Medina County officials warn surging treatment rates are straining child-care budget

Debbie Kylie, director of Medina County Job and Family Services, told the Medina County Board of Commissioners on May 27 that sharply rising daily rates at residential treatment facilities are driving significant new costs for the county’s child-protection system.

Kylie said facility rates paid by county agencies have increased in some cases “nearly 30%” compared with last year and that counties have little choice but to pay those rates when courts, law enforcement or other authorities place children in treatment settings. “We can't do anything other than pay those rates, so we're forced to pay those rates,” Kylie said.

The issue matters because the county is paying for both room-and-board and specialized services for children placed in treatment settings, and staff must travel monthly to visit children who are housed out of county. Kylie described travel to facilities in Toledo and Cincinnati and said Medina County has only two agency vans, which forces staff to use personal vehicles for some visits.

Kylie provided multiple figures during her remarks. She said that in 2024 “Medina had 20 children in care and 15 of them were in treatment facilities.” She also said the agency currently manages a larger caseload, telling commissioners that the division has “a hundred and 8 children in care” and that she has left vacancies unfilled to absorb costs. Kylie said the average daily cost she cited for children “in care” is about $500 per day, and she used that figure to illustrate the scale of current spending.

Kylie described limits on federal reimbursement: medication and clinical services may be covered by Medicaid, and some federal/state match dollars exist, but she said eligibility rules (referred to in the meeting as “4 e”) use income standards that are now “ridiculously low,” reducing the pool of children who qualify for that portion of federal reimbursement.

Kylie said she joined a rate-setting committee convened by the Public Children Services Association and that the state’s Department of Children and Youth has proposed a “rate card” process under which the state would collect facility charge data through an RFP or RFQ to increase transparency. Kylie said the approach aims to reduce opaque, county-by-county negotiations where larger counties may pay higher rates.

Commissioners asked about the age profile of children in treatment; Kylie said the average age in treatment facilities is about 13 to 13½ and that some children could remain in care until age 18. She said a subset of children are in permanent custody and therefore not subject to reunification efforts.

Kylie described policy and service changes underway at the state level, including the Family First requirements and Qualified Residential Treatment Program (QRTP) standards she said prompted some providers to raise rates to meet new requirements. She also noted proposals for regional wellness campuses intended to provide higher-level therapeutic capacity so some children might move from residential treatment to therapeutic foster care.

Kylie asked commissioners to note the fiscal pressure and described steps the agency has taken to manage costs, including leaving certain positions vacant and participating in intercounty rate-setting efforts. She said the county is awaiting federal budget allocations that could affect Title IV-E and other federal funding streams.

No formal board action on funding or policy was taken at the May 27 meeting; Kylie’s presentation was an informational update and the board did not vote on additional appropriations during her remarks. Kylie said she would continue to work with peer directors, the state, and coalition partners on rate transparency and workforce issues.

Commissioners thanked Kylie for the update and for participating in statewide discussions on rate setting.