Foster Care: States with Approval to Extend Care Provide Independent Living Options for Youth up to Age 21

Youth who leave the foster care system at age 18 are often ill-prepared to live on their own and may face challenges as they transition to adulthood, such as difficulties finding stable housing. The Fostering Connections to Success and Increasing Adoptions Act of 2008 allowed states to receive federal reimbursement through title IV-E of the Social Security Act for a portion of the cost of extending care to certain eligible youth up to age 21. The Act also allows youth ages 18 up to 21 to live in a supervised setting in which the individual is living independently. One such setting may be an apartment, with monthly check-ins with a case worker (referred to as supervised independent living arrangements).

GAO was asked to review supervised independent living arrangements and services for older youth. Among other things, this report examines (1) the types of supervised independent living arrangements available; (2) factors states reported considering when placing youth in these living arrangements; and (3) how selected states prepare youth to live independently.

GAO surveyed state child welfare agencies in the 26 states approved by the Department of Health and Human Services (HHS) to receive federal funding to support their extended foster care programs; interviewed state and local child welfare officials and stakeholders in five states selected for factors such as variation in child welfare administration systems; reviewed relevant federal laws, regulations, and guidance; and interviewed HHS officials.

The 26 states that have approval to receive federal funding to support their extended foster care programs for youth ages 18 up to 21 reported providing a range of supervised independent living arrangements. These arrangements include transitional living programs, private residences, and other settings (see figure). Officials we spoke with in five selected states said transitional living programs typically involve private child welfare agencies that lease apartments or facilities for youth, either at a single site or scattered across a geographic area, and offer on-site case management and supports to help youth build independent living skills. For private residences, youth may choose where to live, such as a private or shared apartment. In these cases, youth are typically responsible for their own lease, and may receive minimal supervision compared to youth in transitional living programs. For other settings, states reported options such as college dorms and residential employment training programs. Nineteen states also reported allowing youth under 18 to live in supervised independent living settings in certain instances, such as when they are pregnant, parents, or attending college, although such placements are generally not eligible for federal funding.

Factors that most states reported considering when placing youth in supervised independent living arrangements include the youth's life skills—for example, their ability to budget finances and schedule medical appointments—as well as their education and employment status. Officials in selected states also said they consider the availability of housing, which may be limited in certain localities due to a lack of affordable housing options or other factors, and the options available to youth with complex needs, such as those who are pregnant and parents.

Officials in four selected states said they help prepare youth in extended foster care to live independently by providing targeted trainings and other supports, such as financial literacy training. In all five selected states, youth can also learn independent living skills through services offered more broadly to all older youth in foster care, officials said, including assistance with housing, education, employment, and daily living skills, such as grocery shopping and budgeting.

In fiscal year 2017, over 440,000 children were in the foster care system,  largely due to neglect. Data from the Administration for Children and  Families (ACF), within the Department of Health and Human Services  (HHS), show that nearly 102,000 of these children were youth nearing  adulthood (ages 14 and up). Our prior work and other research studies  have found that youth in foster care are likely to face challenges as they  transition to adulthood. For example, studies conducted in three  midwestern states found that youth transitioning to adulthood and out of  state foster care systems at age 18 had lower rates of high school  completion and enrollment in postsecondary education by age 19,  compared with the general population. These youth also experienced  physical or psychological trauma which may have affected their mental  health. Additionally, they faced housing instability and had higher rates of  other economic hardships compared with the general population.

States may use federal funding to assist youth in foster care as they  transition to adulthood under title IV-E of the Social Security Act (title IV- E), which authorizes federal support for state foster care and adoption  assistance programs. The Fostering Connections to Success and Increasing Adoptions Act of 2008 (Fostering Connections Act) allowed  states to receive federal reimbursement under title IV-E for a portion of  the cost of extending foster care to certain youth beyond their 18th  birthday, up to age 21. Federal reimbursement under title IV-E is  generally limited to eligible youth removed from homes with very low  incomes, among other eligibility criteria. The Fostering Connections Act  also authorized federal reimbursement to support youth in foster care  ages 18 up to 21 who are placed in a supervised setting in which the  youth is living independently. States generally have discretion to  determine the types of settings that meet this requirement. Such settings  may include independent living arrangements, such as the youth’s own  apartment, with monthly check-ins with a case worker, referred to as  supervised independent living arrangements. The amendments made by  the Fostering Connections Act do not preclude states from placing youth  under age 18 in supervised independent living arrangements. However,  states generally may not seek federal reimbursement for placing youth  under 18 in these settings. In addition, the John H. Chafee Foster Care  Program for Successful Transition to Adulthood (Chafee Program)  provides funding to states for independent living services, such as  mentoring, educational assistance, and vocational training, to support  older youth in foster care and youth who have recently left foster care.  Despite these efforts to increase supports for youth in foster care  transitioning to adulthood, little is known about the living arrangements  offered to youth ages 18 to 21 in states where extended care is offered  (extended-care states), especially how states have set up supervised  independent living arrangements, and the types of services that assist  these youth.

You asked us to explore the types of independent living arrangements  and services available to older youth. This report examines (1) the types  of supervised independent living arrangements available to youth in  extended-care states, (2) what factors extended-care states reported  considering when placing youth in supervised independent living, (3) what  federal and other sources extended-care states use to fund supervised  independent living arrangements for youth, and (4) how selected  extended-care states prepare youth to live independently.

