The surprising connection between Medicaid, opioids and foster care

By: Jonathan Thackeray, MD, FAAP

As the U.S. Senate continues to debate the “‘Better Care Reconciliation Act of 2017”, lost in the conversation is the potentially devastating impact on the coverage and care for the over 30 million children covered by Medicaid and, in particular the threat posed to a unique group of children at particular risk – children in foster care.

There are currently over 400,000 children in foster care, almost all of whom have experienced various forms of trauma in their young lifetimes. These include physical abuse, sexual abuse, emotional maltreatment, neglect, and in rapidly growing numbers in our area – exposure to parental opioid and other drug use. Montgomery County, in fact, was recently branded as the “epicenter” of opioid use in the United States. As the opioid epidemic heightens, a clear and alarming trend has emerged - the number of children placed into foster care in Montgomery and neighboring counties is well ahead of previous years. The number of children in foster care, in fact, now exceeds the number of foster parents available to care for them.

Largely because of the trauma they have experienced, children in foster care often have many more significant medical and behavioral health needs than children not in foster care. According to the American Academy of Pediatrics, as many as 80 percent of children come into foster care with at least one medical problem and one in three have a chronic medical condition, often undiagnosed and untreated prior to entering care. Almost 40 percent have significant oral health issues. Up to 80 percent of children enter into care with a significant mental health need and approximately 60 percent of children younger than 5 years have developmental health issues.

So how would Medicaid cuts affect these children? It is simple – almost all children in foster care qualify for managed Medicaid in the state of Ohio. Medicaid dollars have been critical to improve access to home- and community-based behavioral health services, provide linkage to specialty medical services, and tackle unique issues these children face such as disparities in the over prescription of psychotropic drugs. These improvements in coverage, however, come at a high price. Children in foster care are disproportionately expensive compared to other children covered by Medicaid. The proposed federal legislation necessitates significant reductions in coverage at the state level. As a relatively expensive group, it is almost certain children in foster care will fall victim to these reductions in coverage. As Bruce Lesley, President of First Focus describes: “States might choose to cut Medicaid costs for foster kids in a number of ways. They could limit access to mental health services, reduce access to care by cutting provider payments, and eliminate intensive case management. Or worse, they could restrict optional eligibility coverage or even reduce the pathway to Medicaid coverage by reducing the ability of child welfare agencies to investigate reports of abuse.”

Children comprise half of all people with Medicaid, and it is essential they are not left out of the national conversation. The “Better Care Reconciliation Act” simply isn’t better. Not for any child by any measure, and certainly not for those most vulnerable of our children – those in foster care.

What you can do.

Please join with us and other advocates to spread the word about protecting Medicaid for children, especially those in foster care.  Include the hashtag #KeepKidsCovered in all social media posts/tweets on Facebook and Twitter. Send electronic letters to U.S. Senators via the Speak Now for Kids website, enter your information and personalize the letter to share why protecting Medicaid coverage, access to care and funding for children’s health is important to you.  Don't forget to include the  message about foster children! 

We need to be advocates for children. Children don’t vote, they don’t have a collective voice.  As adults who care about their health, safety and future we put kids before politics and understand their future is the legacy we will leave.