MEDICAL EXPENSES
Another category of barriers that interferes with effective
performance of interjurisdictional responsibilities is difficulties in obtaining funding for educational or medical expenses for
children waiting for, or already in, interstate placements.5 This section describes
strategies that States use to address such difficulties and evaluates the effectiveness of these strategies, supports needed at the national or Federal level to
implement additional strategies, and
open-ended responses that provide additional information on how States implemented specific strategies.
5Although these two types of expenses are the most common
monetary issues posing barriers to interstate placements, other types of funding needs may pose barriers to interjurisdictional placements. For example, one State reported that the cost of visitation with parents and siblings was another funding issue that created a barrier to such placements.
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A summary section highlights the significant findings related to overcoming barriers to interjurisdictional work created by funding issues for a child’s educational or medical expenses.
3.4.1 Assessment of Strategies Used to Address Education or Medical Funding Issues
The survey listed 12 strategies that States could use to resolve problems in obtaining funding for educational or medical
expenses for children placed out of State. Most of the
responding States use at least half of the strategies listed; 17 use between 10 and 12. Six States use fewer than seven strategies. States that use fewer strategies may be effectively targeting the ones that they believe will benefit children the most. The States that use most of the strategies may have more resources to try multiple methods to overcome funding issues for medical and educational expenses.
The left box on Figure 3-7 shows that 80 percent or more of States use the top six strategies:
As sending State, provide coverage for medical
expenses for non-Title IV-E children placed in another State (92 percent).
As receiving State, specify availability and accessibility of resources to meet a referred child’s needs (90 percent).
As receiving State, offer Medicaid coverage as part of Temporary Assistance for Needy Families (TANF) child- only grants for children in relative placements
(88 percent).
As receiving State, provide Medicaid to children
receiving State-funded adoption assistance from another State residing in our State (85 percent).
As sending State, provide coverage for additional medical costs not covered by Medicaid for Title IV-E children placed in another State (85 percent). As receiving State, cover educational expenses of
3-3 5 Se ction 3 — Surve y Find ings
Figure 3-7. Assessment of Strategies to Address Funding Issues for Educational or Medical Expenses
85 88 90 92 83 85 79 67 58 50 48 21 0 10 20 30 40 50 60 70 80 90 100
Place information on State’s Web site regarding coverage of medical and educational expenses of children placed in State from other States Generally cover medical expenses not covered by sending
States for children lacking Title IV-E eligibility Change State law/policy to allow foster children or children in pre-adoptive placements to be considered residents of State for purposes of the provision of education Develop process for resolving interstate issues with educational and medical expenses in a timely manner Fund the educational expenses of children placed in foster care
or pre-adoptive placements in other States Include a form indicating our expectations as to how medical
and educational expenses will be covered when referring a child for placement in another State Cover educational expenses of children sent from other States Provide coverage for additional medical costs not covered by
Medicaid for Title IV-E children placed in another State Provide Medicaid to children receiving State-funded adoption
assistance from another State residing in our State Offer Medicaid coverage as part of TANF child-only grants for
children in relative placements Specify availability and accessibility of resources to meet a referred child’s needs
15 13 10 8 0 0 0 0 0 0 0 79 52 50 42 33 21 15 17 0 0 10 20 30 40 50 60 70 80 90 100 50 25 31 50 60 21 69 15 25 50 54 23 42 33 33 21 8 40 33 6 25 19 8 10 18 44 39 48 54 75 77 75 84 81 81 75 8 4 2 6 6 2 25 8 8 2 2 35 21 56 10 33 12 6
Total % Use Strategy % Very Effective % Somewhat Effective
Total % Don't Use Strategy % Need Assistance % Currently Investigating
Use Strategy (%) Don’t Use Strategy (%)
Provide coverage for medical expenses for non-Title IV-E children placed in another State
The denominator for each percentage shown is based on the total number of States reporting data for that strategy. For Use Strategy, the gap between each pair of upper and lower bars represents the percentage of States that reported strategy use with a rating of “ineffective” or “don’t know.” For Don’t Use Strategy, the gap between each pair of upper and lower bars represents the percentage of States that do not use the strategy and have no plans to implement. For further explanation, see “Guide to Figures for Assessment of Strategies” on page 3-3.
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Overall, the 12 strategies addressing barriers related to funding of educational and medical needs can be categorized as follows:
Strategies that sending States use to pay for children’s
educational needs
Strategies that receiving States use to pay for children’s educational needs
Strategies that sending States use to pay for children’s
medical needs
Strategies that receiving States use to pay for children’s medical needs
Policy or procedural strategies to improve funding of educational and medical needs of children in interstate placements
Results related to these strategies will be discussed under these five categories.
Sending States meeting cost of educational needs
Two-thirds of responding States fund the educational
expenses of children whom they send to other States
when necessary. Of the 32 States that fund educational expenses of children placed out of State, 16 assessed this strategy as very effective and 10 rated it as somewhat effective. One State’s response reiterates the salience of this strategy: “Funding of educational expenses in other States is
the only way to assure the child receives requested services.”
Another State described their acceptance of this fiscal responsibility as follows: “Based on ICPC requirements, our
State placing agencies are made aware [that] we are responsible for all costs related to education not otherwise covered.”
Receiving States meeting cost of educational needs
Of the 48 reporting States, 40 (83 percent) cover educational
expenses of children sent from other States—a strategy
that most respondents assessed as very effective (26 States) or somewhat effective (11 States). In open-ended responses, a number of States reported that they treat children placed into their State as residents and do not require payment from the sending State for education. This practice was described by one State in these words: