Healthcare in the Child Welfare System

In society, there are a few aspects of life that most agree are fundamental to individual well-being, one of those being health. It is connected to all other foundations of society, whether that be education, family life, or place of residence. However, we tend to think that the health of young people is inconsequential since pediatric diseases and other chronic conditions are not as common. By assuming that children are healthy, many children that need appropriate care to establish a solid foundation of health are ignored. One group that has faced the brunt of this inequality is children in the foster care system.


A vast majority of youth in foster care are eligible for Medicaid through Title IV-E eligibility. Title IV-E is a part of the Social Security Act and provides funds for foster care [1]. Medicaid provides many benefits for these children. Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) covers care such as screening services, behavioral health services, psychotropic medications, and reproductive health services [1]. Such services are essential; a 2015 American Academy of Pediatrics article states that a third of foster care children come into the system with a chronic condition [2]. Despite how expansive the Medicaid coverage may seem, there are challenges. As noted in 2015 by the Medicaid and CHIP Payment and Access Commission, when children switch between homes, health conditions can go untreated, and duplicated services may arise if providers lack access to medical histories [3]. Behavioral health services are especially important; a 2016 study by Pediatrics highlights that children in foster care are 6 times more susceptible to behavioral problems [4]. However, the 2015 Medicaid and CHIP Payment and Access Commission report points out the vulnerability of foster care youth to unnecessary psychotropic prescriptions [3]. Although the Child and Family Services Improvement and Innovation Act of 2011 mandates that states keep track of psychotropic prescriptions for foster care children [1], more accountability is necessary so that appropriate health care is provided and needs are satisfied.


Those who age out of foster care are also impacted by policies. They represent an important subgroup, former foster care youth, that are often neglected. If we cannot ensure that a child under the care of foster agencies receives proper and substantial assistance, then when that child leaves and ages out of the system, the foundation of health care is weak. Of course, prioritizing the health care of children in the system is important, but ensuring that those same children have adequate resources once they age out is equally necessary. For most former foster care youth, access to Medicaid continues until age 26, as long as they were in foster care up until 18 years of age (or the maximum age you can receive federal foster care) and were enrolled in Medicaid while in the foster care system [5]. This sounds great in practice, but as discussed in a 2018 Kaiser News article, many are concerned that former foster care youth may not be aware of this health coverage extension, leaving health conditions untreated [6].


Untreated health conditions, whether physical or mental, are dangerous to a child’s health, and can also affect other aspects of their life, such as education, possible employment, and overall well-being.


Clearly, there are two groups whose health care concerns need to be addressed: those that are in the foster care system and those that have aged out. Medicaid should increase reimbursements to providers of mental health services so that children have a more expansive and accessible network of providers that are willing to treat mental health conditions. Medical schools should increase mental health training in their curriculum so that providers are more equipped with the knowledge to appropriately guide these youth towards better health. This could also help diminish the inappropriate prescriptions of psychotropic medications. It is also important that data and medical histories are more accessible to providers so that health care needs are met. For those that age out of the system, there should be more educational campaigns centered around increasing awareness for former foster care youth that health care access still exists. Foster care agencies and local health care organizations should be involved in such campaigns for maximum effectiveness.


Fundamentally, the foster care system is so much more than helping children who do not have a safe nor stable home. These children have a lot of trauma and health conditions that need to be treated seriously. The goal of the system is to provide care. Better health care in and out of the system will create a stronger foundation for these youths, which is a necessary step in improving well-being. Health care policies must keep this intention in mind.


References:

1) Child Welfare Information Gateway. (2015, May). Health-Care Coverage for Youth in Foster Care—and After. https://www.childwelfare.gov/pubs/issue-briefs/health-care-foster/

2) Szilagyi, M. A., Rosen, D. S., Rubin, D., & Zlotnik, S. (2015). Health care issues for children and adolescents in foster care and kinship care. Pediatrics, 136(4), e1142-e1166.

3) Medicaid and CHIP Payment and Access Commission. (2015, June). Chapter Three: The Intersection of Medicaid and Child Welfare. https://www.macpac.gov/wp-content/uploads/2015/06/Intersectionof-Medicaid-and-Child-Welfare.pdf

4) Turney, K., & Wildeman, C. (2016). Mental and physical health of children in foster care. Pediatrics, 138(5).

5) Congressional Research Service. (2018, October 26). Medicaid Coverage for Former Foster Youth Up to Age 26. https://fas.org/sgp/crs/misc/IF11010.pdf

6) Galewitz, Phil. (2018, August 24). Medicaid Covers Foster Kids, But Daunting Health Needs Still Slip Through The Cracks. Kaiser Health News. https://khn.org/news/medicaid-covers-foster-kids-butdaunting-health-needs-still-slip-through-the-cracks/ R

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