Examining the Costs of Medicating America’s Foster Children

Today the Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security held a hearing on the financial and societal impact costs of medicating foster children.  Chairman, Tom Carper (D-DE) opened the hearing by admitting that a recent Government Accountability Office (GAO) study had in fact confirmed one of his worst fears: that children in foster care were being improperly prescribed mind-altering medications at an alarming rate, that had proved to be a waste of tax payer dollars, and an affront to the health and well-being of children. The findings were clear: children were being prescribed medication in excess of the maximum dosage for their age as recommended by the Food and Drug Administration (FDA), hundreds of children were found to be receiving more than five or more medications at one time, and finally that children under the age of one were also being prescribed mind-altering meds.

Following Carper’s opening statement, Ranking Member Scott Brown (R-MA), spoke about his dismay at the findings of the GAO report, and affirmed that he had already reached out to his home state of Massachusetts to inquire as to why nearly 40% of the foster children in the state were being prescribed at least one psychotropic drug (a rate almost four times that of non-foster children). He also noted that since the United States Department of Health and Human Services (HHS) has limited authority to adequately oversee state monitoring programs for youths in state custody, in many cases the programs fall short of providing the comprehensive oversight that is desperately needed. Instead, states’ were relying on HHS’ best practices to help inform state monitoring programs for children in state custody. He urged HHS to do more, including providing consistent and comprehensive guidelines in this area in order to more effectively treat and reduce harmful risks to children in the Medicaid program, and particularly foster children.

Next up was Ke’onte Cook, a twelve-year old from Texas, who spent over four years in foster care and at one time was on multiple anti-psychotic medications. He recounted the time he spent in foster care and in mental hospitals and how for the majority of the time he was treated with medication, instead of therapy like he currently receives. He described some of the side-effects that the medications caused and said that he was often told the reasons that he was being prescribed certain meds, but has come to realize over the years that he does not have Attention Deficit Hyperactivity Disorder (ADHD) nor is he bipolar. In fact, he is excelling in school and his extra-curricular activities.

HHS Administration on Children, Youth and Families (ACYF) Commissioner Bryan Samuels shared his personal story and experience and confirmed that HHS is strongly committed to the appropriate prescription and use of psychotropic therapies for children. He insisted that HHS is willing to comply with the GAO recommendation to issue a guidance to state Medicaid and child welfare agencies explaining the best practices for monitoring the use of psychiatric drugs in foster children. However, he clarified that Congress would first have to intervene with legislation before HHS could issue a national standard that all state Medicaid agencies would have to follow. As a result, Brown and Carper agreed to work with him to achieve this shared goal. Samuels also spoke to some of the broader needs of the child welfare system, and reiterated the Administration’s commitment to continue to build the capacity of the system to more effectively respond to the complex needs of the children they serve.

The Chairman closed by offering a challenge for all parties to accept responsibility in ensuring that Medicaid program works for all of the children it serves. Carper and Brown agreed to plans to write bipartisan legislation to reduce the risks that children in foster care would be inappropriately prescribed psychotropic drugs.

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