Monthly Archives: March 2013

The Affordable Care Act (ACA) and Former Foster Youth

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When the Affordable Care Act (the ACA) was signed into law, it provided a valuable benefit to young adults by allowing them to stay on their parents’ medical insurance until they reached the age of 26. The ACA’s provision allowing children to stay on their parents’ health insurance to age 26 is one of the law’s most popular provisions, for good reason. It takes most people some time to finish college and establish a career or to find a job that would allow them to obtain and maintain quality health care coverage. The ACA allows young adults to stay on their parents’ insurance and have vital health care coverage throughout college and it gives them time to establish themselves without having to worry about the catastrophic health care bills that would result from a health crisis.   A medical crisis that results in a large medical bill and the often extraordinary debt associated therewith is a difficult issue with which to be burdened at any age, but young adults are especially vulnerable. Young adults had the highest rate of uninsured of any age group and the lowest rate of employee provided coverage when the ACA was signed into law.  Incurring a burdensome medical debt at such a young age can hinder a young adult over the important years when he or she is embarking upon a career, obtaining an education, or otherwise attempting to establish a livelihood.

Given all of this information, Congress left one group of young adults waiting for this coverage. Foster youth have had to wait nearly four years longer than their peers who were not in foster care.  This, even given that the state is the parent of these youth, they are our children. These youth, our children, often have chronic health issues associated with the abuse or neglect which was the reason for their entry into foster care. Many have mental health or emotional health issues, and they do not have access to the familial and social safety net on which their peers can rely. That the ACA has made this group of former foster youth wait for the same coverage their peers enjoy is shameful.

After a nearly four-year wait, beginning in January of 2014, states will be required to provide Medicaid coverage to youth who are under 26 years of age and were in foster care and receiving Medicaid when they attained 18 or such higher age at which the state’s federal foster care assistance ends under title IV-E of the Act (when they reached 18 or aged out of foster care).  Despite the wait, this is excellent news for young adults who were in foster care. Particularly because anyone who meets these requirements is eligible for Medicaid, even if an individual is age 23 and has not had Medicaid coverage for years, if that individual meets the requirements, he or she can obtain Medicaid coverage.

Unfortunately, the Department of Health and Human Services (HHS), which is the agency that creates regulations for the implementation of federal laws, is proposing a regulation that would require states to provide Medicaid to young adults ONLY in the same state in which they were in foster care and not to a young adult who, for example, is attending college in one state but aged out of care in a different state. This is a glaring inequity. The same restriction does not apply to young adults who enjoy the benefit of their parents’ insurance, have the benefit of the familial safety net that parents’ provide, and did not age out of the foster care system.  Given that former foster youth are a very mobile population; this proposed regulation is of concern. Several foster care and children’s advocacy organizations have urged the department of Health and Human Services to issue regulations that would require states to provide foster youth with access to Medicaid coverage, regardless of the state in which they choose to reside.  The final regulations will be released later this year.

You can learn more about this issue from these sources:

Proposed Rule

CAI’s Comments

Children’s Defense Fund: Joint letter sent to HHS regarding the proposed rule

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Author: Christina Riehl, Senior Staff Attorney at CAI

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Re-alignment or Retreat from Responsibility?

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Looking back on legislative developments having an impact on California’s children in 2012, it is hard not to notice two things that smashed into each other:

  • The State has effectively ended any funding for child welfare, instead “re-aligning” that funding responsibility to California’s 58 very different counties and assuring them additional programmatic flexibility.
  • Outside news reports and audits excoriated the child welfare system in Los Angeles County, the State’s largest.

As the Los Angeles Times wrote in February of 2013 about an internal L.A. County review done in 2012, a “stifling bureaucracy” was impeding effective child welfare:

“Investigations tend to rely on bureaucratic rules, not common sense and close observation, the report found. The department has issued more than 4,000 pages of policies detailing how social workers should do their jobs.

‘Creating social work road maps with this level of ‘how-to’ is like expecting a therapist to use a script that tells her what questions to ask and what responses to expect from her client in a therapy session,” the report said.

Lowell Goodman, a spokesman for the union representing the social workers, said, ‘Even the finest social workers in the country could not perform their best work in this system.’

‘Paperwork and the relentless attention to following [thousands of pages of] policies supersedes hands-on social work in importance,’ he said.”

An audit by the State Bureau of State Audits found similar problems and has noted that the County has not addressed them. [1]

County failures in administering child welfare are not new.  Sacramento County, for example,also hired an outside consultant to review its operations after a spate of grisly child deaths were reported in the Sacramento Bee.  The consultant in its final report in 2009 identified a large number of bureaucratic impediments to social worker effectiveness that imperiled the lives of children. For example, the Sacramento County report found:

“The County’s guidelines for its social workers contain 167 policies spanning more than 1,300 pages. Over 60 percent of these guidelines were last created or updated more than five years ago. CPS’s existing guidelines include a mix of outdated or conflicting guidance, caused, for example, when the division created a new guideline without revoking or amending a prior guideline document related to the same procedure.”

“The current CPS requirements and  operating structure hamper its ability to provide child welfare services effectively and efficiently.  Moreover, inconsistent procedures and failure to follow best practices have resulted in negative  outcomes for some children in the County’s child welfare system. Utilizing poor practices has also resulted in families and children not receiving the best services to meet their needs.  Consequently, the issues within these families that brought them into the child welfare system in  the first place may continue to be unaddressed, leaving children at risk. Improving CPS  operations and processes is imperative if the County is to address these issues and optimize its  service delivery to families and children in the future.” 

Likewise, in response to news stories in Los Angeles County about CPS performance, SEIU Local 721 in 2011 authored an exhaustive and detailed set of recommendations for improving and streamlining operations and enhancing social worker productivity. Most of the suggestions could be implemented within existing resources. Suggestions included how to eliminate duplicative paperwork, improve coordination between departments and employees, and shift staffing to ensure greater productivity and job satisfaction. But, these suggestions have been largely ignored.

And all of these county-level failings took place during the world prior to re-alignment, when the State had the power of the purse to influence policy.  Now, while the federal government continues to look to the State as the one throat to choke when it comes to ensuring its Title IV-E money is well spent, the State has less of a central role in guiding child welfare policy than perhaps ever before.

What is clear is this:  only until State and federal governments get serious about monitoring how federal tax dollars are spent will California’s abused and neglected children obtain the level of care and services they deserve.

 

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