To address each research question, we designed and administered an  electronic survey of state child welfare agencies in the 26 states approved  by HHS to offer federally funded extended care as of February 2018.  The survey was conducted between August and October 2018 and we  obtained a 100 percent response rate. The survey included open-ended  and closed-ended questions about states’ policies and practices  regarding supervised independent living arrangements, states’ data on  youth in extended care and in supervised independent living, state  spending and funding sources for these living arrangements in state fiscal  year 2017, as well as questions about data reliability. We also analyzed  states’ responses on the number of youth in extended care and the  number of youth in care that were eligible for title IV-E reimbursement in  state fiscal year 2017 to determine their title IV-E eligibility rate for the  fiscal year.

To ensure the quality and reliability of the survey, we pretested the  questionnaire with three extended-care states that vary in geographic  location and numbers of youth in care, among other factors. We  conducted the pretests to check (1) the clarity and flow of the questions,  (2) the appropriateness of the terminology used, (3) if the information  could be easily obtained and whether there were concerns about the  reliability of data that would be collected , and (4) if the survey was  comprehensive and unbiased. We revised the questionnaire based on the  pretests. We reviewed responses to assess if they were consistent and  contained all relevant information, and followed up as necessary to  determine that states’ responses were complete, reasonable, and  sufficiently reliable for the purposes of this report; we excluded data  where we had concerns about their reliability.

To complement information gathered from our survey, we held in person  and phone interviews with selected child welfare stakeholders in five  states—California, Illinois, Maryland, New York, and Tennessee. We  selected the states based on several factors, such as variation in child  welfare administration systems (i.e., state- versus county-administered),  geographic location, and length of time HHS-approved extended care has  been in effect, among other factors. Stakeholders who participated in the  interviews included officials from state and local child welfare agencies  and representatives from 20 private child welfare agencies working with  state or local child welfare agencies to provide supervised independent  living arrangements or independent living services. In the states we  visited in person—California, Illinois, and Maryland—we also spoke with  youth ages 18 to 21 in extended care, and toured supervised independent  living settings for these youth. The information gathered in the five  selected states is not generalizable to all extended-care states. To obtain  more information about states’ options for implementing extended care  and supervised independent living arrangements, as well as funding  these arrangements, we also interviewed HHS officials. Additionally, we  reviewed relevant federal laws, regulations, and HHS policies and related  research.

To develop our methodologies, we reviewed related literature and  interviewed child welfare experts. During this process, we explored  analyzing federal data on youth in foster care from two federal databases:  (1) the Adoption and Foster Care Analysis and Reporting System  (AFCARS), and (2) the National Youth in Transition Database (NYTD).  We determined these databases to be insufficiently reliable for our  reporting purposes due to concerns about the completeness of the data  pertaining to extended care services and participants. Additionally, we  determined that the data collected through our survey and site visits  would be sufficient to address our research objectives.

We conducted this study from January 2018 to May 2019 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.

When children are removed from their homes, state or local child welfare  agencies are typically responsible for coordinating their placement and  provision of services. State or local child welfare agencies may also  contract with private child welfare agencies to help them administer child  welfare services.

Child welfare agencies often place children in a foster home or in group  care settings, depending on the child’s needs. Children placed in foster  families may live with unrelated foster parents, relatives, or fictive kin  (e.g., close family friends who are not relatives). Group care settings— also known as congregate care—typically include group homes and child  care facilities that provide 24-hour care and/or treatment for groups of  children. For example, these settings may include child care institutions,  residential treatment facilities, or maternity homes, according to HHS.  Child welfare agencies may provide foster caregivers with a monthly  payment (referred to as a foster care maintenance payment) to help cover  the costs of a child’s care, as determined by each state.

Children generally remain in foster care until a permanent suitable living  arrangement can be made, either by addressing the issues that led to the  child’s removal and returning the child to his or her family; or through  adoption, guardianship, placement with a relative, or another planned  permanent living arrangement. In some cases, the child reaches  adulthood before leaving foster care, commonly referred to as “aging out”  of foster care. Historically, aging out typically occurred at age 18, but  some state-funded programs implemented prior to the enactment of the  Fostering Connections Act in 2008 allowed youth to remain in care  beyond their 18th birthday.

Federal Funding for Child Welfare Programs

Title IV-E of the Social Security Act authorizes federal funding to state  child welfare agencies to help cover the costs of operating their foster  care programs. ACF administers title IV-E and oversees states’ foster  care programs for compliance with IV-E requirements. Title IV-E is the  largest single federal source of funding for child welfare programs,  comprising about 89 percent of federal child welfare appropriations in  fiscal year 2017 (approximately $7 billion of nearly $7.9 billion), according  to ACF. Under title IV-E, states can access funding for their foster care  programs in a few ways.

Title IV-E reimbursements: Title IV-E funds may be used to  reimburse states for a portion of expenses to support the daily care  and supervision of eligible youth in foster care (such as for food,  clothing, and shelter). The eligibility requirements generally limit  reimbursements under title IV-E to youth that were removed from  homes with very low incomes, among other criteria. However, some  states have received waivers from certain title IV-E funding  requirements to carry out HHS-approved demonstration projects.  According to HHS, under these waivers states receive a capped  allocation of title IV-E funds for youth in foster care, and these funds  are generally reserved for youth under age 18.

