On July 13, 2023, the House Energy and Commerce Committee’s Subcommittee on Health held a markup of seventeen bills, including H.R. 4056, the Ensuring Medicaid Continuity for Children in Foster Care Act. This legislation would exempt Qualified Residential Treatment Programs (QRTPs) from the institutions for mental disease (IMD) exclusion in Medicaid. If this bill were to pass, QRTPs would be able to expand their capacity and access Medicaid reimbursement for healthcare costs, resulting in a greater ability to serve the youth in foster care who need time-limited, high-quality treatment services.

Supporters of H.R. 4056, including its sponsor, Representative Bilirakis (R-FL), explained the need for QRTPs as “safe havens” of treatment and qualified care for children in foster care who require extra resources and support from professionals. Mr. Bilirakis states that QRTPs were never intended to fall under the IMD exclusion, so H.R. 4056 would be correcting this misinterpretation. Further, he emphasized the strong oversight and accountability in Title IV-E law for QRTPs, and that this oversight would not lessen if these programs were exempt from the IMD exclusion. Mr. Bilirakis is committed to bipartisan efforts to address this gap in the care continuum and better support children in foster care.

Some committee members spoke in opposition to H.R. 4056, most notably over concerns that exempting QRTPs from being considered as IMDs would lead to a relaxation in oversight and the possibility of children becoming institutionalized for long periods of time. The QRTP regulations stipulate that only children and youth than cannot safely reside in family foster care are eligible for placement in QRTPs. Representative Pallone (D-NJ) expressed his concerns that exempting QRTPs from the IMD exclusion would incentivize putting children in residential care rather than directing funding to community-based initiatives to provide resources and care. Representative Dingell (D-MI) echoed this concern, asserting the importance of receiving care within one’s own community and home. Representative Ruiz (D-CA) spoke from his perspective working in emergency medicine to express his fears that if oversight in QRTPs is relaxed, there is opportunity for greater incidence of abuse, making an already vulnerable population ever more vulnerable. Again, this bill would not relax any of the oversight or protections that are written into the Title IV-E Family First Preservation Services Act.

No amendments were offered, although there is a technical fix that is needed to the bill language that would delink Medicaid reimbursement from Title IV-E maintenance payments. The final vote was 17 ayes to 9 nos, mostly along party lines with two Democrat members voting in favor. H.R. 4056 will move to a full committee markup, along with other bills under consideration for the SUPPORT Act reauthorization.

By Leah Sarfity, Policy Intern