Policy Makers and Administrators

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​Policy Makers and Administrators

Perhaps no group of children is so fundamentally and intimately affected by government policies as children in foster care. State, federal, and local policies set the framework for determining when and how children may be removed from the home, what types of settings and services are available to them, and whether and how family reunification takes place. When children are taken into state custody, policymakers determine such basic issues as where they live, where they attend school, and what kinds of resources are available to heal the physical, mental, or emotional harm they may have suffered.

Several decades of research has firmly established that the health care needs of children in out-of-home care far exceed those of other children living in poverty. Despite the overwhelming evidence of need, studies consistently demonstrate that many health care needs for children in the foster care system go unmet.
AAP Policy Priorities for Children and Teens in Foster Care:
  • All children, including children in foster care, should have a medical home that is accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective. For children in foster care, a medical home can provide a crucial source of stability, continuity of care, and information.
  • Health care financing for children and teens in foster care should support child welfare goals of health, safety, and permanency.
  • The health care system must work in partnership with child welfare agencies to ensure that children in foster care receive the full range of preventive and therapeutic services needed, and participate in all federal and state entitlement programs for which they are eligible.
  • States should ensure that all children entering foster care have an initial physical examination before or soon after placement focused on identifying acute and chronic conditions requiring expedient treatment. All children in foster care should receive comprehensive physical and mental health and developmental evaluations within 1 month of placement.
  • Financing should reimburse health care professionals for the more complex and lengthy visits that are typical of the foster care population. Financing must also cover the cost of the health care management to ensure that this medically complex population receives appropriate and timely health care services.
  • Financing should provide a structure within which accountability occurs, including tracking compliance with health care standards, ensuring the quality of services, ensuring frequent communication among all parties involved in the child's care, promoting fiscal management, and ensuring confidentiality.
  • Congress and the states should establish universal presumed eligibility for Medicaid at entry to foster care, including children in kinship care. Moreover, insurance coverage should extend automatically beyond foster care for 12 months. All states should extend Medicaid coverage to teens exiting foster care to age 21, as provided under the Chafee Foster Care Independence Act.
  • Child welfare agencies and health care providers should develop and implement systems to ensure the efficient transfer of physical and mental health information among professionals who treat children in foster care.
  • Financing should include funds for developing family-based approaches to mental health and developmental services.
  • Health insurance for children and teens in foster care must include a comprehensive benefits package, such as the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) package, to cover the wide array of services needed to ensure optimal physical, emotional, developmental, and dental health.
  • Congress should support research into foster care health issues, including systems, utilization, services, and quality, to ensure that future improvements are evidence-based.
To access tools, resources, and links to support policymakers as they learn about the health issues and needs of children and teens in foster care, visit the Resource Library​ and search by the audience "Policymakers and Administrators".
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