Chafee Program funds: The Chafee Program provides funding to  states, under title IV-E, for support services that are intended to assist  eligible youth in the transition to adulthood. Chafee Program funds are  allocated to each state based on the state’s proportion of the nation’s  foster care caseload. Through the Chafee Program, states can offer  services to youth who have experienced foster care at ages 14 or  older, youth who are likely to age out of foster care, and certain older  youth who have aged out or left the foster care system. States  generally have flexibility in determining the goals, strategies, and  other features of their Chafee programs, as long as states design and  conduct their programs based on the key purposes outlined in the  law. Chafee Program services may include help with education,  employment, financial management, housing, and emotional support  through mentoring. State and county child welfare agencies may  contract with private entities to provide these services. Up to 30  percent of a state’s Chafee Program allotment may also be used for  room and board costs for certain eligible youth. According to HHS  data, services provided under the Chafee Program may vary by state,  including the extent to which states provide room and board financial  assistance services.

While title IV-E is the primary source of federal funding available to states  for child welfare programs and services, states may also use other federal  funds, such as title IV-B of the Social Security Act, Temporary Assistance  for Needy Families (TANF) and Social Services Block Grant funds, as  well as Medicaid. State child welfare agencies also generally combine  state and local funds with federal funds to support their programs.  According to a state survey funded by the Annie E. Casey Foundation  and Casey Family Programs, in state fiscal year 2014, 43 percent of all  child welfare expenditures were from federal sources, and 57 percent  were from state and local funds.

Since the Fostering Connections Act was enacted in 2008, HHS has as of  February 2018 approved 26 states and six federally recognized tribes to  claim title IV-E funding to extend foster care to youth ages 18 to 21.  According to ACF, most of these states (19 of 26) began offering federally  funded extended care between 2010 and 2012, with one state beginning  to provide extended care as recently as 2018.

States have several different options for implementing their extended care  programs. For example, in order to be eligible for extended care, title IV- E requires a youth to meet at least one of five employment or education  conditions specified in the statute. States can choose to use all or some  of these conditions to determine which youth are eligible for their  extended care program (referred to in this report as “eligibility criteria”). In  addition, states can utilize supervised independent living settings for  youth in extended foster care—a placement setting not typically available  for federal reimbursement for youth under age 18. (See table 1 and fig.  1).

The amendments made by the Fostering Connections Act permit states to  use title IV-E funds to place eligible youth age 18 or older in supervised  settings in which the youth live independently. According to a research  brief sponsored by ACF, supervised independent living settings are unlike  other foster care placement options (such as foster homes and group  homes) because they are primarily intended for youth in extended care.  States may place youth under age 18 in supervised independent living  settings, but, as previously noted, they generally may not seek federal  reimbursement for foster care maintenance payments for youth under 18  in such settings.

According to ACF’s program instructions for implementing the Fostering  Connections Act, state child welfare agencies have the discretion to  develop a range of supervised independent living settings which can be  reasonably interpreted as consistent with the law, including whether such  settings need to be licensed and any safety protocols that may be  needed. These instructions state that child welfare agencies may  determine that—when paired with a supervising agency or supervising  caseworker—host homes, college dormitories, shared housing, semi- supervised apartments, or other housing arrangements meet the  supervised setting requirement. Youth in such settings may not have  onsite caregivers and often have increased responsibilities, such as  paying bills, assuming leases, and working with a landlord, according to  ACF documentation. However, youth may receive foster care services,  such as financial support and case management, to help them become  successful adults. Additionally, ACF encouraged child welfare agencies to  continue to work with youth who are in supervised independent living  settings to ensure that youth form permanent connections with caring  adults. This could include exploring options for guardianship, adoption, or  living with other caring adults, and helping youth work towards those  outcomes.

Extended-Care States Reported Providing a Range of Supervised Independent Living Options and Some Allow Youth Under 18 to Live Independently

Supervised Independent Living Arrangements in Extended-Care States Range from Group Settings with On-site Staff to Individual Apartments with Minimal Supervision

In response to our survey, all 26 extended-care states reported offering a  variety of supervised independent living arrangements as a placement  option for older youth in care, with most of the options falling largely in  two broad categories—transitional living programs and private  residences—in addition to a range of other types of supervised  independent living settings (see fig. 2). Overall, across 21 of the 26  extended-care states for which we analyzed placement data, about 34  percent of youth in foster care who were ages 18 to 21 were placed in  supervised independent living settings in state fiscal year 2017 (see  appendix I for additional information).

Twenty-three of the 26 extended-care states reported that they offer  transitional living programs as a type of supervised independent living  arrangement. Generally, officials said these programs provide youth with  the opportunity to practice daily independence and may include on-site  case management and high levels of support built into regular  programming. Supports may include experiential learning activities to  build independent living skills, such as grocery shopping and budgeting.  Local officials in California told us that transitional living programs are a  stepping stone to independence, and they encourage older youth to start  in one of these programs before living on their own. In our discussion  groups with youth in extended care, youth told us transitional living  programs helped them gradually move towards more independence and  learn how to pay bills on their own.

Officials we spoke with in the five selected states—California, Illinois,  Maryland, New York, and Tennessee—described transitional living  programs that use single-site or scattered-site models, or both, ranging  from a group of youth living in a single family home to youth living in  apartments dispersed across a geographical area (see table 2).

