NAMD Testifies on Pharmaceutical Treatment Issues for Children in Foster Care

December 1, 2011- NAMD Director Testifies Before Senate Committee on Pharmaceutical Treatment Issues for Children in Foster Care 

Washington, D.C. – National Association of Medicaid Directors (NAMD) Executive Director Matthew Salo today testified before the Senate Homeland Security and Government Affairs Committee’s Subcommittee on Federal Financial Management, Government Information, Federal Services, and International Security during a hearing focused on the financial and societal costs of medicating America’s foster care children. Mr. Salo told the committee that pharmaceutical coverage and expenditures have been a large and growing concern of the Medicaid Directors for a number of years, particularly psychotropics which pose a unique concern primarily because the trends in costs and utilization are far outstripping every other baseline.

NAMD’s Director discussed the particular concerns for foster care children in the Medicaid program, including some of the findings in the report released by the Government Accountability Office, entitled “Foster Children: HHS Guidance Could Help States Improve Oversight of Psychotropic Prescriptions.” He noted while psychotropic medications show enormous promise in treating a wide variety of serious conditions, there are concerns about how current prescribing patterns can negatively impact the foster care population. He went on to urge policymakers to ensure valid comparisons are made before drawing conclusions.

In discussing the challenges and complexities of this issue, Mr. Salo told the Subcommittee. “There are unfortunately a number of reasons why state oversight policy, or medical practice may have failed to keep up with the ever changing literature or other developments. These are not meant to be excuses for failure to act, but indicative of the breadth of the challenges that face systemic reform. Furthermore, it cannot be stressed enough how unique are the challenges faced by the children in the foster care system.”

Several states were part of the GAO study and all have been undertaking efforts to address the identified shortcomings. Mr. Salo noted that there is a need for broader systemic reform.

“There are a number of solutions that can and should be implemented to help improve this situation. 1) The GAO report recommends promulgating additional federal guidance from HHS to the states; 2) More clinical research is needed on the effects and implications of treating children of any age and in any situation with psychotropics that have only been tested on adults; 3) More work needs to be done to break down the barriers to coordinating and integrating care for vulnerable populations in Medicaid, with an added focus on the varied, complex and challenging behavioral health conditions experienced by children in foster care; 4) While Medicaid coverage and payment policy can and should change, many of the challenges in this issue are medical policy issues, and as such, require the broader medical community to also adapt; and 5) NAMD, working collaboratively with key partners such as the Medicaid Medical Directors and the State Mental Health Program Directors can develop and disseminate best practices in this area and work with states to implement them.”