3.1 Family Co-payments

Lead Agencies must establish and periodically revise a sliding-fee scale for families receiving CCDF services that varies based on income and the size of the family to determine each family’s contribution (i.e., co-payment) and does not create a barrier to receiving CCDF assistance. In addition to income and the size of the family, the Lead Agency may use other factors as appropriate when determining family contributions/co-payments. Lead Agencies may not use price of care or amount of subsidy payment in determining co-payments. Lead Agencies must ensure that the total payment to a child care provider is not reduced because of family’s lowered or waived co-payment. 3.1.1 Family co-payment Lead Agencies may not charge any family more than 7% of a family’s gross income, regardless of the number of children participating in CCDF. a. What is the maximum percent of a family’s gross income any family could be charged as a co-payment? 6.5% b. Does the Lead Agency certify that their sliding fee scales are always based on income and family size (regardless of how many different scales they may use)? [x] Yes. [ ] No. If no, describe: 3.1.2 Sliding fee scale Provide the CCDF co-payments for eligible families in the table(s) below according to family size for one child in care. a. Is the sliding fee scale set statewide? [x] Yes. [ ] No. If no, describe how the sliding fee scale is set: b. Complete the table below. If the sliding fee scale is not set statewide, complete the table for the most populous locality: -- A B C D E F Family Size Lowest monthly income at initial eligibility where the family is first charged a co-pay (greater than $0). What is the monthly co-payment for a family of this size based on the income level in (A)? What percentage of income is the co- payment in (B)? Highest monthly income at initial eligibility where a family is charged a co-pay before a family is no longer eligible. What is the monthly co- payment for a family of this size based on the income level in (D)? What percentage of income is this co- payment in (E)? 1 1255.00 0.00 0.00 2008.00 0.00 0.00 2 1704.00 8.00 0.50 2726.00 178.00 6.50 3 2152.00 18.00 0.80 3443.00 188.00 5.50 4 2600.00 28.00 1.10 4160.00 198.00 4.80 5 3049.00 28.00 0.90 4878.00 198.00 4.10 c. What is the effective date of the sliding-fee scale(s)? 7/1/2024 d. Provide the link(s) to the sliding-fee scale(s): https://hhs.iowa.gov/programs/programs- and-services/child-care/CCA e. Does the Lead Agency allow providers to charge families additional amounts above the required co-payment in instances where the provider’s price exceeds the subsidy payment? [ ] No. [x] Yes. If yes: i. Provide the rationale for the Lead Agency’s policy to allow providers to charge families additional amounts above the required co-payment, including a demonstration of how the policy does not provide a barrier and promotes affordability and access for families: During the 2022 legislative session access to child care was a key topic. The Iowa legislature heard from a number of child care providers that they limited the number of children on child care assistance that their program would take because private pay clients were financially more viable for their child care business. In the 2022 legislative session a code change was passed to allow child care providers to charge child care assistance clients the difference between what the state CCA program pays and what they charge private-pay clients, with the intent that CCA clients may be able to access more options if they were allowed to pay the difference. The additional payments must be agreed upon in writing between the child care provider and the CCA client. ii. Provide data (including data on the size and frequency of such amounts) on the extent to which CCDF providers charge additional amounts to families: The Lead agency is in the process of developing a systematic procedure to collect this information on an ongoing basis. Current information regarding the extent of this practice comes from surveys questions that were part of the Narrow Cost Analysis and price information from a reimbursement project for foster parents. The Narrow Cost Analysis used a representative sample of Iowa’s provider population. Based on that survey 35% of centers and 43% of child development homes charge families additional amounts. The Lead Agency also has a pilot program in which foster parents are reimbursed for the additional amounts that child care providers are allowed to charge to families. Based on information from the 43 participating families (verified by the child care provider) additional amounts range from $14 per month to $330 per month with an average of $234 per month.