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
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 Fer-
nando 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 par-
ents, 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 emer-
gency 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
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 Pre-
vention 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 approach-es to addressing these issues. In the Senate, the Child
Protection and Family Support Act also includes aspects of Family First focused on parental substance
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
To receive federal advocacy communications on
the Academy’s work around child welfare and other
federal policy priorities, email firstname.lastname@example.org.
Heather C. Forkey, M.D., FAAP, a member of the AAP
Council on Foster Care, Adoption and Kinship Care
Executive Committee, discussed the impact of the
opioid epidemic on the child welfare system at a U.S.
House Heroin Task Force briefing.
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.