Health Tech Nerds believes that informed discussion on health care technology, policy, and financing is an indispensable part of improving the healthcare system.
To that end, we publish guest posts with interesting perspectives from the broader health care community that inform or advance these discussions, even and especially when we don’t agree with the conclusions.
We’re pleased to share this piece from Michelle Turner, Founder & CEO, Here Now Health, a virtual behavioral health company for youth and families impacted by child welfare programs.
Medicaid coverage is guaranteed when a child enters the foster system. This makes sense. When a state decides it needs to take custody and become a child's de facto parent, the state needs to provide healthcare coverage. Enter Medicaid.
The average length a child remains in foster care is somewhere between 15 - 20+ months, with a child most likely to return home within the first year. During that time, the foster parents, kinship parents, or the responsible adult uses Medicaid to meet the child's needs: finding therapy, pediatricians, dentists, and often more extensive services. Medicaid is the payor that makes most of this possible. And while finding services that are actually covered by Medicaid is another article in itself (and the reason I built Here Now Health), the coverage is one of the few consistencies in the world of child welfare that can be relied upon.
So what happens when a child returns to their parents? When mom has worked her case plan and the state determines the child can safely go home?
It stops.
Or close enough. The Medicaid coverage tied to foster care ends, and eligibility is redetermined. Sometimes it lapses in the gap. Sometimes the family's income doesn't qualify at all. Or they have subpar commercial coverage. And even if the family is eligible for Medicaid, the child is often switched to a new plan with a new network. Which means restarting the arduous process of finding a new pediatrician, a new therapist, a new dentist and building those relationships from scratch.
We give a family a list of things they have to do to make a safe environment for their children to come home, often with seemingly insurmountable odds stacked against them in the form of poverty, language barriers, mental health issues, addiction. When that family checks enough boxes to have their children returned, the state takes away the very coverage that pays for the services that stabilized and supported the child for the last year or more.
In essence we are saying: go home and find a new pediatrician. A new therapist. A new dentist. And good luck paying for it. And if you mess up, your kids are coming back.
It sounds harsh because it very much is.
Family reunification success is in everyone's interest. The least traumatic, most supportive place for a child is their own family if and when it is safe for the child. It is also the cheapest. Medicaid coverage averages around $300 a month. A child in foster care costs thousands to tens of thousands, depending on their needs, covering housing, food, healthcare, education, and all the staff required to manage a case.
This is not an argument for Medicaid for all. It is an ethical and economic solution to increase the success of our most at risk families and a tool to prevent recidivism into foster care. We do not have enough foster homes. The best way to maximize the ones we have is to reduce the number of children who need them. And prevent those who can safely stay home from coming back.
I'm not naive. I know Medicaid coverage will not prevent all foster needs. As a former foster mom to over 40 children, I have seen the worst. I have cried myself to sleep hearing atrocities that happened to children sleeping in my own home. Things most people don't want to know are happening in their communities. I have watched my husband, a combat Marine veteran and Naval officer, fight back tears when a child walked out our door knowing they would likely be back the next time they were hurt, but being powerless to prevent it.
But I have also seen the other side. Families who did the work, who should have been together, pulled back into the system because the supports fell away the moment they needed them most. And when a child comes back into foster care a second time, the odds are against them. Repeated removals bring more behavioral and mental health struggles and a harder path to permanency. And permanency, a stable and lasting home, is the foundation for everything.
This is easier than you might think. We guarantee coverage for youth who age out of foster care at 18. We provide Medicaid coverage to youth adopted out of foster care until 21. And we have continuous coverage examples outside child welfare, like Medicaid that continues for a mother after childbirth. We can use these as a model for a federal standard: guaranteed coverage for a minimum of 6 months, ideally 12, when a child returns home from foster care.
Where a state has a foster care specialty plan, the child should stay on it. Where it doesn't, they keep whatever plan they had. Either way: same providers, same network, no starting over. Coverage that doesn't end the day a child goes home. That helps keep families together after disruption. In a word, permanency.
