Health Oversight for Children and Youth in Foster Care

6/14/2017

Kids laying in circle on grassFoster youth often face unique and complex health challenges due to difficult circumstances early in life and the potential inconsistency with which they are cared for when in foster care. 

Because of this reality, ensuring the proper health oversight and provision of health care services has long been of interest to states.  According to “Working Together: Health Care Services for Children in Foster Care 2009,” New York State Office of Children and Family Services:

  • Approximately 60 percent of children in care have a chronic medical condition, and 25 percent have three or more chronic problems.
  • Developmental delays are present in approximately 60 percent of preschoolers in foster care.
  • Children in foster care use both inpatient and outpatient mental health services at a rate 15 to 20 times higher than the general pediatric population.
  • Between 40 percent and 60 percent of children in foster care have at least one psychiatric disorder.

To assist states with improving health care outcomes and access for children in foster care, the Fostering Connections to Success and Increasing Adoption Act of 2008 now requires each state to develop a plan, in consultation with pediatricians and other experts, for the oversight and coordination of health care services for foster care youth. The plan must also include consideration of mental health and dental health needs. The plan shall include an outline of:

  • a schedule for initial and follow-up health screenings;
  • how health needs identified through screenings will be treated;
  • how medical information for children will be updated and shared (may include electronic records);
  • steps to ensure continuity of health care;
  • the oversight of prescription medication; and
  • how the state consults with physicians and other professionals in assessing the health and wellbeing of children in foster care.

Further, the Patient Protection and Affordable Care Act requires states to provide free health care to foster children until he or she reaches the age of 26, so long as they were in foster care at the age of 18.

For more information about health oversight of children and youth in foster care, visit NCSL’s Child Welfare Enacted Legislation Database and use the “Health” topic.

Medical, Dental, Vision, Behavioral, or Mental Health Services, Screening
2016

Arizona

2016 AZ SB 1326, Act 273

Relates to behavioral health service and dependent children, requires a program accountability trends report by the Arizona health care cost containment system administration, relates to medical and dental program.

California

2016 AB 1808, Act 292

 

Authorizes a marriage and family therapist trainee or a clinical counselor trainee to provide certain services to a minor, including mental health treatment or counseling services on an outpatient basis or residential shelter services. Requires such trainees to notify his or her supervisor or an on-call supervisor where the trainee volunteer is employed within a specified time-period of treating or counseling a minor. Requires the trainee to notify the supervisor after the treatment or counseling session.

Delaware

2016 HB 126, Act 85

 

Relates to delinquency proceedings in family court, establishes a minimum age of responsibility in juvenile prosecutions, bars criminal and juvenile delinquency prosecutions of children under a specified age, specifies that such children may be required to participate in any pre arrest diversionary program, and any child believed to be abused, neglected, dependent or in need of mental health services may be referred to the Division of Prevention and Behavioral Health or the Division of Family Services.

District of Columbia

2016 DC B 671, Act 363

 

(Emergency Act) Approves, on an emergency basis, Modification Nos. MO20 and MO21 and proposed Modification No. MO23 to Human Care Agreement No. DCRL-2013-H-0039A with The National Center for Children and Families to continue to provide case management and traditional and therapeutic family-based foster care services for children, authorizes payment for the services received and to be received under these modifications.

Florida

2016 FL SB 12, Act 2016-241

 

Relates to mental health and substance abuse programs and services, involuntary and emergency placements and services, state courts, case management, certain rights and services for certain children, coordinated systems of care, receiving and treatment facilities and systems, financing, patient representatives and advocates, transportation and service plans and accountability, grants, revenue maximization, certain behavioral health entities, benefits, recordkeeping, provider liability, and licensure.

Hawaii

2016 HI SB 2886, Act 181

 

Relates to the age of consent for adolescent mental health services, states that a minor who is fourteen years of age may consent to mental health treatment or counseling services provided by a licensed mental health professional, includes involvement of the minor's parents or legal guardians unless the professional determines it would be inappropriate, requires parental or guardian consent to prescribe medication to the minor or to place the minor into an out-of-home or residential treatment program.

