In My Eyes: Limitations of the Affordable Care Act for Foster Youth

Dustin Haley
Dustin Haley

Today’s guest blog post is written by Dustin Haley, a CCAI 2013 intern, University of Texas undergraduate student, and former foster youth.

As the Affordable Care Act (ACA) is rolled out, many former foster youth will have increased availability for medical coverage.  Starting in 2014, youth who aged out of foster care will be eligible to remain on Medicaid until age 26, a huge win for child welfare advocates and former foster youth.

Youth in college will now have the peace of mind of always having their health insurance covered, and will not have to choose between books and medical care.  Former foster youth who are working part time will also be able to support themselves without having the unnecessary burden of healthcare costs. However, limitations to the ACA will negatively impact many of the former foster youth. As a former foster youth myself, I am all too familiar with these restrictions but it wasn’t until I started interning with CCAI that I learned I could advocate to change this policy.

First Focus, a bipartisan advocacy organization, recently took a look at this regulation, in addition to the rest of the ACA as it applies to foster youth.  They found that as it stands now, coverage will only be guaranteed to those who remain in the state where they resided when they were 18.  This is a huge issue for foster youth around the nation, as they often travel to different states for extended periods for school, jobs, or internships.  Many also move to be closer to support systems, whether they are close friends or extended family.  First Focus points out that restrictions on residency only apply to foster youth, not to adopted children nor to youth raised in a traditional family.

During CCAI’s summer Foster Youth Internship (FYI) Program, foster youth from around the nation come to DC work on Capitol Hill.  Most all of them come from different states and thus are not eligible to receive Medicaid in DC.  Since I’ve started interning at CCAI, I’ve learned about one of last summer’s interns, who ended up needing medical treatment, but experienced difficulties because he was not in his “home” state.

I contacted Josh to learn more about his experience and he explained how he had just returned from a trip to Ecuador when he started as an FYI participant last summer.  Soon thereafter, Josh started to experience serious stomach issues stemming from possible parasites contracted while abroad.  He went to a quick-service clinic in DC and had to pay full cost for treatment.  Unfortunately, the practitioners in the clinics are not specialists and could not figure out what he had contracted.  Seeing a specialist in DC would have cost Josh too much money out of pocket and was thus forced to fly back to Tennessee.  He was able to get the proper treatment from a specialist there and he soon recovered.

I too have run into the same struggles as Josh since being out of my home state—Texas—and completing my internship in DC this semester.  I recently injured my knee, but due to the limitations on Medicaid, I was not able to seek out treatment.  Had I seen a doctor, they would have surely ordered X-Rays and possibly an MRI.   Without insurance, these bills quickly add up.  My struggles, along with the struggles of all foster youth, should not be lost on child welfare advocates.

The Center for Medicaid and Medicare Services recently opened up to debate the section of the Affordable Care Act regarding former foster youth.   Organizations have been able to submit comments, many of which proposed medical coverage for former foster youth irrespective of the state they resided in when they were 18.   I, for one, hope to see change that eventually leads to greater benefits to the youth.

Investing in the Future of our Children

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Image Courtesy of The Next Generation

Yesterday, the Washington Post, The Next Generation and the W.K. Kellogg Foundation hosted the “Children and Families Summit 2013,” a convening of parents, policymakers, and experts unified in their belief that our nation not only can, but must, do better at investing – personally, privately and publicly – in the future of our children. The day’s agenda focused on a relatively simple and yet profound question: How can we as a nation strengthen support systems for those young people and parents who desperately need them?

As this important conversation continues,  we must remember that hidden within the millions of children who live in poverty, lack access to a high quality education, or suffer unnecessarily from chronic health conditions are our nation’s  half a million foster children. In taking these children into our governments’ care, do we not also make an implied promise to provide them the attention and support they need to become successful, stable adults?  Most would say the answer to this question is unabashedly yes, and yet what research shows is that foster children are chief among those falling through the gaps in our current system.

