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Advocacy highlights how Medicaid strengthens child welfare system :

September 20, 2017

The recent efforts by the Academy and pediatricians to protect Medicaid as Congress debated health care reform shed light on an often untold story — the program’s important role in the child welfare system, especially its emphasis on keeping families together as they heal.

The opioid epidemic in particular has shown how Medicaid can be a lifeline to families. The crisis is straining the foster care system as more children are being separated from their parents due to neglect or parental overdose. This trend means the preventive and treatment services Medicaid offers to families are increasingly critical. During the health care debate, several lawmakers spoke out against drastic cuts to the program, citing its ability to connect families with treatment or services.

While this connection is not new territory for the Academy, the recent elevation of the dialogue surrounding Medicaid has created an opportunity to further amplify these messages and push for policies that support vulnerable families.

‘Glimmer of hope’

Medicaid covers 99% of children in foster care, ensuring their access to affordable, comprehensive and quality health insurance. These children, and those who are at risk of entering foster care, are disproportionately exposed to trauma and can have complex medical needs, making quality health care coverage critical.

Therefore, any fundamental changes to Medicaid’s structure or funding cuts would have a significant impact on children and youths in foster care.

“Medicaid is the glimmer of hope for millions of families, including those who might have nowhere else to turn without it,” said AAP President Fernando Stein, M.D., FAAP, in a letter to the editor recently published in the Wall Street Journal. “We would do well to remember this when discussing ways to ‘fix’ Medicaid, or we risk cutting off a critical lifeline for millions of vulnerable children.”

In addition, Medicaid supports continuity of care. When children are removed from their home for their health and safety, Medicaid allows foster parents, relative caregivers or adoptive parents to care for their often-complex medical needs.

Furthermore, children who age out of foster care are eligible for Medicaid up to age 26 in most circumstances. As they can have disproportionate health needs, particularly for mental health services, Medicaid enables them to live full lives focused on attending school and starting careers.

Addressing the opioid crisis

Drug overdoses led to 64,000 deaths in 2016, an increase of over 22% from the prior year. Opioids are the major driver of this trend, particularly synthetic opioids such as fentanyl. Recently, President Donald Trump declared the opioid crisis a national emergency and has convened a government commission to help address the epidemic.

This growing public health threat has led to an increase in the number of children in foster care, which has been rising consistently since 2012. Parental substance use was a factor leading to removal from the home for nearly a third of children in 2015, compared to just less than 25% in 2005.

For families impacted by the opioid epidemic, Medicaid provides access to substance use disorder treatment that can keep them together as they heal. These services place the importance on prevention and treatment, instead of incentivizing family separation.

Turning policy into action 

Amid any threats to Medicaid or its funding, the Academy will continue to undertake advocacy efforts to protect and preserve the program, including its role in strengthening and supporting the child welfare system.

In conjunction with this work, the Academy is urging bipartisan action on comprehensive child welfare reform and is spearheading this advocacy with several leading health organizations.

Although the AAP-championed Family First Prevention Services Act did not advance last Congress, there is bipartisan legislation in both the U.S. House of Representatives and U.S. Senate designed to meet the goals of the original bill.

In June, the House approved five bills that represent key elements of Family First, including reforms that would keep parents and children together during inpatient substance use disorder treatment and support innovative multidisciplinary approaches to addressing these issues. In the Senate, the Child Protection and Family Support Act also includes aspects of Family First focused on parental substance use.

The Academy has endorsed both bills and is calling on the House and Senate to work together to advance these policy reforms as part of a comprehensive child welfare reform package without delay.

The Academy also recently received a grant from the Annie E. Casey Foundation to serve as a lead partner in the Children Need Amazing Parents campaign, which is focused on creating state and federal policy reforms to promote quality parenting for children in out-of-home care, including foster parents, kinship caregivers and birth parents. This effort will enable the Academy and chapters to promote reforms that lead to quality caregiving for children in foster care.

As the Academy continues this work, pediatricians who care for children in out-of-home care will be critical to effecting policy change to meet their health needs.

To receive federal advocacy communications on the Academy’s work around child welfare and other federal policy priorities, email

Save the Date! 2018 AAP Legislative Conference 

The 2018 AAP Legislative Conference will take place April 8-10 in Washington, D.C. Participants attend skills-building workshops, hear from guest speakers, learn about policy priorities impacting children and pediatricians, and go to Capitol Hill to urge Congress to support strong child health policies.

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