Foster Children Do Not Receive Adequate Health Care

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CMS and state childwelfare officials are failing to provide adequate access to physicaland mental health services to children in foster care, witnesses onThursday said at a House Ways and Means Subcommittee on Income Security and Family Support hearing, CQ HealthBeatreports. Panel Chair Jim McDermott (D-Wash.) said studies show thatbetween 30% and 80% of foster children have chronic health conditions,including mental illnesses in many cases.

According to McDermott, The National Survey of Child and Adolescent Well-Beingfound that three of four child welfare beneficiaries with significantmental illnesses were not receiving care within 12 months after aninvestigation into child abuse and neglect. Foster children in mostcases are eligible for Medicaid, but "many still do not receiveadequate health services, especially for mental health conditions,"McDermott said.

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Erin Sutton -- director of child safety at the Minnesota Department of Human Services, who testified on behalf of the American Public Human Services Association-- said Medicaid payments for "targeted case management" help ensurefoster children receive needed care. A 2005 study found that childrenwith case managers were more likely to receive care for physicalillnesses, as well as dental and clinic-based care, Sutton said.Thirty-eight states offer at least some targeted case managementservices, and in at least 40% of those states, foster children enrolledin Medicaid receive such services, Sutton added.

However,under the Bush administration's fiscal year 2008 budget proposal,federal matching rate for targeted case management would drop from upto 77% to no more than 50%. The provision, signed by President Bushlast year, also requires CMS to define "direct care services," forwhich targeted case management funding could not be used -- a"seemingly minor" change that could have a significant impact if thedefinition is too broad, Sutton said. CMS is auditing targeted casemanagement programs in several states. The agency also is auditingMedicaid-funded "Rehabilitation Services" benefits, which are reducingthe cost of foster children's mental health care received outside ofhospitals.

Seattle pediatrician Abraham Bergman, who calledthe foster care system "state-sponsored child abuse," recommended thatthe House adopt a bill that would require states to coordinate healthcare for foster children. According to Bergman, the services involved"are all covered by Medicaid," so improvements in access to care couldby achieved "without new money" (Reichard, CQ HealthBeat, 7/20).

Reprinted with permission from kaisernetwork.org. Youcan view the entire Kaiser DailyHealth Policy Report, search the archives, and sign up for email deliveryat kaisernetwork.org/email. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, afree service of The Henry J. Kaiser Family Foundation.

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