Medical coverage is typically the most critical service for relative caregivers. A Louisiana worker noted that it was often more of a concern than the child-only TANF grant. The worker added that the relative will say, "I don't really need this but I need the Medicaid for the child." Staff in a Washington local office reported that they typically could arrange immediate Medicaid coverage for relative caregiver cases.
In Maryland, Oklahoma, and Washington, all children who receive child-only TANF payments are automatically covered by Medicaid. To receive medical coverage in Louisiana under KCSP or through kinship care in Wisconsin, the relative caregiver must contact a separate human service office, which is in charge of applications for Medicaid and the State Children's Health Insurance Program (SCHIP).
In Wisconsin, children in relative care receive Medicaid managed care, while children in foster care receive fee-for-service Medicaid. This situation creates challenges for children who transition from foster care to relative care. Because not all providers accept Medicaid managed care, children may need to change providers, especially for mental health care.
Well-child visits, vision and hearing screening, dental services and mental health services are covered by Medicaid under the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Few children are insured privately by their caregivers. Relative caregivers voiced complaints commonly heard among Medicaid populations regarding the dearth of providers in certain specialties, including psychiatrists, dentists, and orthodontists. As a Wisconsin grandmother noted, "This [Medicaid] service is very lacking. There are not doctors or dentists available that can provide services. Even if you have medical assistance, you can't get services for the kids."
Across the five states, informants noted that children in relative care often had distinct mental health needs. Unlike children in TANF households, children in TANF cases with relative caregivers are typically separated from their parents because their parents were incarcerated, abused alcohol and/or drugs, or their whereabouts were unknown. These children often have long-term issues stemming from sexual abuse, exploitation, and separation and attachment disorders, requiring counseling and therapy.
Informants noted that many relative caregivers lack the skills necessary to identify children's needs and locate appropriate services. Caregivers who lack knowledge of available services and who have no experience with maneuvering the Medicaid and welfare systems to receive needed services have particular difficulties.
|"Relatives have no recourse, unless they're pretty savvy to the system."
Child Welfare Worker, Washington
Although many informants reported that mental health and counseling services were needed, several factors limited access to treatment. These factors include a lack of providers who accept Medicaid, a lack of providers who provide quality care, long waiting times for appointments, and insufficient treatment for children's needs. These issues are further exacerbated for children living in rural areas where there is a lack of providers generally, children living with caregivers who lack transportation, and children in managed care.