Healthcare for Children

and other child welfare news for May 8, 2024.

A new report from Georgetown University addresses the significant drop in the numbers of children enrolled in Medicaid and CHIP over the past year following new federal “unwinding” requirements. During the pandemic, states weren’t required to follow the normal procedures requiring regular re-assessment of eligibility for these programs. They now are. In percentage terms, the biggest drops in medical coverage for children were in South Dakota (-28%), Montana (-27%), and Utah (-25%). As of January 2024, states now have to assess eligibility only once per year.

These programs are critical to child health, as almost half of America’s children are eligible for one of them. They’re also crucial to the financial stability of our healthcare system, especially our rural hospitals that would otherwise be providing unpaid healthcare for children. As of January 2024, states can “certify” eligibility for a child for an entire year. But there’s more that states can do. In Georgia, the State a few years ago adopted “express lane eligibility” (ELE). Through this program, when a family applies for food stamps (SNAP), the benefits agency (DFCS) can automatically determine if the family qualifies for Medicaid or CHIP. Because food security is often a greater priority for families than medical coverage and because eligibility requirements for both programs are similar, ELE ensures that a significant percentage of eligible children have health insurance. In March 2024, Georgia’s Medicaid agency took steps to change the procedures so that a family seeking food stamps must affirmatively “opt out” of health coverage for their children if they don’t need it a measure that will likely increase further the children receiving Medicaid or CHIP coverage. Additionally, states can obtain waivers from the federal government to improve coverage for children, including waivers that allow states to keep children covered for several years without a redetermination.

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In other news:

• Let’s talk about kinship care. This article about the new “kinship caregiver” benefits in Michigan rightly notes that it only applies to children in formal state custody. But look at this new Virginia law which specifically provides for a new “Parental Child Safety Placement Program.” I’m liking this as an alternative to the “safety plans” and “voluntary kinship” programs often used by child welfare agencies and often derided as “shadow foster care.” Under Virginia’s model, the written plan lays out all the duties of the child protection agency, the caregiver, and the parent during the 90-day voluntary placement. It requires the agency to provide ongoing services to the placement provider, child, and parents. Unless extended voluntarily for up to 90 additional days, the model requires the agency to go to court if the safety issues aren’t resolved by the end of the voluntary placement. I’ve proposed a process like this myself, although I’d also ensure the relative caregiver had some funding — at least for childcare. h/t Eric Reynolds!

• Iowa is amending its State Medicaid Plan to add Therapeutic Foster Care as a covered service. This is an important service for children with complex behavioral needs.

• Child advocates in Maine are disappointed in the legislature’s failure to enact system reforms, which included a proposal to make the state child welfare agency a separate entity. Advocates there also want more transparency in child abuse proceedings.

• Speaking of transparency, from a retired juvenile court judge, here’s a renewed call for opening juvenile courts to the public, published by the American Bar Association.

• A federal judge has, I hope, learned that the “scared straight” approach doesn’t work after he was reprimanded for cuffing and temporarily detaining the daughter of a defendant in his courtroom in response to the father’s concerns about her behavior.

• Connecticut’s legislature has added back into its mandated reporter laws some flexibility, allowing professionals to do a preliminary inquiry and giving them immunity for actions taken or not taken in good faith.

• New Hampshire is joining other states seeking to ensure its Safe Haven laws are working as intended.

• Bored geeks can read this more academic piece on lawsuits against child welfaer agencies.

• How did Indiana’s child protection system fail Kinsleigh Welty?

• A 13-year old in South Carolina weighed only 47 pounds at the time of his death by starvation.

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