Local caseworkers may continue to check in with youth in both single-site  and scattered-site transitional living programs, but private agencies  operating these programs are typically responsible for providing more  frequent case management and supervision, according to officials in the  selected states (see text box). One youth in a scattered-site program in  California told us that he meets with his county case worker every couple  of months, but he meets with program staff on a weekly basis and  sometimes several times a week.

Examples of Single-Site and Scattered-Site Transitional Living Programs in  Selected States Single-site program: Officials from a single-site, all-male program in Tennessee  described it as a family-like environment. Youth in the program live in cottages and  house managers live in private quarters attached to the cottages. Program participants  have their own bedrooms, and share bathrooms and common areas such as the kitchen.  Youth over age 18 do not require 24-hour supervision, but have 24-hour access and  daily interaction with the house managers. Youth typically receive an allowance of $150  per month (reduced to $100 if they are employed) to purchase personal items such as  hygiene products.

Scattered-site program: Officials from a private agency in California explained that their  agency holds master leases on one- and two-bedroom apartments across Los Angeles  and Alameda counties for youth who have demonstrated their readiness for more  independence. An education and employment specialist or youth advisor meets with  youth living in these apartments once a week, but youth can access program staff via  phone anytime and are encouraged to attend activities at the agency’s main site. Youth  receive a monthly stipend for personal expenses and their rent is paid by the program,  but they are encouraged to work to manage additional living expenses. Those who stay  in the program until they age out of foster care may remain in the apartment and take  over the lease.

Officials and representatives of private agencies we spoke with in four of  the selected states said that they have transitional living programs  specifically for certain populations that need specialized support. For  example, Illinois officials described programs in their state that specialize  in serving youth with mental illnesses, youth who are developmentally  delayed, pregnant or parenting youth, youth who are dually involved with  child welfare and justice systems, and youth with problematic sexual  behaviors, such as sexual offenders. (See sidebar.)

State and local officials we spoke with in the selected states said that  youth who are ready to practice living more independently, in many  instances with no on-site supervision, may live in private residences.  Youth in these settings may choose where they would like to live, in  comparison to youth in transitional living programs whose options may be  limited to the apartments and facilities offered by the programs. Officials  said that youth may live in apartments or private homes that are  integrated in the community, and they are often responsible for signing  their own lease or rental agreement.

According to officials in the selected states, the level of supervision  provided to youth living in private residences varies, but is generally less  than youth in transitional living programs. Officials we spoke with in all  five selected states confirmed that, at a minimum, case workers are  expected to have monthly, in-person contact with youth. These visits are  typically to confirm if youth are still in their living arrangement, and to  determine if youth are experiencing any challenges, such as limited  access to resources in their community. However, officials said that some  youth may receive more frequent case management and supervision,  such as youth who have behavioral or mental health conditions. For  example, officials at one private agency in Illinois told us their staff have  weekly check-ins with youth who require legal assistance or have mental  health needs. State and local officials in two states mentioned that in  addition to monthly in-person contact, case workers typically have more  frequent communication with youth via phone calls, texting, or video  conferencing. If youth are located far away to attend college or pursue  other opportunities, caseworkers may use these alternative modes of  communication to maintain contact and provide support. For example, a  case worker for a private agency in Illinois told us that she video chats  with her client twice a week, and communicates via text messaging and  email several times a week, to provide support for this college student  living in a private residence while studying abroad.

Generally, states vary in the types of settings they allow for private  residences, according to our survey results. Among the 26 extended-care  states, the most common types of settings states reported offering include  living in a shared apartment or home with a friend or roommate (25) or  living in a private apartment or home (24). Most states reported that they  also allow supervised independent living arrangements where a young  person lives in a foster family home (20) (see text box).

Living Arrangements with Current or Former Foster Parents   In response to our survey, most states reported that they allow youth in supervised  independent living arrangements to live with a foster parent. Officials in two states  mentioned that because these placements are considered supervised independent living  settings, youth are eligible to receive a stipend directly from the child welfare agency for  rent and living expenses. The youth and their foster parent(s) may establish a rental  agreement so the youth can practice paying rent. In three states, officials also said that  they provide foster families with information and resources to teach and demonstrate  independent living skills, such as cooking and cleaning a home. State and local officials  said this arrangement allows youth to remain connected to a supportive adult, while also  learning to live independently. In our discussion groups with youth in extended care, one  youth told us that living with a foster family can be a good choice when a youth has a  good bond with the foster parents, and when the foster parents allow the youth to have  more independence.

Youth in private residences typically receive a stipend to pay for their rent  and other costs, according to our survey results. States reported that  stipend amounts ranged from $421.80 to $1,715 per month. However,  states reported having different expectations for youths’ responsibilities in  covering their living expenses. Officials in some states said they require  youth to supplement their stipend with income from their employment to  cover living expenses. Officials in other states said they may encourage  youth to work because the stipend may not be enough to cover most of  their housing and other costs. Officials in one county said that youth may  receive up to $850 per month but that amount may be adjusted based on  the income they earn while attending school. In another state, officials  reported that youth are expected to pay at least $50 towards their rent  and, depending on the young person’s budget and financial obligations,  the child welfare agency typically pays the difference directly to the  landlord. One youth we spoke with in Illinois said that while working and  going to school part-time, he built up his savings with help from the  stipend that he received from the child welfare agency.

