The IV-E Waivers and Family First Prevention Services Act prioritize prevention services, including services that reduce out-of-home placements. Placement in out-of-home care is associated with a variety of adverse outcomes as well as high costs to society. Studies that focus on utilization of health services suggest that these costs are not evenly distributed among recipients, and that high utilizers make up a small percentage of individuals who utilize a disproportionate share of resources. The purpose of the paper is to examine child characteristics and child welfare services associated with high welfare costs, defined as the top decile of child welfare costs. Results indicate that older age of child, child sexual abuse and/or neglect, and inability of parent to provide care are associated with high child welfare costs. Parental substance abuse or domestic violence in the household are less common among children with high costs. High cost children are more likely to have serious behavioral problems perhaps reflecting the severity of these problems. Residential treatment and group home placements and services were also associated with having high costs.