how funds were reinvested, and 4 states 
did not respond. 

[22] Examples provided do not sum to 20 because some states reported 
more than one challenge and other states reported challenges not 
discussed here. 

[23] Pub. L. No. 112-34, § 106(c), 125 Stat. 369, 377 (2011) (amending 
42 U.S.C. § 673(a)(8)). 

[24] The Single Audit Act, as amended, requires an annual "single 
audit" of certain entities that expend more than a specified amount in 
federal awards. The Office of Management and Budget issues guidance 
for implementing single audit requirements as described in Circular 
No. A-133, Audits of States, Local Governments, and Non-Profit 
Organizations, and the Compliance Supplement. The Compliance 
Supplement provides auditors the information needed to understand 
federal programs' objectives, procedures, and compliance requirements 
relevant to the single audit. It also provides auditors with guidance 
for determining whether federal programs are compliant with these 
requirements (laws, regulations, and provisions of contract or grant 
agreements). 

[25] One state (Georgia) is working with HHS to bring its title IV-E 
plan into compliance with all federal requirements for the program. 
The Commonwealth of Puerto Rico is also working with HHS to finalize 
its title IV-E plan. 

[26] HHS officials told us that they also review Annual Progress and 
Services Reports that states and tribes submit describing the progress 
they made in the previous year toward accomplishing the goals and 
objectives in their title IV-B plans. However, while these reports may 
include some narrative addressing aspects of the provisions covered in 
the Fostering Connections Act, these reviews are focused on title IV-B 
programs, and generally do not cover programs under title IV-E. 
Officials also told us that they conduct title IV-E eligibility 
reviews. However, the purpose of these reviews is to determine if 
children in foster care meet the federal eligibility requirements for 
foster care maintenance payments, not to monitor state implementation 
of other federal requirements. 

[27] In April 2011, HHS published a request for public comment on ways 
to improve the CFSR process. See Federal Monitoring of Child and 
Family Service Programs; Request for Public Comment and Consultation 
Meetings, 76 Fed. Reg. 18,677 (Apr. 5, 2011). 

[28] See GAO, Child Welfare: Enhanced Federal Oversight of Title IV-B 
Could Provide States Additional Information to Improve Services, 
[hyperlink, http://www.gao.gov/products/GAO-03-956] (Washington, D.C.: 
Sept. 12, 2003). 

[29] The five components of internal controls are (1) control 
environment; (2) risk assessment; (3) control activities; (4) 
information and communications; and (5) monitoring. See GAO, Standards 
for Internal Control in the Federal Government, [hyperlink, 
http://www.gao.gov/products/GAO/AIMD-00-21.3.1] (Washington, D.C.: 
November 1999). 

[30] For example, in response to our survey, nearly half of states 
reported that they do not use data to assess their state's performance 
related to reasonable efforts to place siblings together or federal 
school completion or attendance requirements. More than one half did 
not use data to assess their performance related to developing a 
personalized transition plan within 90 days before each youth ages out 
of foster care. 

[31] These examples of uneven implementation are drawn from a limited 
number of states and cannot be generalized. Determining whether and to 
what extent these examples of potential uneven implementation raises 
concerns about compliance with the Fostering Connections Act was 
beyond the scope of this review. 

[32] We did not attempt to substantiate these examples or determine 
the extent to which they were indicative of broader practice. 

[33] At least 12 of the youth we interviewed reported being separated 
from some or all of their siblings upon placement. Placement with 
siblings also changed over the course of their experience in foster 
care. 

[34] Fostering Connections to Success and Increasing Adoptions Act of 
2008 (Fostering Connections Act), Pub. L. No. 110-351, 122 Stat. 3949 
(codified as amended in scattered sections of 42 U.S.C.). For this 
review, we focused primarily on selected amendments made by the 
Fostering Connections Act to title IV-E of the Social Security Act. 
See table 1 in the body of this report for the specific provisions 
selected. 

[End of section] 

GAO's Mission: 

The Government Accountability Office, the audit, evaluation, and 
investigative arm of Congress, exists to support Congress in meeting 
its constitutional responsibilities and to help improve the 
performance and accountability of the federal government for the 
American people. GAO examines the use of public funds; evaluates 
federal programs and policies; and provides analyses, recommendations, 
and other assistance to help Congress make informed oversight, policy, 
and funding decisions. GAO's commitment to good government is 
reflected in its core values of accountability, integrity, and 
reliability. 

Obtaining Copies of GAO Reports and Testimony: 

The fastest and easiest way to obtain copies of GAO documents at no 
cost is through GAO's website [hyperlink, http://www.gao.gov]. Each 
weekday afternoon, GAO posts on its website newly released reports, 
testimony, and correspondence. To have GAO e-mail you a list of newly 
posted products, go to [hyperlink, http://www.gao.gov] and select 
"E-mail Updates." 

Order by Phone: 

The price of each GAO publication reflects GAO's actual cost of 
production and distribution and depends on the number of pages in the 
publication and whether the publication is printed in color or black 
and white. Pricing and ordering information is posted on GAO's 
website, [hyperlink, http://www.gao.gov/ordering.htm]. 

Place orders by calling (202) 512-6000, toll free (866) 801-7077, or 
TDD (202) 512-2537. 

Orders may be paid for using American Express, Discover Card, 
MasterCard, Visa, check, or money order. Call for additional 
information. 

Connect with GAO: 

Connect with GAO on facebook, flickr, twitter, and YouTube.
Subscribe to our RSS Feeds or E mail Updates. Listen to our Podcasts.
Visit GAO on the web at [hyperlink, http://www.gao.gov]. 

To Report Fraud, Waste, and Abuse in Federal Programs: 

Contact: 
Website: [hyperlink, http://www.gao.gov/fraudnet/fraudnet.htm]; 
E-mail: fraudnet@gao.gov; 
Automated answering system: (800) 424-5454 or (202) 512-7470. 

Congressional Relations: 

Katherine Siggerud, Managing Director, siggerudk@gao.gov: 
(202) 512-4400: 
U.S. Government Accountability Office: 
441 G Street NW, Room 7125: 
Washington, DC 20548. 

Public Affairs: 

Chuck Young, Managing Director, youngc1@gao.gov: 
(202) 512-4800: 
U.S. Government Accountability Office: 
441 G Street NW, Room 7149: 
Washington, DC 20548. 

[End of document]