Other Supervised Independent Living Settings

States also reported allowing youth to live in a variety of other types of  supervised independent living arrangements. According to our survey,  other types of supervised independent living arrangements include  college dorm rooms (22 states), Job Corps or employment training  programs (21), single room occupancies (19), or mental health or  substance use treatment facilities (15). Officials we spoke with said that  they continue to provide case management and supervision to youth in  these placements, and may also support youth with a stipend to assist  with living expenses. Additionally, they said that when colleges go on  break during the winter or summer, case workers work with youth to find a  temporary placement if needed to ensure there is no lapse in housing.  Temporary placements may include living with former foster parents,  friends, or renting their own apartment.

States Reported Allowing Youth Under 18 to Live in Supervised Independent Living Arrangements in Certain Instances and Providing Additional Supports

Supervised independent living settings are primarily intended for youth  age 18 and older in extended care; however, some states also reported  allowing these arrangements for youth under 18. In response to our  survey, 19 of 26 states reported allowing youth under age 18 to live in  supervised independent living arrangements. State and local officials said  that in instances when youth under 18 are placed in supervised  independent living arrangements, they are generally placed in college  dorms or transitional living programs. In one state we visited, a  transitional living program official said that the program accepts youth as  young as 15 years old in a very few instances. (See table 3.)

Local officials and case workers said that they place youth under age 18  in supervised independent living settings on a case-by-case basis if their  case worker determines that the young person is mature and capable  enough to manage living with less supervision (see text box).

In response to our survey, 17 states reported that when youth under age  18 are placed in supervised independent living settings, they generally  receive additional supervision or supportive services compared to youth  18 and older. Two states reported that no additional supervision or  supportive services are provided for youth under 18 in independent living  arrangements beyond those provided to youth ages 18 to 21. Officials  we spoke with in three of the five selected states provided examples of  the additional supports they offer to younger youth in these settings.

Officials at one private agency in Tennessee told us that if youth  under 18 in their transitional living program are unable to ride the bus  to high school, program staff will transport them to school.

State officials in California said that generally, youth under 18 living in  transitional living programs receive more hands-on support. Officials  at one private agency in California said the supports provided to youth  under 18 in their transitional living program include 24 hour access to  on-site program staff and weekly meetings with their case manager.

Officials in Maryland told us youth under 18 living on their own receive  additional case management support to evaluate how the youth is  adjusting to living on their own, and to provide additional guidance on  budgeting and household management.

While many states allow youth under age 18 to live in supervised  independent living settings in certain circumstances, over half of all  extended-care states (15 of 26) reported that the typical age that youth  enter this placement type is 18. Officials in three of the selected states  said that even when the state allows it, these arrangements are not often  used for youth under 18. Additionally, officials we spoke with reported that  highly independent settings, such as their own apartment, are typically  reserved for youth age 18 or older.

States Reported Considering Youths’ Readiness for Supervised Independent Living, but Officials Noted that Housing Availability can Affect Placements

Most states we surveyed reported considering youths’ readiness, such as  life skills, education, and employment status, when placing youth in  supervised independent living arrangements. Officials we spoke with in  four of the five selected states similarly noted that supervised  independent living is most appropriate for youth who have demonstrated  their readiness. These officials also noted that they consider the  availability of housing options, including for youth with complex needs,  which can affect youths’ placement in supervised independent living  arrangements.

Life skills. In response to our survey, most states reported considering  youths’ life skills when placing youth in supervised independent living.  Specifically, 19 states reported requiring or recommending that youth  participate in an assessment to gauge their mastery of certain life skills,  such as the ability to budget finances or schedule medical appointments.  For example, state officials in California said they developed an  assessment form with questions such as whether youth understand the  risks associated with using credit cards, can shop for food and prepare  meals, and know how to do laundry. Caseworkers in one California  county said that they consider youths’ ability to manage their living costs  and their rental responsibilities prior to approving a supervised  independent living placement.

Education and employment. Most states also reported considering  education and employment when placing youth in supervised  independent living. Specifically, 16 states reported requiring or  recommending that youth have a high school diploma or General  Education Development certificate, or be enrolled in secondary or post- secondary school, in order to be placed in supervised independent living.  Additionally, 17 states reported requiring or recommending that youth be  employed or enrolled in a job training program. For example, in Illinois,  youth who want to live in private residences must have a job for at least  45 days prior to being referred for placement, and continue working for at  least 15 hours per week while in the private residence.

Five states reported considering other indicators of readiness beyond life  skills, education, and employment when placing youth in supervised  independent living settings. For example, the District of Columbia  reported requiring that youth (1) have no pending or unresolved criminal  proceedings at the time they apply for supervised independent living, and  (2) have a checking account with a minimum balance of $100 and actively  participate in the child welfare agency’s financial literacy program.