Louisiana

2016 LA HB 719, Act 642

Relates to minors who are mentally ill or suffering from substance abuse and in need of immediate medical treatment, relates to procedures pursuant to issuance of a physician's emergency certificate for treatment of a minor, relates to transportation of a child in whose name an emergency certificate has been issued, authorizes certain persons to accompany the child during such transportation.

Maryland

2016 MD SB 252, Act 57

Authorizes the Medical Assistance Program, as permitted by federal law, to provide dental care for certain former foster care adolescents, requires the Department of Health and Mental Hygiene to apply to the Centers for Medicare and Medicaid Services for a certain waiver.

Maryland

2016 MD HB 511, Act 58

Relates to the dental care services provided for by the State Medical Assistance Program to former foster care adolescents who, upon reaching adulthood, were in foster care, requires the Secretary of the Department of Health and Mental Hygiene to administer the Program for the provision of comprehensive medical, dental and other health care services, requires the Department to apply for a federal waiver for the provision of said services.

Minnesota

2016 MN SB 2896, Act 101

Relates to human services, requires training for child foster care providers, relates to mental health training and fetal alcohol spectrum disorders training, specifies the annual training requirements on fetal alcohol spectrum disorders.

Ohio

2016 OH HB 230, Act 2016-109

Regards the practices of chemical dependency counseling and prevention services, repeals a definition for alcohol and other drug prevention services, provides a new definition for prevention services, adds a new related certification to include prevention consultant, relates to the number of hours of compensated experience and clinical supervisory experience and education for licensure.

Oklahoma

2016 OK SB 1217, Act 280

Relates to mental health and minors in need of treatment, relates to a minor who because of mental illness or drug or alcohol dependency poses a substantial risk of harm to self or others, provides that the mental health or substance abuse history of the minor may be used in evidence to determine treatment, provides that the mental health or substance abuse history of the minor shall not be the sole basis for this determination, provides for licensed drug, alcohol and mental health counselors.

Utah

2016 UT SB 82, Chapter 231

Amends and enacts provisions concerning child and family services, requires child welfare caseworkers within the Division of Child and Family Services to use evidence informed or evidence based safety and risk assessments to guide decisions concerning a child throughout a child protection investigation or proceeding, requires the Division, through a contract with the Department of Health, to establish and operate a psychotropic medication oversight pilot program for children in foster care.

Washington

2016 WA HB 1713, Chapter 29

Integrates adult and youth chemical dependency, mental health, and primary care systems, relates to involuntary commitment and discharge procedures, detention orders and petitions, medical evaluation, crisis responders and dependency specialists, detoxification and alternative treatment facilities, indemnification, patient rights, disclosure and notification requirements, bed capacity, involuntary placement, multidisciplinary teams, behavioral health organizations, penalties, and incarceration alternatives.

2015

Florida

2015 FL HB 1055, Act 2015-177

Child Fatality/Near Fatality, Health and Mental/Behavioral Health 
Relates to child protection, provides for representation of Children's Medical Services on teams investigating certain child deaths or other serious incidents, provide qualifications for Statewide Medical Director for Child Protection and district medical directors, requires the Department of Health to approve a third-party credentialing entity to administer a credentialing program for district medical directors, relates to expert witness physicians testifying in child abuse cases.

Minnesota

2015 MN HB 1535, Act 78

Relates to human services, provides for human services policy modifications relating to children and family services, chemical and mental health services, direct care and treatment, operations, health care, and continuing care, makes changes to child care assistance programs, home and community-based services standards, medical assistance, the alternative care program, Northstar Care for Children, children's therapeutic services and supports, and human services licensing provisions.

Nebraska

2015 NE L 240

Changes the termination of the Behavioral Health Screening and Referral Pilot Program which addresses the unmet emotional or behavioral health needs of children that can be replicated statewide.

North Dakota

2015 ND HB 1314, Act 128

Relates to consent for emergency medical care for a minor who has been sexually assaulted, provides emergency medical care or forensic services to a minor who is a victim of sexual assault without the consent of the minor's parent or guardian, requires reasonable steps to notify the minor's parent or guardian of the care provided.

