On May 12, 2021, the Ways and Means Subcommittee on Worker and Family Support held a hearing on “Making a Difference for Families and Foster Youth.” The hearing was intended as a review of potential updates and changes to the two Title IV-B programs for reauthorization later this year.  CWLA submitted testimony for the record highlighting some key concerns for Congress to address in the coming year.

Among the topics addressed were racial equity with a call to make reforms of the Multi-Ethnic Placement Act (MEPA) and changes to the Title IV-E kinship care including background check requirements.

The testimony also asks Congress to address the current IMD-QRTP controversy in some regions of the country. As we have come closer to the implementation date there has been instruction in some states that a facility meeting the requirements and standards under the new Title IV-E QRTP law may be classified as an Institution for Mental Diseases (IMD) under the Medicaid law. Medicaid’s long-standing IMD exclusion prohibits the federal government from reimbursing for health and behavioral health services rendered to Medicaid-eligible patients in IMDs.  Children while placed in a facility classified as an IMD are not eligible for Medicaid to cover any health and behavioral health service provided in the IMD or health care providers outside the IMD.


As we state in the testimony; “If state child welfare agencies abide by the standards and laws as negotiated and passed by Congress in 2018 through the Family First Prevention Services Act, funding should not be based on different interpretations.  Lack of coordination between child welfare and Medicaid at the state and federal level continues to be a challenge and frequently a barrier to care for children and families in the child welfare system.  It is critical for Congress to address this since two of the new services provided through Family First Services are conditioned on Medicaid being the payor first before substance use treatment and mental health services can be accessed under Title IV-E.”


We also highlighted educational needs of children in foster care (see: What CWLA Said About Education and Foster Care), the need for Congress to amend both Title IV-E and Title II and Title XVI (SSI) laws to better support children in foster care, passage of the John Lewis Every Child Deserves a Family Act, extending foster care to age 21 in all fifty states and we recommend that Congress review strategies to reunite youth with parents in instances when parental rights have been terminated.  We cite a January 2021 ACYF memo that said, “For some of these children and youth who are still in foster care, there may be just cause to reconsider reunification with one or both parents. That is, we should consider the possibility that reunification may be a viable option for these children and youth…Currently, 22 states have laws that allow for reinstatement of parental rights. These statutes are most often grounded in the best interest of the child legal standard and are grounded in the understanding that life circumstances can and do often change for the positive for parents. A parent or parents who may not have been able to safely or adequately care for a child in the past may become a safe and appropriate option in the future…”