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Proposed Medicaid Cuts Pose Threat to Child Welfare System

Michael Conroy
Dental resident Madison Myers Galloway checks the teeth of Justin Perez, 11, during an office visit in Indianapolis. Health care advocates worry proposed health care changes could take away coverage for children.

Child advocates warn that Senate Republicans’ latest proposal to repeal the Affordable Care Act could threaten child welfare funding. Cuts to Medicaid, advocates said, could force states and counties to divert limited child welfare dollars to cover the cost of health care to children in out-of-home placement.

In Allegheny County, Medicaid covers all 1,500 children in foster care. According to three analyses in recent days, the Graham-Cassidy bill would cut federal funding for Pennsylvania’s Medicaid program by an estimated 19 to 25 percent between 2020 and 2026.

The analyses came from the federal Centers for Medicare and Medicaid Services, Kaiser Family Foundation and Avalere Health, a Washington-based health policy consulting firm. The nonpartisan Congressional Budget Office has said it won’t be able to assess the plan’s impact before September 30, the last day the Senate may approve the measure.

States are legally obligated to meet the health care needs of children who have been removed from their homes. Depending on the extent of proposed Medicaid cuts, states and counties could be forced to divert limited child welfare dollars to the cost of healthcare, according to KidsVoice Executive Director Scott Hollander.

“This effort to try to cut costs is trying to do so on the backs of abused and neglected children,” Hollander said.

KidsVoice provides legal representation to children in Allegheny County’s child welfare system. The children tend to have severe health needs due to past trauma and neglect, according to Hollander.

Hollander said the issue has received little attention from policymakers at a time when child welfare budgets nationally have not been growing and could also face cuts.

“When people think about who receives Medicaid and entitlements,” he said, “no one’s thinking about children who are abused and neglected and are part of the child welfare system.”

The Director of Allegheny County’s Department of Human Services, Marc Cherna, said the proposed cuts to Medicaid would also harm children through their impact on parents. For example, he said, if the Graham-Cassidy bill limits Medicaid funding for substance abuse treatment, parents who struggle with addiction might not be able to care for their children.

Cherna said his biggest concern about the Graham-Cassidy bill is that the county could be forced to ration care for children and other vulnerable populations such as seniors and the intellectually disabled.

An-Li Herring is a reporter for 90.5 WESA, with a focus on economic policy, local government, and the courts. She previously interned for NPR Legal Affairs Correspondent Nina Totenberg in Washington, DC, and the investigations team at the Pittsburgh Post-Gazette. A Pittsburgh native, An-Li completed her undergraduate studies at the University of Michigan and earned her law degree from Stanford University. She can be reached at aherring@wesa.fm.
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