Last Tuesday, March 11, Department of Health and Human Services (HHS) Secretary Kathleen Sebelius came before the House Ways and Means Committee to testify on the President’s proposed budget for FY 2015. While much of the discussion focused on the Affordable Care Act and its implementation, the Secretary did include comments on the new proposal to target a small amount of funding between child welfare and Medicaid to address a better and more limited use of psychotropic medication and to improve alignment of health care services for children in foster care.
Sebelius described it as, “$500 million for a new Medicaid [Centers for Medicare and Medicaid Services (CMS)] demonstration in partnership with [the HHS Administration for Children and Families] ACF to provide performance-based incentive payments to states through Medicaid, coupled with $250 million in mandatory child welfare funding to support state infrastructure and capacity-building.” She went on to say, “This transformational approach will encourage the use of evidence based screening, assessment, and treatment of trauma and mental health disorders among children and youth in foster care in order to reduce the over prescription of psychotropic medications. This new investment and continued collaboration will improve the social and emotional outcomes for some of America’s most vulnerable children.”
The Administration proposes, for each of the next five years, $50 million through ACF along with an additional $100 million a year through Medicaid. Many of the specifics are still to be worked out, but the funding awarded through ACF would help build capacity by enhancing the child welfare workforce; providing reliable screening and assessment tools; and facilitating coordination between child welfare and Medicaid, especially Early and Periodic, Screening, Diagnosis, and Treatment (EPSDT); training for foster parents, adoptive parents, guardians, and judges; implementing evaluation tools and providing data. At the same time, CMS would provide incentive grants to state Medicaid agencies if they could achieve certain targets and goals regarding services to children in foster care and similar children.
The goal is to enhance services that would not just reduce the over use of psychotropic medications for children in foster care but also enhance the therapies and services to children and families in this population: it has the potential to improve services for a population of children and families beyond foster care placements. ACF data show that 18 percent of the approximately 400,000 children in foster care were taking one or more psychotropic medications at the time they were surveyed (NSCAW II data collected Oct. 2009 – Jan. 2011). The Government Accountability Office (GAO) has estimated an even higher range of 21 to 39 percent. Children in foster care are prescribed psychotropic medications at far higher rates than other children served by Medicaid, and often in amounts that exceed the Food and Drug Administration’s guidelines.
Passing the funding request in Congress may be a challenge since it is mandatory, requiring passage through the authorizing committees rather than going through the annual appropriations (which also would be a challenge). For the ACF funding, the authorizing committees are the House Ways and Means Committee and the Senate Finance Committee.