Here are just a few sobering facts: according to the American Academy of Pediatrics, compared with children from the same socioeconomic background, children in care have much higher rates of serious emotional and behavioral problems, chronic physical disabilities, birth defects, and developmental delays. Educational attainment studies reveal that less than 50% of youth in care graduate from high school and only 3% go on to get a college degree. As if those statistics are not compelling enough, studies also show that as many as one in four foster youth will end up homeless, in jail or die within a year of leaving care.

There are many reasons why children in foster care are not achieving their potential; I would like to focus on just two. First, as Paul Tough explains in great detail in his new book, How Children Succeed, “what matters most in a child’s development… is not how much information we can stuff into [a child’s] brain in the first few years. What matters instead is whether we are able to help [them] develop a very different set of qualities; a list that includes persistence, self-control, curiosity, conscientiousness, grit and self-confidence.”  According to Tough, it is these skills, and not the accumulation of book knowledge, that are what allows students to maintain focus during a difficult exam or get noticed for having a “good work ethic” in the workplace.

And who is it whom most often helps cultivate such skills in children? Good parents.  In fact, one of the most compelling parts of yesterday’s events for me came during the remarks of sixteen year old Alfa Lopez who introduced the Secretary of Education to the audience. Lopez said what an “only in America” moment it was for her—a  Los Angeles teen who hails from a low income neighborhood with a school dropout rate over 50%—to be in Washington, D.C. and introducing such an important government official. She opened with “Thanks to my parents, who sacrificed everything to give me what they never had.”

Not only do foster children not have the benefit of being raised by the type of parents who lead to success stories like Alfa, we are also failing to provide too many youth that type of parenting while in care.   We currently have one foster family for every four children who need care and a high number of those who are fostering are doing so for all the wrong reasons.  Foster children move from home to home almost as often as the seasons change and the vast majority of teens in foster care are growing up in group homes, many of which resemble prisons, not families.  One way to bring about change for children  would be to invest in systems that allow children to go from broken homes into supportive settings with caring adults who are willing and able to build the skills celebrated by Tough.

The second reason foster youth continue to struggle is that major federal programs designed to meet the needs of disadvantaged children in general too often miss the mark in meeting the needs of children in care.  Here are just some examples: one third of all children in foster care are under five years old when removed because of abuse and neglect.  Because they are in care they are categorically eligible for Head Start Services, and yet according to the National Study on Child and Adolescent Well Being, only 6% of children in foster care are enrolled in this important program. Similarly, although foster youth are three times as likely as the general population to be identified as being in need of special education services, they are half as likely to receive them.  Foster youth are less likely than their counterparts to be enrolled in federally-supported, school-based enrichment programs such as after-school activities or mentoring initiatives.

Why is this?  Again, there are many reasons but one of the main problems is that most of these programs rely on a parent—or at least an adult acting like a parent—to enroll these youth in these programs.  Youth in care are most often represented by social workers who have a long list of things they are supposed to be doing for the children in their caseload and often lack the time, expertise and resources needed to accomplish these goals. Foster parents, as discussed before, are also not ably fulfilling this role.  So the programs exist to help youth in care, they are just not currently doing so.

These are the types of questions CCAI strives to provide answers to everyday.  We look forward to working with Next Generation, the Washington Post and all of the committed partners who attended the event yesterday.   As my former boss Senator Landrieu used to say, “Children might only constitute thirty percent of America’s population, but they are undeniably 100% of America’s future.”

How the Adoption Incentives Program can Incentivize Adoptions

Today, the Subcommittee on Human Resources of the Committee on Ways and Means held a hearing to review the success of several privately run programs to increase the number of children adopted out of foster care. This marks the beginning of the committee’s efforts to review—and hopefully reauthorize—a federal program entitled the Adoption Incentives Program.  Originally created in 1997 as part of the Adoption and Safe Families Act, the Adoption Incentives Program has delivered a total of $375 million in bonuses to states that were successful in increasing the number of children adopted out of foster care.

Subcommittee on Human Resources of the Committee on Ways and Means Adoption Incentives Hearing.
Subcommittee on Human Resources of the Committee on Ways and Means Adoption Incentives Hearing.

