By Marian Wright Edelman
It is unfathomable to me that week after week I must continue to defend the Medicaid program that for more than 50 years has protected the health and well-being of tens of millions of America’s most vulnerable. We know many of the 37 million children enrolled in Medicaid today are from poor or low-income families and that 40 percent of children with special health care needs benefit from Medicaid. Among these children are almost half a million foster children, nearly 40 percent of them under age six. These children, invisible to many, are the most vulnerable of the vulnerable. Most have been abused or neglected, removed from their families and placed in foster care — either a family foster home, group home or child care institution — clinging to hopes of returning to their families or finding a new permanent family through adoption or with a relative guardian. A growing number today are children of parents struggling with opioid addiction or other mental health challenges. Fortunately, foster children who suffer from physical and mental health conditions at much higher rates than their peers who are not in foster care are eligible for Medicaid to help put them on the path to success. But today Medicaid is facing the biggest threat in its over half a century history. The House of Representatives has voted to gut it and the Senate is poised to be equally cruel in the misnamed Better Care Reconciliation Act, jeopardizing the health and futures of millions of vulnerable children and families who have counted on Medicaid.
Virtually all children in foster care have suffered trauma in their lives and have greater health and mental health needs than children not in care. A study by the American Academy of Pediatrics finds children in foster care are twice as likely as their non-foster care peers to have developmental delays, asthma and obesity; are three times more likely to have ADD/ADHD, hearing problems and vision problems; are five times more likely to have anxiety; are six times more likely to have behavioral problems; and are seven times more likely to suffer from depression. Not only does Medicaid ensure foster children access to basic health care but it gives child welfare agencies the opportunity to connect children to the critical behavioral health services and treatment they need to build a healthier future and enable them to live independently and contribute to society. Foster children represent 29 percent of Medicaid expenditures for children’s behavioral health services.
Jack and Linda Quirk became foster and then adoptive parents in California for Marissa, now 15; Reuben, 14; and Anna, 10, after their biological children went off to college. All three suffer from fetal alcohol spectrum disorders and intellectual and behavioral health challenges requiring extensive care. Reuben, who is on the autism spectrum, has severe behavioral control problems related to attachment disorder and fetal alcohol exposure and is often uncontrollably violent. The family has moved to Illinois to be near a specialized residential facility to remain close to Reuben as he receives needed care. Without Medicaid the Quirks could not have afforded their adopted children’s extensive specialized care and all three would almost certainly have been in more expensive long-term group care instead of a loving family.
Medicaid also helps keep children out of foster care by getting parents the treatment and services they need before they come to the attention of the child welfare system. The expansion of Medicaid to 11 million low-income adults in the Affordable Care Act gave many parents and other caregivers — some of them for the very first time — much-needed access to services to address problems that otherwise might have resulted in removal of children from their care.
Once children are in foster care, Medicaid helps child welfare agencies secure the funding necessary to offer mental health, substance abuse and other specialized treatment to parents to help stabilize families and return children home safely. Medicaid also helps place nurses and other health specialists inside child welfare agencies.
Without Medicaid to address the special needs of our vulnerable children placed in foster care, children are likely to stay longer in care, to be removed from families who can no longer meet their special needs, and to be placed in more restrictive and costly institutional settings at state expense. Although foster care is supposed to be temporary, the average length of stay is nearly two years. For more than 30 years, many of the children with special needs who exit foster care to adoptive families have been able to continue to receive Medicaid to help their new permanent families care for them.
Missouri mother Lori Ross, President and CEO of Foster/Adopt Connect, and her husband adopted a sibling group of eight from foster care. The children have complex trauma, developmental delays, serious mental health diagnoses, and very challenging behaviors. Without Medicaid the family would already have hit its private insurance lifetime cap, which doesn’t begin to cover the costs of their children’s mental health services. The in-home service for children with significant special needs developed with the help of Medicaid has given all of these children a permanent family and saved Medicaid tens of thousands of dollars annually in more expensive treatment options. Their oldest child, now 18, recently graduated from high school and is pursuing employment and independence with his parents’ love and support.
Children placed permanently from foster care with relatives also are eligible for Medicaid. This has been especially critical as relatives are sought out to care for more and more children impacted by the opioid crisis. And we cannot forget about the estimated 20,000 children each year who transition out of foster care as they turn 18 without permanent families. These young people often received Medicaid in foster care for mental health and other health care needs, and can benefit from continued treatment as young adults to help keep them on course as they attend school or begin work. Too often youths aging out of foster care are at increased risk of homelessness, joblessness and incarceration. When Congress passed the Affordable Care Act (ACA) enabling young people to stay on their parents’ insurance until the age of 26, it also required all states to provide continued Medicaid to age 26 for youths transitioning from foster care at age 18 or older who had been in care in the state. The loss of Medicaid for these young adults would dramatically increase their vulnerabilities.
Medicaid’s indispensable services continue to be under unprecedented attack. The House of Representatives has already passed the American Health Care Act that would slash Medicaid funding more than $800 billion and put a severe cap on future spending. The Senate is planning to vote this month on its misleading Better Care Reconciliation Act that would provide worse care for millions of children. It would end Medicaid as we know it and slash funding by 26 percent in the first ten years, a cut that would grow to 35 percent in 20 years, with much of the savings created by these cuts and caps going to fund more unneeded tax cuts for America’s wealthiest individuals and corporations. The contrast is stark and morally reprehensible when you consider the futures of children like the Quirks and the Rosses have lovingly welcomed into their families.
Any of you who are parents, grandparents, foster parents — as my parents were — or have adopted children know there is nothing more crushing than the thought of losing a child. Yet the cruel threats to Medicaid being considered in the Senate make that fear very real for tens of millions. What do we value if we don’t value a family’s love for their child and the honor and commitment they have made to care for them? No amount of tinkering will make this terrible mean spirited bill safe for children in foster care, those adopted or other vulnerable children. Please call your Senators today. Call again tomorrow and the next day until they can open their eyes to the human reality that millions of children’s lives and needs for family and stability are more important than tax cuts to powerful rich corporations or individuals. Children deserve nothing less.
Marian Wright Edelman is President of the Children's Defense Fund whose Leave No Child Behind® mission is to ensure every child a Healthy Start, a Head Start, a Fair Start, a Safe Start and a Moral Start in life and successful passage to adulthood with the help of caring families and communities. For more information go to www.childrensdefense.org.