By Zach Laris, Bolder Horizon

The term “child welfare policy” can confuse as much as it illuminates. When first hearing it, many mistakenly think it’s about the generic wellbeing of children, or cash assistance. 

Child welfare policy is fundamentally about family trauma and child health. A new Georgetown CCF brief also shows that it’s integrally linked with Medicaid.

Child welfare policy is the collection of laws and funding focused on:

• Preventing and responding to child abuse and neglect.
• Avoiding unnecessary foster care by addressing family crises, including:
  • Unmet parental substance use disorder or mental health treatment needs;
  • Housing instability;
  • Domestic violence; 
  • Other forms of intergenerational trauma; and
  • Associated economic shocks and deprivation.
• Providing foster care when children can’t remain safely with their family. 
• Reconnecting family after foster care, through reunification, guardianship, or adoption.
• Helping young people who age out of foster care transition into adulthood.

Medicaid plays an important role across all of these situations, promoting health and also cultivating safe, stable, nurturing relationships to address the trauma children experience. 

Child welfare policy and practice rest on three foundational pillars: 

1. Safety. Protecting children from abuse and neglect, and intervening when it occurs.
2. Permanency. Ensuring children have a consistent connection to a stable family. 
3. Wellbeing. Helping children and families who experience trauma heal and thrive.

Medicaid is there every step of the way and is key to each of these core pillars.

Medicaid Keeps Children Safe

Medicaid improves child safety. Increased child health coverage, including through Medicaid, is associated with reduced substantiated physical abuse. Medicaid expansion for parents is associated with fewer screened-in child neglect cases.^, Medicaid’s comprehensive coverage promotes economic stability and prevents crises that lead to child welfare involvement.

Medicaid Promotes Permanency 

Medicaid makes durable family connections possible. By connecting parents to substance use treatment, it keeps families safely together and helps them reunify. That’s critical when at least a third of children are removed at least in part due to parental drug abuse. 

When children need foster care, the gold standard is kinship care; placement with grandparents or other relatives. These relatives often have limited financial means and may be retired. Medicaid covers children so grandparents can focus on love and support, not medical bills.

Children adopted from foster care often have significant special needs. Their categorical eligibility for Medicaid^, allows adoptive families to focus on providing a stable and supportive home. Without Medicaid, many would be unable to afford caring for the children they adopt.

Medicaid Advances Wellbeing

Healthy attachment relationships with caregivers are critical for child health and development. Trauma disrupts that attachment. Parents’ trauma increases risk for substance use disorders. Medicaid-funded treatment heals parents and children together, so they can thrive.

Medicaid covers over 99% of children in foster care.^,, The trauma they experienced increases their mental health needs, and Medicaid funds the services they need to heal. 

A study of the Family First Prevention Services Act (P.L. 115-123) found that implementing higher-quality residential care will require significant investment and support.^, Continued Medicaid investments for access are critical to avoid exacerbating an already challenging crisis.

Medicaid Strengthens Families 

Maintaining strong Medicaid investments is critical to supporting parents and keeping children safe. Foster, kinship, and adoptive families are more stable because of Medicaid coverage. 

Bipartisan policymakers just reauthorized Title IV-B of the Social Security Act, a key child welfare law. As policymakers consider Medicaid changes, this brief shows its role in child welfare. 

Zach Laris is a child welfare policy entrepreneur and writes the Child Welfare Wonk, a weekly child welfare policy newsletter. He founded and leads Bolder Horizon, a nonpartisan child welfare policy nonprofit. Previously he led the American Academy of Pediatrics’ child welfare policy and advocacy work. He received an MPH in Health Policy from George Washington University, writing his capstone about child welfare policy and youth mental health.