When these private contractors are religious-based not-for-profits, always remember:
"You can not audit God".
Michigan is experimenting with the same policies and is still under federal monitoring.
Medicaid fraud in child welfare will always prevail in the wake of privatization with oversight.
Nebraska privatization of child welfare hasn't produced 'any measurable benefit,' new study finds
LINCOLN — Nebraska’s five-year experiment with privatizing child welfare has not produced “any measurable benefit” for the state, according to a study released Thursday.
The study compared results achieved by state child welfare workers and by the Nebraska Families Collaborative, the private agency that manages child welfare cases in the Omaha area.
It found no significant difference — either positive or negative — in outcomes for children and families and no cost savings.
“Privatization promised better outcomes at a lower cost, and that has not happened,” the authors wrote. “It was, perhaps, a worthy experiment, but it has failed.”
But Helaine Hornby and Dennis Zeller, the study’s authors, said it is not clear what direction Nebraska should go from here.
They offered three options — staying the course with the private contractor, returning all case management responsibilities to the state or revamping the roles of the state and the collaborative to achieve real reform.
Each option could result in better services and improved results, the study said. However, each choice would require some changes in order to be successful.
State lawmakers commissioned the study last year, as part of a bill authorizing the Nebraska Department of Health and Human Services to extend its contract with the collaborative into 2015.
State Sen. Bob Krist of Omaha, who sponsored last year’s legislation, expressed confidence in the results of the study. He said he expects policymakers will take several months to discuss it and weigh the options.
“It’s up to the Legislature and new director of HHS to work jointly and make sure that the changes we make are evidence-based and that we go in the right direction,” he said.
Krist said he doesn’t know what direction the state may end up taking. He said it may be an option that draws from several of the study’s recommendations.
However, he said he would argue against anything that would create more disruption for children, families and workers.
“The political ramifications of flushing what we have are unpalatable,” Krist said.
The child welfare system has endured several disruptions since Nebraska launched the privatization effort in November 2009.
Since then, four of the five original private contractors lost or ended their contracts, citing inadequate reimbursement from the state. By early 2012, the collaborative was the only contractor.
David Newell, the collaborative’s president and CEO, said the best choice would be for the private agency to continue managing cases in Douglas and Sarpy Counties.
He defended what the collaborative has achieved, saying the agency has produced the best outcomes ever for children and families in the area.
“Our region has been transformed from being the historically lowest-performing child welfare system in Nebraska to being on par with or better than the other service areas for the very first time,” he said.
The study compared current outcomes for the Omaha area with the rest of the state. It did not compare current outcomes for the Omaha area with outcomes in previous years.
Newell could find himself on the other side of the table with the collaborative, however. Gov. Pete Ricketts named him this week as a finalist for the top HHS position.
According to the study’s authors, the only argument for maintaining the current privatized system is to avoid disruption.
They said the argument for returning case management to the state is that privatization has not fulfilled its promises, which takes away the rationale for having a private agency force services on families.
The authors said the third option could produce better results for children and families.
Under that option, the collaborative would take on a new role as the lead agency in creating and managing new and expanded in-home services, while the state would resume managing cases.
Among other highlights of the study:
— The state spends an average of $74.17 per day per client on services, while the collaborative spends $48.10. But the collaborative charges parents for services, using a sliding fee scale if they are not eligible for Medicaid, a practice that the study said means clients and Medicaid are paying the difference in costs.
— The state has to pay back more than $20 million of federal foster care funds because it could not document how the money was spent by the private contractors. Nebraska continues to lose out on available federal funds because of problems created by how the collaborative is paid.
— While a key goal of privatization was to serve more children in their own homes, the proportion of state wards in out-of-home care has remained steady at around 70 percent over the five years.
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