Perhaps inspired by Iowa Sen. Chuck Grassley’s many investigations over the years, or maybe the Teapot Dome investigation, Senators Jon Ossoff (D-GA) and Marsha Blackburn (R-TN) this past week announced a Senate investigation into Georgia’s child welfare system. It appears the bipartisan duo’s interest was piqued by recent reports from the Atlanta Journal-Constitution and Georgia’s Office of the Child Advocate. I wouldn’t be surprised to see the inquiry expanded to Sen. Blackburn’s home state of Tennessee, where its Department of Children’s Services has its own issues.
I think most folks would wonder why a US Senate committee would be interested in delving into a state’s child welfare system. Certainly, most of us who have worked in state government bristle at the thought of federal oversight, much less a federal investigation. But the reality is that almost all state child welfare laws, rules, regulations, and policies are, directly or indirectly, dictated by federal law and policy. Through sections IV-E and IV-B of the Social Security Act, the federal government funds much of states’ child welfare budgets.
Through the Child Abuse Prevention and Treatment Act, Adoption and Safe Families Act, the Adoption Assistance and Child Welfare Act, and numerous other laws, Congress has conditioned the provision of those funds on state assurances that they are implementing policies that Congress favors. Additionally, almost all children in foster care, and many of the children touched by child welfare and juvenile justice systems, receive or are eligible for Medicaid. That program contains two requirements very key to serving children in foster care as well as those with complex behavioral health needs: “Early and Periodic Screening Diagnosis and Treatment” (EPSDT) requirements and the IMD (“Institution for Mental Disease”) Exclusion. In brief, the first Medicaid requirement is intended to ensure that any child under 21 on Medicaid can access all medically necessary treatments, even if those treatments are not normally within the State’s Medicaid “plan.” The second prohibits Medicaid from covering mental health treatment facilities, except for certain hospitals, if those facilities have more than 16 beds. In my opinion, the IMD exclusion is a major reason we don’t have sufficient capacity to treat children with complex behavioral health needs. Providers simply can’t make a small facility work financially.
Given the heavy hand of the federal government on state child welfare policy, a Senate investigation might well offer the opportunity for state-level advocates to seek more freedom to implement reforms at the local level. Here’s a few issues I’d like to see tackled:
Foster parent licensing. I hear from many foster parents that the burdens of going through the fairly lengthy process of becoming a certified foster parent. How can we ease those burdens, especially for new foster parents and those who only want to provide respite care. In a demonstration of what’s possible, the Biden administration recently proposed easing foster parent certification regulations for kinship caregivers.
The IMD Exclusion. The Family First Prevention Services Act authorizes states to use federal IV-E funds for very carefully monitored Qualified Residential Treatment Facilities for children and youth in care with significant behavioral health treatment needs. But under FFPSA, Medicaid is supposed to the the “payor of first resort” for therapeutic services. Unfortunately, authorities agree that most such facilities would violate the IMD provisions, so Medicaid would not be available. The result is that few such facilities have opened, and some children in care who could benefit from intensive treatment are placed either in psychiatric hospitals or, in some cases, hotels and agency offices.
Child and Family Services Reviews. The federal government, through the Children’s Bureau, regularly monitors state compliance with federal requirements through these and similar reviews or audits. While useful, I have long been concerned that the manner in which these reviews are conducted ends up creating a “check the box” mentality among frontline case managers, supervisors, and leadership. When combined with federal litigation requirements such as the Kenny A. settlement here in Georgia, there is a danger that instead of freeing up state systems to determine in a holistic manner the best way of serving children in care, the requirements stifle innovation and measure outcomes based upon metrics that are not necessarily related to child safety and well-being.
I’m sure other folks out there could come up with a more extensive list of issues that a Senate investigation could cover. Given the importance of federal law in this field, I hope this will be an opportunity to make progress.
In other news:
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