Texas

2015 TX HB 19, Act 324

Relates to a preventive services program and mental health programs for veterans and military families who are at high risk of family violence, abuse or neglect, includes collaboration with services for child welfare, services for early childhood education, and other child and family services programs.

2014

California

2014 AB 1790

2014 Cal. Stat., Chap. 766

Requires the State Department of Social Services to convene a stakeholder group to identify barriers to the provision of mental health services by mental health professionals with specialized clinical training in adoption or permanency issues to children receiving those medically necessary specialty mental health services. Require the stakeholder group to make specific recommendations by Jan. 31, 2016, for voluntary measures to address those barriers, but would provide that those recommendations are not binding on any state or local government agency or private entity. Require the stakeholder group to coordinate with, and endeavor not to duplicate, existing local, state, or national initiatives.

Delaware

2014 DE SB 266

 

Recognizes that Delaware has an obligation to protect, support, and assist children in the foster care system. Appropriates $50,000 to Nemours which shall be used for the establishment and operation of a task force to study the health and receipt of health service for children in the custody of the State. Details that it is the intent of the General Assembly that the Task Force conduct an analysis of the health and receipt of health services of these children using data supplied by Division of Medicaid and Medical Assistance and other departments as necessary. Details the staffing of the committee.

Illinois

2014 IL SB 2909

2013 Ill. Laws, P.A.  830

Requires the Department to provide each parent or guardian and responsible adult caregiver participating in a safety plan a copy of the written safety plan. Requires the Department to also provide each parent or guardian and responsible adult caregiver safety plan information on their rights and responsibilities that shall include, but need not be limited to, information on how to obtain medical care, emergency phone numbers, and information on how to notify schools or day care providers as appropriate.

2013

Arizona

 

2013 AZ SB 1375

2013 Ariz. Sess. Laws, Chap. 220

Requires Arizona Department of Economic Security on or before, Oct. 1, 2015, in collaboration with ADHS and AHCCCS to determine: The most efficient and effective way to provide comprehensive medical, dental and behavioral health services for children who are in a foster home, in the custody of ADES or in the custody of a probation department.

Connecticut

2013 CT SB 972

2013 Conn. Acts, P.A. 13-178

Requires the development of a plan for meeting children’s mental, emotional and behavioral health needs, requires the inclusion of certain strategies, including school and community-based mental health services integration and early intervention enhancement, provides for collaboration with emergency mobile psychiatric service providers, training of school resource officers, mental health providers, pediatricians and child care providers, home visitation, and a study on nutrition and psychotropic drugs.

2012

Kansas

2012 KS HB 2631

2012 Kan. Sess. Laws, Chap. 2012-109

Relates to dental care availability and access. Allows the practice of dental hygiene to be performed with consent of the parent or legal guardian, on children participating in residential and nonresidential centers for therapeutic services or receiving family preservation services, on all children in foster care homes, runaway youth programs and homeless shelters as well as on children in schools; relates to health.

Nebraska

2012 NE LB 821

2012 Neb. Laws, L.B. 821

Creates the Nebraska Children's Commission; requires legislation to create the Department of Children's Services. Creates the Nebraska Children's Commission to provide a permanent forum for collaboration among state, local, community, public and private stakeholders in child welfare, and requires the Health and Human Services Committee to prepare legislation for 2013 to create the Nebraska Department of Children's Services for programs including child welfare, behavioral health, developmental disabilities, public health and Medicaid as such programs apply to children.

Washington

2012 WA HB 2536

2012 Wash. Laws, Chap. 232

Concerns the use of evidence-based practices for the delivery of services to children and juveniles. Sets a baseline assessment of utilization of evidence-based and research-based practices in the areas of child welfare, juvenile rehabilitation, and children's mental health services. Recommends the reallocation of resources for evidence-based and research-based practices.

Right to Health Care/Health Care Coverage/Funding/Medicaid
2016

California

2016 AB 1849, Act 609

 

Requires, for a foster youth transition plan, information provided regarding health insurance options to include verification that the youth or nonminor is enrolled in Medi-Cal and a description of the steps that have been or will be taken by the social worker or probation officer to ensure the eligible youth or nonminor is transitioned into the Medi-Cal program upon case closure. Revises the list of information, services, and documents are required to be provider to the nonminor including a benefits card.

