For many children, Medicaid is a critical source of health and related support services, including both outpatient and inpatient mental health services. Medicaid supports the Early Periodic Screening, Diagnosis, and Treatment (EPSDT) program and also funds long-term mental health care for children who need more intensive or restrictive services, including hospitalizations and residential treatments. In recent years, federal spending on prescription medications has consumed a greater portion of Medicaid budgets. This can be partly attributed to growing Medicaid expenditures on new and more costly psychotropic medications for children – many of which have not been tested for use in this population.
In the Medicaid program, children in foster care are much more likely to use psychotropic medications than children who qualify for Medicaid through other aid categories. Admittedly, children who have been abused or neglected often have a range of unique physical and mental health needs, physical disabilities and developmental delays, far greater than other high-risk populations. For instance, foster children are more likely than other children who receive their health care coverage through Medicaid to experience emotional and psychological disorders and have more chronic medical problems. In fact, studies suggest that nearly 60 percent of children in foster care experience a chronic medical condition, and one-quarter suffer from three or more chronic health conditions. Roughly 35 percent have significant oral health problems. In addition, nearly 70 percent of children in foster care exhibit moderate to severe mental health problems, and 40 percent to 60 percent are diagnosed with at least one psychiatric disorder.
While children in foster care are more likely to experience behavioral difficulties, this alone cannot explain the range of poor prescribing practices documented for this population. Studies have shown that kids in foster care are prescribed psychotropic medications at rates 2 to 3 times higher than other children. A growing body of research citing questionable prescribing practices including polypharmacy, alarming dosages, use of psychotropics in treating infants, lack of adequate monitoring or appropriate therapeutic interventions and “off-label” use of antipsychotics for children and youth in foster care. These concerns are further supported by Government Accountability Office (GAO) reports issued in 2011 and 2014 on state practices around psychotropic medications for foster children.
Get Involved
- Join the First Focus network to receive updates and alerts on how you can help stem the overuse of psychotropics by foster youth
First Focus Resources
- Psychotropic Medication Use in Children on Medicaid
- Addressing the Health Care Needs of Children in the Child Welfare System
- GAO Releases New Report on Improving HHS Guidance to States in Addressing Overuse of Psychotropic Medications for Youth in Foster Care
- The President’s 2015 Budget: A New Initiative to Improve Behavioral Health Outcomes for Foster Youth
First Focus Campaign for Children Resources
- House Letter Supporting Overmedication Reform Initiative
- Caring for Our Kids: Are We Overmedicating Chilldren in Foster Care?
- The Financial and Societal Costs of Medicating America’s Foster Children
Other Resources
Federal
- ACF and CMS Demonstration to Address Over-Prescription of Psychotropic Medication for Children in Foster Care (HHS)
- HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions (GAO)
- Concerns Remain about Appropriate Services for Children in Medicaid and Foster Care (GAO)
- HHS Could Provide Additional Guidance to States Regarding Psychotropic Medications (GAO)
- Additional Federal Guidance Could Help States Better Plan for Oversight of Psychotropic Medications Administered by Managed-Care Organizations (GAO)
- HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions (GAO)
- Child Welfare Information Gateway Use of Psychotropic Medications
- Centers for Medicare & Medicaid Services (CMS) Summary of State Resources to Address Psychotropic Medication Use in Children in Foster Care
Academic
- Center for Health Care Strategies, Inc.
- CHOP Policy Lab
- Tufts University Multi-State Study on Psychotropic Medication Oversight in Foster Care
State Examples
- Psychotropic Medication Utilization Parameters for Children and Youth in Foster Care, Texas Department of Family and Protective Services and University of Texas at Austin College of Pharmacy
- Guidelines for the Utilization of Psychotropic Medications for Children in Foster Care, Illinois
- PsychDrugs Action Campaign, National Youth Law Center, California