State leaders were badly stung a decade ago when their attempt to privatize Nebraska’s child welfare services threw the system into disarray. It took years to straighten out the problems and restore public confidence. That tumultuous experience provided an important lesson: Stability is vital for the child welfare system, whose services help abused and neglected children.
Now, concerns have understandably arisen that a new state decision threatens the stability of child welfare services, this time for Douglas and Sarpy Counties. The Nebraska Department of Health and Human Services has selected a new, out-of-state private child welfare provider for the two counties, with the provider’s low-cost bid a key consideration. Kerry Winterer, a former head of Nebraska HHS, wrote in a Midlands Voices essay Friday that the decision is a major mistake.
The current provider, PromiseShip (the only remaining private child welfare in Nebraska), scored higher than its competitor — St. Francis Ministries, a Salina, Kansas, nonprofit — on measures for service quality and management. But HHS awarded the contract to St. Francis, which offered a bid of $196 million over five years, far lower than PromiseShip’s proposal of $341 million.
St. Francis currently serves more than 31,000 people through subsidiaries in Nebraska and six other states, plus two Central American countries.
HHS officials say that they will hold St. Francis to the needed standards for service delivery and cost management and that the Kansas-based nonprofit offers the best opportunity for innovative service.
The state has an enormous responsibility to get this right. Child welfare service for Douglas and Sarpy Counties is complicated, demanding work requiring a high level of competence. PromiseShip — a collaborative nonprofit that includes Boys Town, the Child Saving Institute and Heartland Family Service — currently handles 40% of the state’s caseload and some 59% of the cases requiring the most extensive intervention. The total number of children served last year in the two counties was just under 5,000.
Public confidence will be gravely shaken if these tasks are mishandled. Critics point to various concerns regarding St. Francis:
» Multiple placements. Kansas has transferred children multiple times at a rate far higher than in Nebraska: 7.1 times for every 1,000 days spent in Kansas foster care in 2017, compared to Nebraska’s statewide rate of 2.56 moves per 1,000 days in January 2017. This issue spurred a lawsuit against Kansas state officials.
» Caseloads. Nebraska law limits HHS workers to 12 to 17 cases. St. Francis’ proposal for a Nebraska contract was built around a target of 25 cases per case manager.
» Contract cost. In its protest to the state, PromiseShip stated that Nebraska’s per-case cost, statewide, was $3,000 in 2017 and $3,100 in 2018, whereas in its bid St. Francis proposed a per-case cost of $1,130 in year one and $1,650 in year two. St. Francis’ contract with Kansas “has been amended multiple times” to increase the payment rate to the nonprofit, PromiseShip wrote. State Sen. Sara Howard of Omaha, who chairs the Legislature’s Health and Human Services Committee, said she has concerns over whether St. Francis could fulfill the contract at the proposed rate. During the failed privatization effort a decade ago, cost issues forced all private providers but one — the agency now named PromiseShip — to pull out of service delivery in Nebraska.
St. Francis says it can achieve significant cost savings through innovative service-delivery approaches, a key goal in having a private provider.
The state Department of Administrative Services, in its response to PromiseShip, said that cost was only about 25% of the bid selection criteria. A team of HHS financial officers “questioned both vendors on costs, cost management and other financial particulars, assessing them qualitatively on their responses.”
The state intends to “ensure that once services are provided, case management ratios fall within statute,” Administrative Services said.
With this decision, the state is taking a major risk. It’s imperative that the transition be made seamlessly and that the state rigorously ensure that service is delivered at the appropriate standard. Meeting those obligations is crucial to make sure that abused and neglected children receive needed help and that the system retains a vital need: stability.