Maine

2016 ME HB 1043, LD 1518, Act 444

Ensures children in the care of caretaker relatives and other surrogates can access health care, authorizes a surrogate to give consent for health care for a minor, provides that a surrogate may not withhold or withdraw life-sustaining treatment or deny surgery, procedures or other interventions that are life-saving and medically necessary, provides that a health care practitioner who takes certain steps and who renders health care is not liable for failing to have secured certain consent.

Michigan

2016 MI SB 114, Act 94

Relates to contracts for care children and youth with special health care needs, provides that if a county board of commissioners enters into such contract, a judge of the county family division of circuit court shall refer to the proper agency, institution, or hospital with which the contract has been made for the poor, sick, distressed, abandoned or needy child or youth with special health care needs residing in the county as have been provided for by the appropriations made in accordance with this act.

New Hampshire

2016 NH SB 534, Act 2016-203

Directs the department of health and human services and the department of education to develop a comprehensive system of care for children's behavioral health services, provides for cost-effectiveness, decreased use of inpatient and residential services, increased cross-system collaboration, decreased duplication, and improved use of Medicaid, establishes reporting requirements, authorizes the departments to enter into an interagency agreement regarding program implementation.

North Carolina

2016 NC SB 838, Act 2016-121

Requires further reporting from the Department of Health and Human Services related to transformation of the Medicaid and NC Health Choice Programs, modifies certain provisions of the Medicaid transformation legislation.

Pennsylvania

2016 PA HB 1322, Act 192

Amends existing law that consolidates, editorially revises, and codifies the Public Welfare laws of the Commonwealth regarding the Keystone Education Yields Success Program, child care, medical assistance, Medicaid managed care for children, managed care organization assessments, kinship care, and licensing of family child-care homes.

Washington

2016 WA HB 2746, Chapter 106

Modifies the Juvenile Justice Act regarding court orders for residential treatment and expanding the chemical dependency disposition alternative to include mental health and co-occurring disorder treatment, requires the costs incurred by juvenile courts for the mental health, chemical dependency, and/or co-occurring disorder evaluations, treatment, and costs of supervision required under these provisions to be paid by the Department of Social and Health Services.

2015

Oregon

2015 OR HB 2234, Act 100

Modifies the Juvenile Justice Act regarding court orders for residential treatment and expanding the chemical dependency disposition alternative to include mental health and co-occurring disorder treatment, requires the costs incurred by juvenile courts for the mental health, chemical dependency, and/or co-occurring disorder evaluations, treatment, and costs of supervision required under these provisions to be paid by the Department of Social and Health Services.

2014

California

2014 CA SB 508

2014 Cal. Stats., Chap. 831

Requires the department to implement provisions authorized by federal law to provide Medi-Cal benefits to an individual until his or her 26th birthday if he or she was in foster care on his or her 18th birthday or such higher age the state has elected under federal law. Requires the department to exercise its option under federal law to extend Medi-Cal benefits to independent foster care adolescents, as specified. Requires the department to exercise its option under federal law to extend Medi-Cal benefits to individuals under 21 years of age placed in foster homes or private institutions and individuals under 21 years of age for whom a specified adoption agreement is in effect. Require that all the income considered when determining an individual's eligibility under these provisions be disregarded.

New Hampshire

2014 NH HB 572

2014 N.H. Laws, Chap. 2014-80

Establishes a commission to study public-private partnerships to fund medical care for abused and neglected children. Requires the commission to determine and recommend a stable funding mechanism, including but not limited to a private-public partnership involving medical insurers, local hospitals, state funding, and enhanced Medicaid reimbursement, to pay for medical evaluations by providers with training and experience in child abuse and neglect in cases raising the concern of possible maltreatment.