Since the inception of the Adoption Incentives Program, more than half a million children found their forever homes. Despite this success, however, over 100,000 foster children are still waiting to be adopted.  If trends continue, approximately 50% of these children will succeed in finding homes through adoption and 50% will continue to wait.  Statistics reveal that those who remain waiting are most often older children, members of larger sibling groups or those children who have special physical or mental health needs.  In fact, according to a the most recent AFCARS report, the average age of a child adopted out of foster care is 6, while the average age of a child waiting to be adopted out of care is 8.

So the question before Congress is this: how can the federal government incentivize states to find a home for every child? The programs highlighted in today’s committee hearing prove beyond a shadow of a doubt that there is no such thing as an unadoptable child, just an unfound family.   There are at least three lessons to learn from these programs’ experiences.

  • States cannot employ “a one-size-fit-all” strategy for finding a permanent home for a child.  Efforts to recruit an adoptive family for a child must be as diverse as the children themselves.
  • States that have succeeded in finding homes for older and special needs children have done so in close partnership with community and faith-based partners.  Such partnerships allow state child welfare agencies to be more innovative in their approach; address critical workforce gaps; increase their reach into communities where perspective adoptive parents are likely to be found; and provide post- adoption support.
  • Finally, success in finding an adoptive family for every child who needs one is premised on the belief that all children need and deserve a family

If Congress hopes to replicate the successes of the types of programs highlighted today it must learn from these lessons and better incorporate them into the current Adoption Incentives Program.  Congress might also want to consider whether the current model of providing an individual bonus per adoption is the best way to incentivize adoption for older and special needs children. Perhaps this group would be better served by a model similar to the Department of Education’s “Race to the Top,” a federally-funded contest which provides funds to states that successfully put forward groundbreaking, thoughtful plans to address four key educational reform areas.  While the full effects of “Race to the Top” remain to be seen, preliminary findings indicate that it has been successful in spurring innovation and improving in educational outcomes. A similar approach might better incentivize states to be more innovative by providing more concentrated support for their efforts to find homes for harder to place children.

Another idea might be to use the adoption bonuses as a way to incentivize certain policies and practices that have been proven effective in finding homes for children. For instance, provide rewards to states that use adoption recruiters as opposed to making finding an adoptive family one of the many tasks assigned to an overloaded caseworker.  Or grant bonuses to states that severely limit the use of an alternative planned permanent living arrangement (APPLA) for older youth.  Under this approach, the federal government might use the “carrot approach” to reward states that provide robust post adoption services, reduce the amount of time between termination of parental rights and the completion of adoption and engage in interstate adoptions.

We would like to thank Chairman Reichert for his leadership in dedicating the first subcommittee hearing of the 113 congress to such an important and impactful topic. We look forward to working with Members of Congress to explore these and other ways this important program might better serve its stated goal: to find families for waiting children.

CCAI Featured in Award-winning Documentary Film about International Adoption

STUCK_PosterArt_small

We are proud to announce that STUCK—an award winning documentary about international adoption—features CCAI’s Executive Director, Kathleen Strottman. As Kathleen explains in the documentary, which uncovers the personal, real life stories of adopted children and their parents, “the right to a family is a basic human right and our policies have to start recognizing that.”   The film also features CCA Co-Chair Senator Mary Landrieu, Senator Richard Lugar and Charles Nelson, Co-Principal Investigator of the Bucharest Early Intervention Project.

On March 1st, Both Ends Burning Founder Craig Juntenen will be launching a 60 city bus tour to promote the film and issue a call to action for the United States Government to promote international adoption as a worthy and effective way to find homes for children without families.

To view the trailer for STUCK, follow this link: http://vimeo.com/bebcampaign/stuckthemovie

To learn about how you can help spread the word about STUCK, click here: http://bothendsburning.org/involved/

CSPAN’s Washington Journal Features CCAI

Kathleen_CSPANOn Saturday, CSPAN’s Washington Journal interviewed CCAI Executive Director, Kathleen Strottman, about the Russian adoption ban, international adoption, and how Members of Congress can affect adoption and foster care issues. Click on the picture to watch the full interview or follow this link: http://www.c-spanvideo.org/program/310768-5