Availability of housing options, including for youth with complex  needs. State and local officials in two of the five selected states said that  they may place youth in private residences as a default or short-term  option when no other living arrangements are available for youth age 18  or older. For example, officials in Tennessee said that transitional living  programs and other housing options for youth outside of metropolitan  areas are more limited. To ensure that youth in these areas do not  experience homelessness, the officials said they may rely on other living  arrangements, such as providing youth with stipends to live in private  residences. Additionally, officials in New York and California said in  certain localities, there may be constraints offering certain supervised  independent living settings due to a lack of affordable housing. For  example, officials in one San Francisco area county said some youth who  want to live independently choose to move to a different part of the state,  or even out of state, because their stipend for a private residence is  insufficient to afford an apartment there. Officials in all selected states  also said that there are shortages of foster parents willing to provide care  for youth ages 18 to 21, which can generally affect their options for living  arrangements.

State and local officials from all five selected states also cited challenges  finding housing options that are equipped to serve certain subpopulations  of youth with complex needs, such as youth with acute mental health  needs, youth that are also involved in the juvenile justice system, and  pregnant and parenting youth. For example, local and private agency  officials said state child welfare agencies may require parenting youth in  supervised independent living settings to be in larger apartments, which  may be too costly to afford. In addition, officials in four selected states  said private agencies may be less likely to accept youth with acute mental  health conditions or youth involved in the juvenile justice system if the  agencies do not have the resources to address their needs.

In addition to these considerations, officials we spoke with in all five  selected states and other stakeholders said they consider the importance  of giving youth in extended care greater involvement in decision making  as they become adults. Local officials in California said they believe in  allowing youth to take risks and experience the challenges of living  independently while they have support from the child welfare system.  Similarly, local officials in Tennessee said that giving youth choices in  their living arrangements and considering their needs and goals is  important for keeping them engaged in extended care.

Most States Reported Using Title IV-E Funding for Supervised Independent Living Arrangements but Several had Low Title IV-E Eligibility Rates for Youth in Extended Care

Most (24 of 26) extended-care states we surveyed reported using title IV- E funds to support youth in supervised independent living arrangements.  Most (19 of 26) states also reported using Chafee Program funds, which  primarily support independent living services, to fund supervised  independent living arrangements. For example, state officials in  Tennessee said that in certain situations when youth need to secure an  apartment quickly, officials may use Chafee Program funds to help with  the deposit. Officials in Illinois told us that they also use some Chafee  Program funds for room and board, particularly for youth who are not title  IV-E eligible.

In addition to title IV-E and Chafee Program funds, most states reported  using a combination of sources, including other federal funds such as  those available under title IV-B of the Social Security Act, as well as state  and local funds, to pay for supervised independent living arrangements.  All states reported using state funds for supervised independent living  (see fig. 3).

Although most states reported using title IV-E funds to support supervised  independent arrangements, in several states, few youth in extended care  (regardless of their living arrangement) were eligible for title IV-E  funding. In 14 of the 17 extended-care states for which we calculated  eligibility rates, we found that the majority of youth ages 18 to 21 in care  were not eligible for title IV-E reimbursement in state fiscal year 2017,  meaning that the state was responsible for most or all of the cost of their  care. We found that six of the states had title IV-E eligibility rates of 30  percent or lower. Two states, Virginia and Hawaii, had eligibility rates of  over 70 percent (see fig. 4).

State officials we spoke with in three of the five selected states said that  ineligibility frequently stems from family income exceeding the income  limit for title IV-E funding. Specifically, title IV-E is limited to youth  removed from homes that would have qualified for cash assistance under  the Aid to Families with Dependent Children (AFDC) program as of July  16, 1996. To receive title IV-E funding, youth must have met eligibility  requirements at the time they were initially removed from their home, or at  the time of their voluntary placement agreement. ACF has reported that  fewer families meet the AFDC income standards over time, thereby  reducing the number of all youth who are eligible for title IV-E funding,  regardless of their age. In 2018, we reported on declining title IV-E  eligibility rates for the entire population of youth in foster care.

Officials we spoke with in Illinois and Tennessee said they reconsider a  youth’s title IV-E eligibility once the youth turns 18, using the youth’s  income at that point in time. Officials from these two states told us they  close the original foster care case when a young person turns 18 and  then reopen the case when the young person re-enters extended care.  Using this approach, officials said they can base the title IV-E eligibility  determination on the youth’s income at the time of re-entry into the foster  care system, rather than the income of the home from which the youth  was removed upon initially entering foster care. Illinois officials said this  process helped increase the eligibility of their extended-care population  by more than 30 percent since 2012. Officials we spoke with in the  remaining three selected states said they do not use this approach.

ACF officials said that states can choose to close and re-open cases for  youth in extended care, which would allow new eligibility determinations  based on a youth’s income. However, ACF officials said they do not  monitor states’ choices in this area, or how states’ choices affect their title  IV-E eligibility rate. Officials said they focus on helping states identify  options and provide examples in ACF program instructions so states can  determine what works best with their own policies and procedures.

Four states (Arkansas, Indiana, Maryland, and Massachusetts) reported  in our survey not claiming title IV-E reimbursements for any youth in  extended care in state fiscal year 2017. Officials in two states, Indiana  and Maryland, reported not claiming title IV-E funds for youth in extended  care at least in part because they use a title IV-E waiver. However,  according to ACF, states can claim title IV-E reimbursements for youth  over 18 in addition to their waiver funds, so these two states may be able  to claim additional title IV-E funds for their extended care population.  State officials in Arkansas told us they have not yet established the  proper procedures, internal controls, and monitoring mechanisms to allow  them to claim title IV-E funds for youth in extended care. Officials said  they do not have systems to track when youth may have lost their jobs or  dropped out of school, which could affect the youth’s eligibility for  extended care.

