Children in Foster Care Are Children with Special Health Care Needs
Printable version (PDF)Foster care is intended to provide a safe haven for children who suffer neglect or abuse.1 At any given point in time roughly 400,000 children are in foster care in the U.S.2 Many of these children enter the child welfare system with serious health conditions and can bring with them the effects of the abuse or neglect that caused them to be removed from their homes.3 A disproportionate number of children in foster care come from families living in poverty.4 After entering foster care many children are moved from home to home or from foster care to the juvenile justice system.5
Children in foster care may live in uncertainty, with traumatic experiences and multiple unmet medical needs in their past, coupled with the stress of being removed from familiar caregivers.6 They may suffer from a wide range of acute and chronic physical and mental health conditions.7 All of these factors put children in foster care at risk for developmental delays, mental health problems, increased behavioral problems, and a lower level of success in school and in life.8 Data from the National Child Abuse and Neglect Data System (NCANDS) indicate that 27.5% of children in foster care have a diagnosed disability,9 and more than 80% of children in foster care have serious health care needs, including behavioral, emotional and developmental concerns.10 According to a report by the American Academy of Pediatrics (AAP), “children and adolescents in foster care have a higher prevalence of physical, developmental, dental, and behavioral health conditions than any other group of children.”11 Due to the increased risk for and prevalence of health issues, virtually all children in foster care, even the healthiest, meet the Maternal and Child Health Bureau (MCHB) definition of a child with special health care needs: those who have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally.12
Beyond Medicaid
Under Title IV-E of the federal Social Security Act, children in foster care are eligible for Medicaid benefits from the moment they are placed in care.13 Yet according to a survey of administrators in state Medicaid programs, child welfare agencies and mental health agencies representing 50 states and Washington D.C., conducted by the University of California, Los Angeles (UCLA) Center for Healthier Children, Families and Communities, only 15% of state Medicaid agencies cover children in foster care right away, and non-Medicaid sources are sometimes used to pay for basic health services.14 Additionally, Medicaid coverage may be terminated when children are reunited with their biological families, potentially leading to further disruptions in care.15 A number of state Medicaid, child welfare and mental health agencies participating in the survey reported that Medicaid reimbursement was inadequate for services essential to children in foster care.16 Mental health services is one area of critical need, with 91% of child welfare agencies stating that insufficient Medicaid coverage causes them to use their own child welfare funds for mental health services.17
As with all children with special health care needs, simple coverage is not enough to ensure access to comprehensive, effective health care services. With the passage of the Adoption and Safe Families Act in 1997, states are required to develop and implement standards of care to make sure children in foster care receive the care they need.18 Despite this legislation, children in foster care continue to experience disruptions in care and significant unmet needs.19 In a review of state child welfare agencies, the Administration for Children and Families (ACF) found that 30% of children sampled never received a health care assessment or treatment.20 As with other populations who rely on Medicaid coverage, children in foster care are confronted with an inadequate number of doctors or dentists willing to accept Medicaid or may experience long wait times for services from those providers who do.21, 22 Besides these barriers, children in foster care face additional challenges: information about health care services received and health care status prior to placement may be difficult to obtain, children may be placed with families that are geographically distant from their previous health care providers, or child welfare workers may lack information about the type of health care services children in foster care should receive and thus cannot assess the amount or quality of care delivered.23 Finally, because the physical and health care conditions of children in foster care are often complex, foster care parents may not have sufficient training in addressing health care issues or in accessing the health care system on behalf of their foster children. Adequately addressing the health care needs of children in foster care may be difficult even for the most committed health care provider.24, 25
Clearly the availability of Medicaid coverage alone is not enough to ensure that children in foster care receive the services they need. The “foster care system” is in reality a combination of many interacting agencies and individuals that work together to provide services, financial support and other assistance to children in foster care and their families.26 Improving the system of care for these uniquely vulnerable children depends in part on close collaboration between the health care and child welfare systems that serve children in foster care.27 The benefits of doing so—improved health, well-being, and a better quality of life—will endure long after the child ages out of the foster care system.
Learn more:
Financing the Special Health Care Needs of Children in Foster Care: A Primer
Footnotes
1Bass, S., Shields, M.K., & Behrman, R.D. Children, families, and foster care: Analysis and recommendations. (2004). In R.E. Behrman (Series Ed), The Future of Children. Retrieved October 26, 2011 from http://futureofchildren.org/futureofchildren/publications/docs/14_01_01.pdf
2 U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2011). The AFCARS report: Preliminary FY2010 estimates as of June 2011. Retrieved May. 10, 2013 from http://www.acf.hhs.gov/sites/default/files/cb/afcarsreport18.pdf
3 American Academy of Pediatrics. (2005). Fostering health: Health care for children and adolescents in foster care (2nd ed). Retrieved Oct. 26, 2011 from http://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/healthy-foster-care-america/Pages/Fostering-Health.aspx
4Boyer, B.A., & Halbrook, A. E. (2011). Advocating for children in care in a climate of economic recession: The relationship between poverty and child maltreatment. Northwestern Journal of Law and Social Policy, Volume 6. Retrieved Oct. 26, 2011 from http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1859423
5Children’s Defense Fund. (2010). State of America’s children 2010 report. Retrieved Oct. 26, 2011 from http://www.childrensdefense.org/child-research-data-publications/data/state-of-americas-children-2010-vulnerable-children.pdf
6See note 3, American Academy of Pediatrics.
7See note 3, American Academy of Pediatrics.
8Child Welfare League of America. (2007) Standards of excellence for health care services for children in out-of-home care. Retrieved Oct. 26, 2011 from http://www.cwla.org/programs/standards/cwsstandardshealthcare.htm
9U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2010). National child abuse and neglect data system (NCANDS) child file, FFY 2009 [Dataset]. Retrieved July 28, 2011 from the National Data Archive on Child Abuse and Neglect Web site, http://www.ndacan.cornell.edu
10Ringeisen, C., Urato, M., & Cross. T. (2008). Special health care needs among children in the child welfare system. Pediatrics 2008;122;e232.
11American Academy of Pediatrics, pg. ix.
12McPherson M, Arango P, Fox H, Lauver C, McManus M, Newacheck P, Perrin J, Shonkoff J, Strickland B. (1998). A new definition of children with special health care needs. Pediatrics, 102(1):137–140, pg. 138.
13Halfon N., Inkelas M., Flint R., Shoaf K., Zepeda A., & Franke, T. (2002). Assessment of factors influencing the adequacy of health care services to children in foster care.
14See note 13, Halfton, et. al.
15See note 13, Halfton, et. al.
16See note 13, Halfton, et. al.
17See note 13, Halfton, et. al.
18Public Law 105-89. (1997) Adoption and Safe Families Act of 1997. Retrieved May 10, 2013 from http://www.gpo.gov/fdsys/pkg/BILLS-105hr867enr/pdf/BILLS-105hr867enr.pdf
19U.S. General Accounting Office. (2009). Foster care: State practices for assessing health needs, facilitating service delivery and monitoring children’s care. Retrieved July 7, 2011 from http://www.gao.gov/new.items/d0926.pdf
20American Academy of Pediatrics (2002) Health care of young children in foster care. Pediatrics, 109 (3), 536 – 541.
21See note 8, Child Welfare League of America.
22See note 19, U.S. General Accounting Office.
23See note 8, Child Welfare League of America.
24See note 19, U.S. General Accounting Office.
25See note 20, American Academy of Pediatrics.
26See note 1, Bass, et. al.
27See note 8, Child Welfare League of America.
