Unnecessarily Drugging Foster Care Youth

A concern that comes up again and again with foster care youth and young adults is the issue of overmedication in foster care.

 

A new study, Antipsychotic Treatment Among Youth in Foster Care , examined concomitant antipsychotic use among Medicaid-enrolled youth in foster care, compared with disabled or low-income Medicaid-enrolled youth.

They found that:

• More than a third of youth in foster care without disabilities had multiple anit-psychotic prescriptions lasting longer than 90 days
• Children who were not adopted had the highest rates of prescriptions, representing 38 out of every 100 children in foster care.

In comparison, 26 out of every 100 children who were on public assistance but not in foster care had more than one antipsychotic prescription.

In recent years, doctors and policy makers have grown concerned about high rates of overall psychiatric drug use in the foster care system. Previous studies have found that children in foster care receive psychiatric medications at about twice the rate among children outside the system. 

In 2008, the House Ways and Means Subcommittee on Income Security and Family Support held a hearing on the u tilization of psychotropic medication for children in foster car e.

In 2010, Senator Daniel Akaka (D-HI) asked the Government Accountability Office (GAO) to investigate the prevalence of prescribed psychotropic medications for children in foster care.    

Barriers to Access for Children on Medicaid

According to the New England Journal of Medicine:

"Expansions of Medicaid and the Children’s Health Insurance Program (CHIP) are designed to extend access to high-quality medical care to all U.S. children. However, evidence suggests that the 37 million children covered by Medicaid–CHIP are less likely to receive specialty care than children covered by commercial insurance."

Access Disparities for Medicaid Children
Researchers have found that medical specialists are more likely to deny appointments to children with Medicaid. Assistants posed as mothers and made phone calls to 273 clinics in Cook County, IL. Only 11% of privately insured individuals were denied appointments, while 66% of the children on Medicaid were denied. 

Disparities were also present in waiting times. At the 89 clinics that accepted both insurances, there was a 42 day wait for a child on Medicaid as opposed to a 20 day wait for those with private insurance. 

Possible reasons for the differences include lower reimbursement rates for Medicaid and more problems with the payment process.

Researchers say that the results are not likely to be unique to Cook County. The study was published in the New England Journal of Medicine.

Health Care Needs of Youth "Aging Out" of Foster Care

Did you know that:

• Each year 26,000 youth emancipate from foster care on their 18th birthday and often lose critical Medicaid health coverage?

• Former foster youth experience Post-Traumatic Stress Disorder at six times the rate of their peers in the general population, and twice the rate of veterans returning from war?

• Only 57% of former foster youth have health coverage at ages 23 and 24 --- as compared to 78% percent of their same-age peers without a foster care history?

Beginning January 2014, Medicaid eligibility will be extended to cover children formerly in foster care who are under the age of 26.

2010 Ohio Medicaid Atlas

The 2010 Ohio Medicaid Atlas contains amazing maps and detailed demographics regarding various populations - but emancipated foster youth are not among them.

Despite the fact that current and former foster successfully advocated to extend Medicaid coverage for foster care youth until age 21, there remain barriers to access regarding these benefits that still need to be overcome.

When Ohio foster care youth between the ages of 18-21 go to their local Medicaid office to apply for benefits, they have run into the following challenges:

• The staff person they speak to is unaware that emancipated foster care youth are eligible for Ohio Medicaid until age 21
• The young person is told that their card is "in the mail," and six months or more go by without the young person ever receiving it
• The young person does initially receive Medicaid, but services are dropped before the young person reaches age 21

As I mentioned in a previous blog post:

"The Fostering Connections Act of 2008 requires States to create and maintain a health oversight and coordination plan for each young person in foster care, in order to ensure that each child receives regular and comprehensive care, access to services beyond his or her 18th birthday, and a medical passport."

My hope is that Ohio foster care youth, alumni and allies can continue to work together towards this goal.

Healthcare for Transitional Foster Care Youth

Every year, 26,000 youth emancipate from foster care on their 18th birthday - many of whom immediately lose vital medical coverage as a result.

At this point, only 32 states extend Medicaid coverage to foster care youth beyond age 18.

Even when states do extend Medicaid coverage for foster care youth until age 21, actually being able to access that coverage has been a major challenge for many transitional foster care youth. In Ohio, for example, many transitional foster care youth have waited months to receive their card, only to then have their Medicaid services dropped prematurely.

The National Association of Public Child Welfare Administrators has authored an issue brief, Addressing the Health Care Needs of Transitioning Youth, that describes how some States are working to provide health care to youth who are transitioning out of foster care and into independence.

