The Opioid Bill, Child Welfare and Juvenile Justice

The House and Senate wrapped up a deal on a sprawling bill meant to assist states in fighting the opioid epidemic, which claimed 50,000 lives last year and has contributed to a five-year surge in the number of youth in foster care.

The SUPPORT for Patients and Communities Act, which was finalized while all political eyes were on the confirmation hearing of Supreme Court Justice nominee Brett Kavanaugh, projects to cost around $8 billion, an amount some skeptics of the bill say will not have enough impact. But it does include some provisions specifically of interest to the child welfare and juvenile justice communities.

Medicaid Loophole Closed for Foster Youth

When the Affordable Care Act (ACA) extended the amount of time that young people could stay on their parent’s health insurance until age 26, it made a similar guarantee to youth in foster care. As of 2014, any person turning 18 in foster care would be Medicaid-eligible until at least the age of 26.

But there was one limitation on that provision. Only the state in which the youth was in care would be required to guarantee Medicaid. If a youth wanted to move states to live with family, or to attend college, the receiving state would not be required to enroll them.

The opioid bill closes that loophole, thanks in large part to Rep. Karen Bass (D-Calif.) and other House members continuing to raise the issue since the ACA took effect.

Medicaid Management for Incarcerated Youth

States cannot use Medicaid to cover incarcerated adults or juveniles. Some states do use Medicaid to provide health and mental health services in a detention setting, for youths who are being held before their culpability is judged, but most do not.

When Youth Services Insider researched state Medicaid policies on juvenile offenders back in 2008, we found that some kicked kids off Medicaid when they went in; some suspended their enrollment; and others had no set policy for what local systems did.

The bill does not roll back the prohibition on Medicaid in incarceration settings. But it does require that states keep them eligible. From the bill:

“The state shall not terminate eligibility for medical assistance under the state plan for an individual who is an eligible juvenile … because the juvenile is an inmate of a public institution but may suspend coverage during the period the juvenile is such an inmate.”

Family-Focused Residential Treatment

Substance abuse treatment programs where children can live with a parent during recovery are in short supply. The approach is a viable option for federal funding under the recently passed Family First Prevention Services Act, so there is interest in building up the evidence base in this area and in getting more of them off the ground.

The SUPPORT Act offers a small boost to that goal. It includes a $20 million grant program to help states develop, enhance or evaluate family residential programs.

Also required by the act: within 180 days of its passage, the Department of Health and Human Services (HHS) to produce a guide for states on the various existing opportunities in federal funding to support family residential.

Family Reunification

The bill includes $15 million to test a reunification project that uses a recovery coach model to help reconnect families where a removal of children was prompted in part by substance abuse. The goal is to pilot, evaluate and study replication of such a project.

Another section of this provision that caught our interest is the instruction to HHS to make an assessment of whether such a program could be used at “different intervention points,” such as “when a child is at risk of entering foster care or when a child is living with a guardian while a parent is in treatment.”

YSI wonders if that might not be Congress laying the groundwork to eventually permit reunification funds, under the Promoting Safe and Stable Families (PSSF) program, to be used to help support relatives under the new front-end provisions of the Family First Act. That law allows states to tap into Title IV-E entitlement funds to help prevent the use of foster care in some cases. Evidence-based substance abuse treatment is one of the allowable prevention services.

Family First envisions that some children will need to live with relatives during the recovery process, but it does not allocate any specific funds to assist those families. Perhaps this is a test to see if permitting states to support relatives through PSSF is a good idea.

It will be interesting to see which program becomes the focus of this. YSI’s guess would be that the START model, out of Kentucky, or the STAR model out of Sacramento, are viable candidates.

Safe Care Plans

The bill amends the Child Abuse Prevention and Treatment Act (CAPTA) to include a grant program to help states screen infants and craft safety plans for mothers going home with substance-exposed babies.

Among the allowable uses are evidence-based screening tools for infants who might suffer from withdrawal or Fetal Alcohol Syndrome Disorder, developing protocols on reporting cases to child protective services, and for ensuring a safe care plan before discharge from the hospital.

This pot was slated for $60 million in the earlier House version of the bill, but appears in the recent deal without a new appropriation line. The most recent spending deal in Congress did add that exact amount to CAPTA.

YSI would bet one group interested in this aspect of the bill is the Managing Abstinence in Newborns (MAiN) program, led by Dr. Jennifer Hudson in Greenville, South Carolina. MAiN uses a more aggressive approach to treating the withdrawal symptoms related to Neonatal Abstinence Syndrome (NAS), which can avert long stays in intensive care for infants and strengthen the bond between mother and child.

Click here to read our interview with Hudson. The bill also instructs HHS to study and report on the “best practices from states with respect to innovative or evidenced-based payment models that focus on prevention, screening, treatment, plans of safe care and post-discharge services for mothers.”

If you are interested in reading more about federal child welfare and juvenile justice policy, read our annual special issue “Kids on the Hill: A Special Issue on Child Welfare Policy” by clicking here!

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