When CWLA joined hundreds of organizations in defense of the Affordable Care Act in 2017 and 2018, we explained to Congress, and our members, why the ACA is vital to any efforts to reduce the number of children coming into foster care and in preventing instances of child neglect.
In a June 2017 letter to senators, we said, “As a country, we have taken significant strides in reducing the nation’s foster care numbers in this century. Foster care caseloads stood at 568,000 in 1999. During these past two decades, in part because of congressional support, the number of children and youth in foster care decreased to 397,000 by 2012. As you know from your own states, this progress has been threatened by the increased use of opioids and other substances. To counter this, we need to continue to expand access to both drug treatment and basic health care coverage.
As the President has said, health care is a complex issue. The same is true of child welfare. The child welfare system must support child safety, permanence, and well-being. This includes a focus on the mental and physical health of children and their families and communities, which is essential to reducing the need for children to enter the child welfare system.
The expanded health care coverage through the ACA, including the expansion of Medicaid, has strengthened millions of families by improving their access to health care—especially those provisions that have increased substance use treatment and mental health services. CWLA, in our many legislative agendas delivered to Congress over the years, has highlighted just how much mental health and substance use plays in cases where children are maltreated or placed into foster care.
Last fall, the Department of Health and Human Services released the latest child welfare data. Officials at the Administration on Children, Youth, and Families (ACYF) interviewed child welfare directors in states experiencing the highest increase in foster care numbers. State officials informed ACYF on what the data suggest: “A rise in parental substance use is likely a major factor driving up the number of children in foster homes. Citing opioid and methamphetamine use as the most debilitating and prevalent substances used, some state officials expressed concern that the problem of substance use is straining their child welfare agencies.”
The Affordable Care Act has provided more than $5.5 billion in substance use and mental health services, according to recent research by Dr. Richard Frank and Dr. Sherry Glied of Harvard Medical School and the Wagner School of Public Service at NYU. It is critical that we keep these services in place.
Last year’s foster care numbers released by HHS indicated that in 2015, 427,910 children were in foster care, an eight-percent increase since 2012. New data suggests that drug abuse by the parent was the primary reason for the child’s removal in 32 percent of cases, and a parent’s inability to cope was a factor in a child’s removal in 14 percent of cases. The reduction or elimination of this expanded behavioral health coverage would no doubt increase these numbers.
According to Dr. Frank and Dr. Glied, a full repeal of the ACA would result in a loss of coverage for 2.8 million people with a substance use disorder, including 220,000 people who have an opioid addiction. Additionally, it would eliminate mental health coverage to 1.2 million people with a serious mental health disorder.
According to the National Center on Behavioral Health, many states with the highest opioid overdose death rates have used Medicaid to expand access to medication-assisted treatment. This includes 49.5 percent of medication-assisted treatment in Ohio, 44.7 percent in West Virginia, 44 percent in Kentucky, 34.2 percent in Alaska, and 29 percent in Pennsylvania. Imagine the impact on foster care caseloads, child maltreatment, and other areas of child welfare if the expanded behavioral health and substance use treatment is…repealed…”
Just as in 2017, in 2020, CWLA continues to oppose the repeal of the ACA, even if replaced by a non-existent substitute.