The Fostering Connections Act of 2008 requires States to create and maintain a health oversight and coordination plan for each young person in foster care, in order to ensure that each child receives regular and comprehensive care, access to services beyond his or her 18th birthday, and a medical passport.



InsureKidsNow.gov, a website that offers State-specific information on health insurance coverage for children through Medicaid and the Children’s Health Insurance Program, now offers an online toolkit for professionals.

The National Children's Healthcare Toolkit, designed by the U.S. Department of Health and Human Services' Centers for Medicare & Medicaid Services contains a variety of information, materials, tools, and tactics to assist in education and outreach efforts.

Delayed Health Care for Foster Children

Drugging foster children unnecessarily is not good.

Denying foster children medical services due to citizenship concerns is equally disastrous.

Deficit Reduction Act of 2005 Revisited
Due to recent concerns about illegal immigration, the federal government is now implementing a provision of the DRA which requires that all U.S. citizens who apply for, or renew, their eligibility for Medicaid coverage must document their citizenship.

This ruling was effective on July 1, 2006. It is intended to prevent illegal immigrants from receiving benefits through Medicaid, the government program of health care for the poor.

What About Foster Children Receiving Medicaid?
Therein lies the rub. All children who eligible for Title IV-E funds can be enrolled in Medicaid. Up until now, the very fact that they receive federal foster care payments has been accepted as proof of citizenship.

Likewise, low-income children and children with disabilities within the foster care have had access to Medicaid as well.

Well... not anymore.

New regulations are requiring the documentation of citizenship for every child entering foster care. Without the proper documentation, foster children will remain uninsured.

Approximately 300,000 children enter foster care each year. How many of them will be carrying their birth certificates with them? Many of these children are coming from abusive and neglectful homes, and their families might not have (or be willing to relinquish) vital information.

Due to the circumstances surrounding the emergency removal of children from their homes, state agencies frequently use electronic birth records to establish case files. Now, only the original document, or a copy certified by the issuing agency will be considered acceptable.

Will foster parents be given enough information to apply for birth certificates on children's behalf?

What about the waiting period? Obtaining a birth certificate can take weeks or months.

Denying Foster Children Access to Health Care
Upon entry into foster care, a child might be developmentally delayed or underweight. They may never have visited a dentist or lack up-to-date immunizations.

It is for all these reasons that the American Academy of Pediatrics Committee on Early Childhood recommends a comprehensive medical screening upon entry into foster care.

Children who enter foster care are at high medical risk. How long should they wait to receive treatment?

I agree wholeheartedly with this quote from Robert Greenstein, Executive Director of the Center on Budget and Policy Priorities:

"These children are among the most vulnerable members of our society. To deny them health care coverage for beaurocratic reasons that readily could be resolved, and refuse them coverage while their documents are being located is not defensible."

Kudos to Montana for coming up with a creative solution
Montana's Motor Vehicle Division will issue state identification cards to nearly 2000 foster children.

Casey Family Programs contacts the Department of Health and Human Services
The following agencies joined Casey Family Programs in voicing (and documenting) their collective concern over this issue:

Association of Jewish Family & Children's Agencies
Arkansas Center for Health Improvement
Bazelon Center for Mental Health Law
California Mental Health Directors Association
California State Association of Counties
Child Welfare League of America
County Commissioners Association of Pennsylvania
County Welfare Directors Assocaition of California
Familes USA
Foster Care Alumni of America
Illinois Department of Children and Famiyl Services
Jim Casey Youth Opportunties Initiative
National Advocacy Center of the Sisters of the Good Shepherd
National Association of County Human Services Administrators
National Association of Social Workers
National Education Association
NETWORK, a National Catholic Social Justice Lobby
Pennsylvania Children and Youth Administrator's Association
Public Children Services Association of Ohio
Safe Place: Center for Child Protection and Health
Alliance for Children and Families
Arc of the United States
Children's Health Fund
Vermont Department for Children and Families
Voices for America's Children
United Cerebral Palsy
Wisconsin Counties Association

Sources
Kids in foster care receive state cards. Montana News Station, Great Falls, MT: July 2006.

National organizations warn HHS that citizenship-verification rules could lead to denial of critical medical services to foster children. Casey Family Programs press release: June 30, 2006.

Redmond, Pat. Children in foster care may have to delay health care because of federal regulations on citizenship requirement. Center on Budget and Policy Priorities: July 7, 2006.

Spillane, Shannon. Changes in Medicaid rules 'commendable,' but further changes needed to precent loss of health coverage by poor children and parents. U. S. Newswire: July 7, 2006.