Overuse of Psychotropics in Foster Care

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.

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