{ "id": "R42378", "type": "CRS Report", "typeId": "REPORTS", "number": "R42378", "active": true, "source": "EveryCRSReport.com, University of North Texas Libraries Government Documents Department", "versions": [ { "source": "EveryCRSReport.com", "id": 436348, "date": "2014-12-16", "retrieved": "2016-04-06T19:48:52.103970", "title": "Child Welfare: Health Care Needs of Children in Foster Care and Related Federal Issues", "summary": "Approximately 641,000 children spend some time in foster care each year. Most enter care because they have experienced neglect or abuse by their parents. Between 35% and 60% of children entering foster care have at least one chronic or acute physical health condition that needs treatment. As many as one-half to three-fourths show behavioral or social competency problems that may warrant mental health services. A national survey of children adopted from foster care found that 54% had special health care needs. Research on youth who aged out of foster care shows these young adults are more likely than their peers to report having a health condition that limits their daily activities and to participate in psychological and substance abuse counseling. \nThe Social Security Act addresses some of the health care needs of children in, or formerly in, foster care through provisions in the titles pertaining to child welfare (Titles IV-B and IV-E) and to the Medicaid program (Title XIX). Under child welfare law, state child welfare agencies are required to have a written plan for each child in foster care that includes, among other items, the child\u2019s regularly reviewed and updated health-related records. In addition, state child welfare agencies, in cooperation with state Medicaid agencies, must develop a strategy that addresses the health care needs of each child in foster care. Upon aging out of foster care, youth must receive from the state child welfare agency a copy of their health record and information about health insurance options and designating other individuals to make health care decisions on their behalf if they are unable to do so on their own. \nStates are not permitted to use federal child welfare program funds to pay medical expenses of children in care or those who left foster care due to their age or placement in a new permanent family. However, states can (and do) receive federal support through Medicaid to pay a part of the medical expenses, including well-child visits, dental care, and other services for many of these children and youth. In FY2010, the most recent year for which these data were available from all states, Medicaid agencies reported spending $5.754 billion to provide services to foster care children. Most of this Medicaid services spending was provided on a fee-for-services basis (82%) with the remainder provided through managed care arrangements. \nMost children in foster care are eligible for Medicaid under mandatory eligibility pathways, meaning that states must provide coverage because these children receive assistance under the Title IV-E program, or, because they meet other eligibility criteria such as low income, or receipt of Supplemental Security Income (SSI). Children in foster care who are not eligible under mandatory pathways generally qualify for Medicaid because the state has implemented one or more optional eligibility categories allowing coverage. Further, children who leave foster care for legal guardianship and nearly all children with state-defined \u201cspecial needs\u201d who leave foster care for adoption retain mandatory eligibility for Medicaid provided they receive Title IV-E assistance. Additionally, special needs adoptees who receive state-funded support may also be eligible under an optional Medicaid eligibility pathway specifically for them. \nSeparately, as of January 1, 2014, states are required to continue Medicaid coverage to youth who age out of foster care on their 18th (or later) birthday. This Medicaid coverage was added to the law by the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended), must be available until the youth reaches age 26, and unlike most Medicaid pathways must be provided without regard to the youth\u2019s income and assets. This new pathway for youth who age out of care without return to their parents or placement with a new permanent family parallels another ACA requirement that directs health insurance companies to continue coverage of children up to age 26 who are enrolled in their parents\u2019 private health care plans. Additionally, under a separate eligibility pathway states continue to have the option of providing Medicaid to youth aging out of foster care (up to the age of 21). Under this optional pathway, and unlike the newer mandatory pathway, a youth does not need to have received Medicaid while in foster care to be eligible for the coverage.\nEffective January 1, 2014, the ACA established the Modified Adjusted Gross Income (MAGI) income counting rule. MAGI draws on federal income tax rules (with certain revisions defined in Medicaid law and regulation) to establish uniform standards for what income to include or disregard in determining Medicaid eligibility for most non-elderly and non-disabled people. In transitioning to the new MAGI income counting rule, states were required to establish income eligibility thresholds no less than the effective income eligibility levels that were applicable in the state on the date of enactment of the ACA (i.e., March 23, 2010). In addition to this transition policy, several additional protections ensure that children in, or formerly in, foster care retain eligibility under the new counting rules. \nThe ACA made additional changes to assist adults in obtaining private health insurance, and young adults leaving foster care may benefit from these changes. The ACA may also include new opportunities for providing health insurance to child welfare-involved children and their families, such as those children in foster care who are vulnerable to losing Medicaid upon returning home.", "type": "CRS Report", "typeId": "REPORTS", "active": true, "formats": [ { "format": "HTML", "encoding": "utf-8", "url": "http://www.crs.gov/Reports/R42378", "sha1": "03506850db89d9d6837b449c4459234aba58d598", "filename": "files/20141216_R42378_03506850db89d9d6837b449c4459234aba58d598.html", "images": null }, { "format": "PDF", "encoding": null, "url": "http://www.crs.gov/Reports/pdf/R42378", "sha1": "c1a5d26fd74a608e077f1eeedbe144807f886fe2", "filename": "files/20141216_R42378_c1a5d26fd74a608e077f1eeedbe144807f886fe2.pdf", "images": null } ], "topics": [ { "source": "IBCList", "id": 2651, "name": "Child Well-Being" }, { "source": "IBCList", "id": 594, "name": "Medicaid and CHIP" } ] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc819941/", "id": "R42378_2014Nov19", "date": "2014-11-19", "retrieved": "2016-03-19T13:57:26", "title": "Child Welfare: Health Care Needs of Children in Foster Care and Related Federal Issues", "summary": null, "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20141119_R42378_edc47790be03943fde612d308016053f5f670f51.pdf" }, { "format": "HTML", "filename": "files/20141119_R42378_edc47790be03943fde612d308016053f5f670f51.html" } ], "topics": [] }, { "source": "University of North Texas Libraries Government Documents Department", "sourceLink": "https://digital.library.unt.edu/ark:/67531/metadc491290/", "id": "R42378_2012Jul24", "date": "2014-07-24", "retrieved": "2015-01-27T19:40:46", "title": "Child Welfare: Health Care Needs of Children in Foster Care and Related Federal Issues", "summary": "The report begins with a discussion of major findings. It then briefly describes the foster care population and their unique health-related issues. Next is an overview of the federal programs and policies in three areas--child welfare, Medicaid, and private health insurance--that directly or indirectly address some of the health care needs of such children and young adults. The report concludes with a discussion of issues pertaining to these federal policies.", "type": "CRS Report", "typeId": "REPORT", "active": false, "formats": [ { "format": "PDF", "filename": "files/20140724_R42378_8db614d6acb27c6d28615a94a90c15f7c247c448.pdf" }, { "format": "HTML", "filename": "files/20140724_R42378_8db614d6acb27c6d28615a94a90c15f7c247c448.html" } ], "topics": [ { "source": "LIV", "id": "Child welfare", "name": "Child welfare" }, { "source": "LIV", "id": "Foster home care", "name": "Foster home care" }, { "source": "LIV", "id": "Child health services", "name": "Child health services" } ] } ], "topics": [ "Domestic Social Policy", "Health Policy" ] }