Last Tuesday, June 20, the House of Representatives adopted a series of bipartisan child welfare bills. The five bills were all taken from last year’s Families First legislation that had been adopted by the House last summer. Taken together the bills would speed up placements across state lines, improve regional partnership substance use treatment grants and expand support for youth in or aging out of foster care.
These changes may be needed if the current bills dealing with the ACA are adopted potentially increasing pressure on child welfare systems and increasing the number of children and youth in foster care. As noted in the CWLA letter of opposition to the American Health Care Act:
- The ACA has provided more than $5.5 billion in substance use and mental health services,
- In 2015, 427,910 children were in foster care, an eight-percent increase since 2012 with drug abuse by the parent as the primary reason for the child’s removal in 32 percent of cases, and a parent’s inability to cope a factor in a child’s removal in 14 percent of cases.
- 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.
- Full repeal would eliminate mental health coverage to 1.2 million people with a serious mental health disorder
- Medicaid provides access to medication-assisted treatment—that is medication for addiction plus therapy—an approach vital in some epidemic states. 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—all states with increasing foster care numbers and high opioid addiction
All five child welfare bills are scored by the CBO as not having a cost and in fact some were adjusted from the way they were written in Families First Act to assure there would not be a cost. Although the accuracy of CBO has been attacked during the health debate, any future cost of child welfare legislation is taken at face value and never disputed. The five bills are not expected to pass the Senate as standalone bills in part because some would need adjustments that would require costs if they are not part of a bigger bill. Possible future Senate bills include a revised Families First Act or a needed reauthorization of the Title IV-B programs part 1 and part 2.
The bills include HR 2742: Modernizing the Interstate Placement of Children in Foster Care Act, (Congresswoman Jackie Walorski (R-IN) and Congressman Danny Davis (D-IL). Sometimes described as the “NEICE” bill it sets aside $5 million in current Child Welfare Services funding to expand the use of web-based technology in the placement of children across state lines. HR 2857: Supporting Families in Substance Abuse Treatment Act, (Congresswoman Kristi Noem (R-SD) and Congresswoman Judy Chu (D-CA)) extends foster care maintenance payments for a child in foster care while that child resides with a parent while in family-based residential treatment program. HR 2834: Partnership Grants to Strengthen Families Affected by Parental Substance Abuse Act, (Congressman Danny Davis (D-IL) and Kristi Noem (R-SD)), makes some small changes to the regional partnership grants which expire this year. It would allow for smaller competitive grants to spread their reach and require that state substance abuse agencies be a required partnership for the grants. HR 2866: Reducing Barriers for Relative Foster Parents Act, (Congressman Lloyd Smucker (R-PA) and Terri Sewell (D-AL)), directs HHS to identify model standards in the licensing of relative foster care and requires states to report on their standards and any waiver of those standards. HR 2847: Improving Services for Older Youth in Foster Care Act, (Congressman John Faso (R-NY), and Congressperson Karen Bass (D-CA)) expands the use of Chaffee transitional funding for states that extend foster care to 21.
CWLA has endorsed each of the five bills. We will monitor any final adjustments if they should move forward before giving final support.
The recent opioid epidemic highlights the role that addiction and mental health play in child welfare. Further examination shows how foster care numbers are jumping in states hit by opioids. In Ohio foster care number went up from 12,223 to 13,205 between 2013 and 2015, in Arizona 14,399 to 17,738, and in Indiana 12,382 to 17,073 all between 2013 and 2015. In Montana, which also has the challenge of methamphetamines the numbers rose from 2,232 to 2,807 and the number of children entering foster care in 2015 was at 1,940 which is more than total entries into foster care for 2009 and 2010 combined.
Both the Senate and House bills will end the Medicaid program as it has existed for 50 years. Both would provide caps on funding to states or give states the option of a block grant. That increases the likelihood that long term care services (nursing homes) with an aging baby-boom population may be competing for needed mental health and substance use services. With less substance use funding for opioids, methamphetamines and one of the consistently top addiction over the years, alcoholism, what is the likelihood that future Congresses will need more legislation to assist families in need of treatment and youth needing transitional assistance?