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Statement of Shay Bilchik, President/CEO, Child Welfare League of America At Congressional Briefing Highlighting the Health Care Needs of Children in the Child Welfare System

September 7, 2006

Washington, DC - Good afternoon. I am Shay Bilchik, President and CEO of the Child Welfare League of America (CWLA). CWLA welcomes all of you to this forum and thanks you for taking the time today to learn about the extensive health care needs in the child welfare population and what we can do to better meet these crucial needs.

Earlier this week, The Washington Post reported that for the first time in almost a decade, the number of children younger than 18 without health insurance increased last year, by 361,000. In 2005, 8.3 million - or 11.2 percent - of the nation's nearly 74 million children lacked coverage, up from 10.8 percent the year before. These are troubling times in our nation, as it appears that not only have we stopped making progress in ensuring that the basic needs of our most valuable citizens - our children - are met, but we are actually going backwards.

These newest statistics apply to the general population of children and are extremely worrisome, as the future of our nation, both morally and economically, is contingent on the healthy development of our next generation. Children and youths served by the child welfare system are, for the most part, drawn from the ranks of children from low-income families, who suffer the greatest from the lack of affordable access to high-quality health care. It is an unfortunate reality that many children and adolescents living in poverty are currently being debilitated by health conditions and problems that a responsive health care system could address and rectify.

Children in the child welfare system are almost universally reliant on Medicaid as a source of health coverage. The importance of adequate access to health care for these children cannot be overstated, as health concerns are inevitably linked with child abuse and neglect. Children in out-of-home care have unique health care needs, as their experiences prior to entering out-of-home care and their experiences while in care place them at a higher risk of poor physical, mental health and developmental outcomes. Access to quality health care is an important factor in the ability of the child welfare system to meet the needs of the abused and neglected children and youths it serves, whether the children are in their own homes, living with relatives, or in out-of-home care, such as family foster, group or residential care.

As you will hear today, there is a growing knowledge base about the pervasive health problems among children in foster care. Studies have documented that children and youth in out-of-home care experience higher rates of physical and emotional problems, and that significant percentages of children in care suffer from chronic medical conditions.

Though a very small portion of the total Medicaid population, children in foster care are estimated to have 8-11 times the levels of services use of other Medicaid-enrolled children. There is a great need for improved delivery of health services - including physical, dental, mental health and developmental services - for children in the child welfare system.

Over the years we have partnered with other organizations, including the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry, to improve and expand the provision of health care to these children who need it most. CWLA is currently preparing to publish an updated revised edition of its Standards of Excellence for Health Care Services for Children in Out-of-Home Care, which will provide out-of-home care providers with guidance on best practices in the provision of health care services to all children in the child welfare system.

Yet, we are concerned about the direction our federal leaders are taking on this issue, particularly in the area of Medicaid policy, where ongoing efforts continue to try to chip away at the allowable uses of crucial Medicaid services such as Targeted Case Management and Rehabilitative Services. Given the already enormous challenges in meeting the health care needs of the child welfare population, we need to be increasing resources to help meet this challenge, not undermining current efforts necessary to doing so. It is essential that federal efforts to reform Medicaid take the needs of foster children into account. Although they represent a very small group compared to other categorically eligible Medicaid recipients, their extensive physical and mental health needs make them disproportionately high users of Medicaid and therefore highly sensitive to changes in federal Medicaid policy, especially efforts to restrict the use of currently allowable services.

Again, welcome; this is a critically important issue to learn about and the stakes are high, as the future of these vulnerable children depends in large part on their access to adequate health care. Child welfare agencies assume responsibility for children's health and well-being when they enter out-of-home care - we cannot afford to neglect this responsibility.

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