Selected States Reported Offering a Range of Training and Other Supports to Prepare Youth in Extended Care to Live Independently

Youth in Extended Care May Receive Targeted Assistance in Selected States, As Well As Training and Other Supports Offered to All Older Youth in Care

To help youth develop independent living skills and successfully transition  out of care, state and local officials in four of the five selected states  reported offering targeted training and support for youth ages 18 to 21.  For example:

Officials in one Maryland county said they offer youth nearing age 21  a 3-week intensive training focused on employment and housing  called “Keys to Success.” According to officials, Keys to Success  offers experiential learning through cooking demonstrations,  budgeting and financial literacy training, group trips to stores to look at  furniture or interview-appropriate clothing, and housing fairs. (See fig.  5.)

Officials from Youth Villages, a national nonprofit organization, said  they offer the organization’s intensive YVLifeSet program to youth in  extended care in Tennessee. The program generally lasts six to  nine months and pairs youth with a specialist to meet with weekly to  help them achieve their goals for independent adulthood. For  example, to help youth maintain employment, officials said specialists  can help youth build skills such as how to handle conflict with  supervisors or coworkers, provide customer service, and understand  job expectations, among others.

In Illinois, the state’s “Countdown to 21” program is intended to  encourage youth to plan for long-term education and vocational goals,  and promote their financial stability through financial literacy training.  All youth, at age 19, are referred to the financial literacy training,  which covers topics such as credit and investing, and officials said  most youth complete the training prior to exiting extended care.

Officials in one California county said they offer youth ages 18 to 21  an annual public transportation pass through the Youth on the Move  program, to ensure they can get to work or school.

According to ACF, some extended care states also have a specialized  case management system for youth over 18. For example, officials from  one county in Maryland told us that all youth in foster care are  automatically enrolled in a supervised independent living case  management track when they turn 18. This case management system is  intended to identify a youth’s areas of need and design a plan to prepare  them for living independently, regardless of their current living  arrangement.

Youth in extended care can also participate in independent living services  that are offered more broadly to all older youth in foster care. Officials in  all five selected states reported offering services that support youth in  extended care in their housing, education, financial literacy, and  employment goals, as well as offering health education, mentoring, and  training on daily living skills (e.g., grocery shopping and budgeting).  Examples of types of services the selected states reported offering to all  older youth include:

Housing. Officials from Youth Villages described how their  organization assists youth in Tennessee to learn to find and maintain  stable housing. For example, Youth Villages specialists work with  youth to search for affordable housing options, develop a housing  budget, complete applications, and address background check issues.  Specialists also help youth build and maintain relationships with  roommates and landlords.

Education. County officials in New York described how a local  community college helps youth complete financial aid forms, and  conducts college day simulations and resume-building workshops.

Financial literacy. County officials in Maryland told us they offer  classroom instruction on financial literacy which includes how to  understand financial aid, good banking practices, and how to asses  loans and grants.

Employment. In California, county officials told us about several  programs they offer to help youth meet their employment goals, such  as a youth worker program in which 16- to 21-year-olds are hired to  rotate through different county departments for 18 months.

Health. County officials in Maryland told us they offer yoga classes  and other stress reduction techniques, as well as outings to local  clinics for youth to learn about family planning resources.

Mentoring. County officials in California told us they host weekly  social events to establish community connections between youth in  care, and youth have regular meetings with supportive adults focused  on building connections with family and friends.

Daily living. Officials at a private agency in Illinois told us the youth in  their housing programs have a set schedule to participate in different  life skills activities, such as cooking, doing laundry, and other chores.

Although officials in all five selected states said they offer a variety of  training and supports to help youth in extended care develop independent  living skills, officials in these states also said that youth may experience  challenges using these skills. For example, officials said youth in private  residences may have difficulty covering their living expenses, which can  lead to evictions. A New York county official said some youth living on  their own may struggle with the lack of structure and the amount of  independence in making their own decisions and setting their schedule.  For these youth, officials said the child welfare agency will increase the  level of case management, and offer additional support or services.

Selected States Reported Directing Youth in Extended Care to Services Based on Their Needs and Encouraging Participation with Financial Incentives

To best support the development of independent living skills in youth in  extended care, officials we spoke with in all five selected states said they  use assessments such as the Casey Life Skills assessment, transition  planning, or regular check-ins to determine youth goals, direct youth to  services to meet their needs, and to measure their progress.

A county official in New York described how private child welfare  agencies use the Casey Life Skills assessment every 6 months for  youth in care to target services to areas in which the youth needs to  build skills.

Through its Ready by 21 program, Maryland has yearly independent  living benchmarks for youth, starting at age 14. Officials we spoke  with said that caseworkers can use these benchmarks to assess a  youth’s progress towards living independently, create an individual  service plan based on their progress, and direct youth to additional  resources as needed (see fig. 6).

In addition, title IV-E requires that caseworkers assist youth with  developing a transition planning document. According to state and local  officials, youth periodically meet with their caseworkers to discuss their  progress on their goals, and caseworkers may provide additional  guidance and support as needed during these meetings. For example, a  caseworker in Tennessee described providing youth funds for driver’s  education classes and licenses, prom expenses, and extracurricular  activities, based on conversations with youth about their needs.

