Consistent Health Care and Coverage: Why Upstream Supports Matter for Family Wellbeing

Access to consistent health coverage and a comprehensive array of community-based supports is one of the most effective ways to promote children’s health and wellbeing – and to prevent families from being pulled into systems designed to respond to crisis rather than support children’s health. When families can access the care and services they need early and consistently, health needs are addressed before they escalate, parental stress is reduced, and families are better able to support their children at home and in their communities.

Yet for many families, policy choices make access to consistent coverage and care difficult or impossible, leaving families without the supports necessary to respond to their children’s health needs. Across our work with states, we see parents doing everything in their power to access care – navigating complex systems, managing high costs for services, appealing denials, waiting months for care – only to encounter more barriers that delay or deny them supports altogether.

Inadequate access to care can create conditions that can lead to child welfare involvement. For children and youth with special health care needs, including chronic physical, developmental, behavioral, and emotional needs, these barriers to care can be especially consequential. When care is delayed or interrupted, children’s needs often intensify rather than resolve. As health needs go unmet, families experience increasing stress and instability – not because they are unwilling or unable to care for their children, but because the systems meant to support them are failing to do just that.

When health care systems fail to meet the needs of families, children are more likely to come into contact with deep-end systems like child welfare. In these cases, child welfare involvement is not a response to maltreatment, but to unmet health and mental health needs that should have been addressed earlier and outside of the child welfare system. Across our work with public systems, we see the impact of these systemic failures when families cannot access the services and supports their children need. These failures are not isolated. Research shows, that children and youth with higher health needs are more likely to enter foster care for what many child welfare systems categorize as “caretaker inability to cope,” a term that often reflects families’ lack of access to adequate health care, care coordination, and community-based supports.

Child welfare involvement should not be the solution to meeting a child’s mental health needs. In some circumstances, entering foster care creates access to services that families could not obtain while their children were at home, forcing them to make a false choice between keeping their children at home without the health services they need and giving custody to the child welfare system in order to access health services. Treatment slots (including for a range of therapies or beds in residential facilities) may be prioritized for children in foster care, or the state’s Medicaid plan for children in foster care may include benefits that are more robust and not available to other children. But this dynamic reflects a failure of health care and coverage policy– which leads to inadequate upstream systems and an inappropriate role for child welfare.

Additionally, entering foster care and gaining access to heal services does not always result in a child having their needs met timely or holistically. When children and youth enter foster care, systems often experience delays in providing care. Often, administrative processes related to their entry into care and enrollment in the appropriate Medicaid coverage plan can interrupt care. Professionals, often without full knowledge of a child’s medical history or established providers – must navigate the same provider shortages and waitlists that families face. And while the child’s health coverage may have changed, there are often requirements for new assessments that result in further delays and needs continuing to go unmet. Child welfare systems are not designed to prevent health needs from escalating, to provide ongoing health and behavioral health care, or to support family wellbeing over time.

Asking child welfare systems to respond to unmet health needs places families in an untenable situation and often causes more harm. Family separation is inherently traumatic, and many children and youth experience new or worsening behavioral health challenges during their time in foster care—often due to separation from caregivers, placement instability, and frequent moves. Children and youth in care are three to four times more likely than their peers to be diagnosed with behavioral health conditions, including anxiety and depression – conditions that are often a result of their removal or exacerbated by their experiences in care -and child welfare leaders have acknowledged the system’s inability to effectively care for children who come into foster care for mental health needs.

Children and families deserve better. They should not have to experience a lack of access to adequate health care, care coordination, or community-based supports that can lead to poor health and child welfare involvement. Rather their health, behavioral health, and family support needs should be met by upstream systems that are meant to support families. Preventing unnecessary child welfare involvement requires investing upstream in the systems designed to promote health and wellbeing. It requires comprehensive health coverage, robust Medicaid benefits, effective care coordination, and accessible therapeutic and family supports. When families have access to these supports, children are more likely to remain healthy and cared for at home, caregivers are better able to meet their children’s needs, and families are not forced into systems never designed to serve as a pathway to care.