Virginia

2014 VA HB 586 & 2014 VA SB 416
2014 Va. Acts, Chap. 9

2014 Va. Acts, Chap. 183

Eliminates the requirement that an individual under the age of 19 must have been without health insurance for at least four months or must meet the requirements set forth in the Children's Health Insurance Program to be eligible for assistance under the Family Access to Medical Insurance Security Plan.

2013

California

2013 CA SB 1

2013 Cal. Stats., Chap. 4

Establishes the existing Medi-Cal benefit package as the benefit package for the expansion population eligible under the Affordable Care Act (ACA). Requires, to the extent FFP is available, DHCS to provide Medi-Cal benefits to any individual who is in foster care on his or her 18th birthday until the individual turns age 26. Requires DHCS to adopt the federal option to provide Medi-Cal benefits to individuals that were in foster care and enrolled in Medicaid in any other state.

Missouri

2013 MO SB 127

2013 Mo. Laws, p. 127

Allows for the extension of the Ticket to Work Health Assurance Program, MO HealthNet benefits for persons in foster care, payment for drugs prescribed by an advanced practice registered nurse, implementation of a statewide dental delivery system, home- and community-based care referrals, MO HealthNet eligibility and employer liability for discharge of certain employees, including home health, hospice, and convalescent, nursing and boarding home employees.

Montana

2013 MT HB 262

2013 Mont. Laws, Chap. 387

Extends Medicaid eligibility for minors placed in a subsidized guardianship.

Oregon

2013 OR SB 123

2013 Or. Laws, Chap. 515

Requires the Department of Human Services to adopt rules to establish the Oregon Foster Children's Bill of Rights. Details the rights of complaint. Allows for notice of placement, how to obtain a driver license, how to establish a bank account, how to obtain a credit report and how to obtain health care and mental health care, including services and treatments available without parental consent.

Virginia

2013 VA HB 1500

2013 Va. Acts, Chap. 806

Allows for the contracting for therapeutic foster care services. Details dual-eligibility under Medicaid/Medicare, Medicaid nursing home reimbursement, electronic health records, the Health Benefits Exchange, and Medicaid eligibility requirements.

Information Sharing/Health Passports
2016
California 2016 CA SB 1174, Chap. 840 Requires specified departments to provide the Medical Board with information regarding Medi-Cal physicians and prescribing patterns of psychotropic medications and related services for children and minors placed in foster care using specified data. Requires such data to be shared pursuant to an agreement. Requires the revision of methodology. Requires reports to the results of the data analysis. Requires psychotropic medication guidelines dissemination. Requires contracts for consulting services.
Washington 2016 WA HB 2439, Chapter 96 Establishes the Children's Mental Health Work Group to review the barriers that exist in identifying and treating mental health issues in children with a focus on birth to a specified age, directs the Health Care Authority and the Department of Social and Health Services to identify issues related to network adequacy and report annually to the Legislature on the status of access to behavioral health services for children and youth.
2015
Oklahoma 2015 SC SB 250
2015 SC Gen. Law, Chapter 75
Provides for the right of certain medical professionals to perform medical examinations on and release medical records about a child who is the subject of an abuse or neglect report without parental consent, identifies entities to whom primary care physicians, consulting physicians, and hospital facilities may or must release the medical records, relates to confidentiality of child abuse and neglect records maintained by the Department of Social Services.
Tennessee 2015 TN HB 75
2015 Tenn. Pub. Acts, Chap. 199
Relates to the rights of adoptive and foster care families, requires the Department of Children's Services to disclose certain information about children adopted from the department's guardianship to the adoptive family, relates to health, educational, mental and behavioral health information, as well as nationality, ethnic background, race, and religious preference, requires rules to govern the operation of a foster parent advocacy program, provides for investigation of child abuse

 

About This NCSL Project

The Denver-based child welfare project staff focuses on state policy, tracking legislation and providing research and policy analysis, consultation, and technical assistance specifically geared to the legislative audience. Denver staff can be reached at (303) 364-7700 or childwelfare@ncsl.org.

NCSL staff in Washington, D.C. track and analyze federal legislation and policy and represent state legislatures on child welfare issues before Congress and the Administration. Staff in D.C. can be reached at (202) 624-5400 or cyf-info@ncsl.org.

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