Officials we spoke with in all five states also discussed providing financial  incentives to encourage youth to participate in independent living  services. For example, according to officials in Illinois, if youth complete  the financial literacy course offered by the state child welfare agency, they  receive $1,200 when they exit care. County officials in Maryland  described participating in the Jim Casey Opportunity Passport program.  In this program, officials said, youth who complete financial literacy  training are eligible for a matched savings program of up to $3,000 to  purchase an asset, such as a car. In our discussion groups with youth in  extended care, youth told us that they are responsible for taking the  initiative to participate in services, but financial incentives are helpful.  Youth told us that as a result of these incentives, as well as other  supportive savings programs, some are able to exit care with substantial  savings.

We provided a draft of this report to HHS for review and comment. In  response, HHS provided technical comments, which we incorporated as  appropriate, but did not provide general comments on the draft report.

As agreed with your offices, unless you publicly announce its contents  earlier, we plan no further distribution until 30 days from its issue date. At  that time, we will send copies of this report to interested congressional  committees and to the Department of Health and Human Services. In  addition, the report will be available at no charge on the GAO website at  http://www.gao.gov.

If you or your staff have any questions about this report, please contact  me at (202) 512-7215 or larink@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 II.

Appendix I: Youth in Extended Foster Care by Placement Type

Figure 7 below presents the total number and percentage of youth in  extended care by living arrangement (referred to as placement type)  during states’ fiscal year 2017. Table 4 and Figure 8 present the number  and percentage of youth in extended care by state and placement type  during each state’s fiscal year 2017, respectively. Placement types  include foster family homes with relatives or non-relatives, group homes  or institutions, supervised independent living arrangements, and other  types of arrangements. Figure 7, Table 4, and Figure 8 present  information for 21 extended-care states. We excluded five of the 26  extended-care states we surveyed because they reported point in time  data that did not reflect their entire state fiscal year 2017, or they reported  data that were not reliable for the purposes of our analysis.

To develop Figure 7, Table 4, and Figure 8, we assessed the information  we collected in our survey of extended-care states on youth ages 18 to 21  for whom the state child welfare agency had responsibility for placement,  care, or supervision during states’ fiscal year 2017. We administered the  survey to state child welfare agencies in the 26 states approved by the  Department of Health and Human Services (HHS) to offer federally  funded extended care as of February 2018. The survey was conducted  between August and October 2018 and we obtained a 100 percent  response rate. Specifically, we asked states to provide data on the  number of these youth in care by placement type. In addition, we asked  states to provide data on the number of youth under age 18 that were  placed in supervised independent living or other independent living  arrangements.

To ensure the quality and reliability of the survey, we pretested the  questionnaire with three extended-care states to check (1) the clarity and  flow of the questions, (2) the appropriateness of the terminology used, (3)  if the information could be easily obtained and whether there were  concerns about the reliability of data that would be collected, and (4) if the  survey was comprehensive and unbiased. We revised the questionnaire  based on the pretests. We reviewed responses to assess if they were  consistent and contained all relevant information, and followed up as  necessary to determine that states’ responses were complete,  reasonable, and sufficiently reliable for the purposes of this report; we  excluded data where we had concerns about their reliability.

Appendix II: GAO Contact and Staff Acknowledgments

In addition to the contact named above, Sara Schibanoff Kelly (Assistant  Director), Aimee Elivert (Analyst-in-Charge), Ada Nwadugbo, and  Alexandra Squitieri made key contributions to this report. Also  contributing to this report were Lucas Alvarez, Sarah Cornetto, Erik  Gartland, Jean McSween, Mimi Nguyen, Jessica Orr, Jerry Sandau, and  Almeta Spencer.

Foster Care: Additional Actions Could Help HHS Better Support States’  Use of Private Providers to Recruit and Retain Foster Families.   GAO-18-376. Washington, D.C.: May 30, 2018.

Foster Care: Most Tribes Do Not Anticipate Challenges with Case Goal  Changes but HHS Could Further Promote Guardianship Assistance.  GAO-16-625. Washington, D.C.: August 8, 2016.

Higher Education: Actions Needed to Improve Financial Access to  Federal Financial Assistance for Homeless and Foster Youth.   GAO-16-343. Washington, D.C.: May 19, 2016.

Foster Care: HHS Could Do More to Support States’ Efforts to Keep  Children in Family-Based Care. GAO-16-85. Washington, D.C.: October  9, 2015.

Foster Care: HHS Needs to Improve Oversight of Fostering Connections  Act Implementation. GAO-14-347. Washington, D.C.: May 29, 2014.

Child Welfare: States Use Flexible Funds, but Struggle to Meet Service  Needs. GAO-13-170. Washington, D.C.: January 30, 2013.

Foster Youth: HHS Actions Could Improve Coordination of Services and  Monitoring of States Independent Living Programs. GAO-05-25.  Washington, D.C.: November 18, 2004.

Young people who leave foster care at age 18 are often ill-prepared to live on their own. To assist them, states can use federal funds to extend foster care to age 21. States can also allow these young people to practice living independently, such as in a private apartment with monthly check-ins with a case worker.

The 26 states approved to use federal funds to extend foster care reported allowing a range of independent living options, such as shared apartments or college dorms. We also found that selected states help prepare young people to live independently by offering training in areas like financial literacy and daily living skills.