By Marsha Levick, Deputy Director/Chief Counsel and Jennifer Pokempner, Child Welfare Policy Director ― Juvenile Law Center
Tomorrow, the U.S. House of Representatives will vote on the American Health Care Act. Child welfare advocates across the country are deeply concerned about the threats this legislation poses to children in the foster care system. The cuts this legislation would have on Medicaid would have a significant negative impact on the child welfare system and pose a special threat to youth with disabilities.
Here are some of the ways the bill most directly impacts the child welfare system:
Per capita caps to Medicaid and providing the option to block grant to states will harm the hardest-to-serve youth and their families. Caps mean states will be forced to ration care. If the need exceeds the caps, the cost will fall on the state or locality – the majority of which will not have adequate funds. Choices will have to be made about whom is provided care and what care is provided. Because youth and families involved with the child welfare system often have high health care needs, these caps will put a strain on the ability of systems to serve youth and families. As a result, kids may enter foster care and costly institutions simply because parents cannot afford their care. Child welfare agencies which are required to provide for the needs of youth in their care will likely be overburdened and have to foot the bill for health care needs. This will strain the capacity of the child welfare system to address child protection needs and will limit their ability to keep families together.
The loss of coverage to poor families will mean an increase in the numbers of youth coming into the child welfare system and a decrease in those able to return home. Medicaid for adults and expansion of coverage to poor adults has greatly improved both the capacity of families to care for their kids and the capacity of child welfare agencies to serve families. Undoing this will drive more youth into foster care and will not create a savings in improved health outcomes.
This law removes the mandate to cover basic mental health services and treatment for addiction. These are among the most crucial services for parents involved in the child welfare system. The need for these services is only growing in states like Pennsylvania, where opioid abuse and the often catastrophic consequences that follow are on the rise. If these services cannot be provided, children will remain in foster care at great cost to the state as well as to children who remain without a family. They will not be able to return to their families as promptly as they would if this vital coverage is maintained. In some cases, the lack of mental health and addiction coverage may mean reunification with their families is impossible – and because more people will fall into addiction, the child welfare system will also be flooded with higher numbers of children.
There is simply too much at stake for youth in the child welfare system and their families that will be undermined by passage of this bill. We strongly urge those who care about these young people to bring these concerns to their lawmakers in advance of tomorrow’s vote.