June 2009 Issue Guide & Events

CABWHP publishes issue guides with thorough analyses of health policy issues addressing mental, emotional and physical health. Our Issue Guides are distributed via mail to Policy Advisory Group members and to over 2,000 colleagues and organizational collaborators.

The Foster Care Crisis:
An Advocacy Priority for Black Women

While May is National Foster Care Awareness Month, CABWHP believes that every month should be Foster Care Awareness Month. Of the more than 513,000 children in foster care in the United States, nearly 75,000 live in California and an overwhelming 27% of California's foster children are Black. With almost 40% of Black children referred to child welfare services in 20061, the Black community must ask why our children are being referred to (and placed in) the system at such alarming rates. This issue greatly impacts the health and well-being of Black women and our families. There are new policy developments in foster care on both the state and federal levels that will help improve outcomes for the young people and families directly impacted by foster care.

Overview: Black Children and Teens in the Foster Care System

Black children are disproportionately represented in the foster care system. In 2006, 7% of California's children were Black, yet Black children constituted 15% of maltreatment referrals and 27% of children in child welfare supervised foster care.2 By their seventh birthday, almost 40% of Black children have been referred to child welfare services and nearly 10% placed in foster care3. In California, 81% of all children entering the foster care system were removed from their homes for neglect-related reasons.4 Furthermore, Black parents in California are more likely than White or Latino parents to be reported for abuse and, if reported, their children are more likely to be placed in foster care. They are also less likely to be reunified with their children than parents of other races.

While children of all races are equally as likely to suffer from abuse and neglect;5 HHS data show that a significantly greater proportion of Black children enter and remain in foster care than children of other races and ethnicities. Black children across the nation were more than twice as likely to enter foster care compared with white children in 2004, and remained in foster care about 9 months longer.6

According to the United States Government Accountability Office (GAO), poverty is a leading factor in the removal of children from their homes into foster care, especially in the case of Black children. Families living in poverty have greater difficulty accessing housing, mental health, and other services needed to keep families stable and children safely at home. Bias or cultural misunderstandings and distrust between child welfare decision makers and the families they serve also contribute to children's removal from their homes and placement into foster care. For example, if a child requires medical attention but his/her parents are unable to find treatment due to a lack of health care benefits for the child, the parents' inability to provide care can be misinterpreted as neglect. Many Black children remain in foster care longer because of difficulties in recruiting adoptive parents and a greater reliance on relatives to provide foster care. These relatives may: (1) be unwilling to terminate the parental rights of the child's parent (as is required in adoption); or (2) need the financial subsidy they receive while the child is in foster care.7

Health Care Challenges

Children in foster care have disproportionately high rates of physical, developmental, and mental health problems and often have many unmet medical and mental health care needs. According to the American Academy of Pediatrics:

Compared with children from the same socioeconomic background, [foster children] have much higher rates of serious emotional and behavioral problems, chronic physical disabilities, birth defects, developmental delays, and poor school achievement. Moreover, the health care these children receive while in placement is often compromised by insufficient funding, poor planning, lack of access, prolonged waits for community-based medical and mental health services, and lack of coordination of services as well as poor communication among health and child welfare professionals.8

Nearly 50% of foster children suffer from chronic health conditions such as asthma, visual and auditory problems, dental decay and malnutrition9. Due to their minimal support network, these children may go without the basic treatment they need to maintain good physical health. Foster children also experience a great deal of trauma due to separation from their families. Furthermore, current statistics show that as many as 75% of children in foster care have been sexually abused10. Many times sexual abuse is not indicated in a child's file because the child has not trusted anyone enough to share this secret. These traumatic experiences impact their health, including their mental health. 50-60% of foster youth have moderate to severe mental health challenges.11 Most go untreated and these youth carry these challenges with them as they transition into adulthood.

Challenges for Emancipated Foster Youth

Once foster children reach 18 years of age, they are often forgotten. Foster youth transitioning into adulthood face different challenges because they lose the minimal benefits that they received as children in the system. In California, over 5,000 children "aged out" of foster care placements between July 1, 2007 and June 31, 2008. This means that because these youth reached 18 years of age, they became ineligible to receive the resources that were available to them when they were minors. As a result, many of these young people graduate from high school into homelessness. In fact, within 18 months of emancipation, 40-50% of former foster children become homeless12.

Incarceration is also a significant challenge for emancipated foster youth. According to the May 12, 2006 Select Committee Hearing of the California Legislature, over 70% of all state penitentiary inmates have spent time in the foster care system13. Moreover, 25% of former foster youth will be incarcerated within the first two years of emancipation14. These shocking statistics are examples of how the system is failing our youth and families. Despite their classification as "adults," these emancipated foster youth need ongoing support as they transition into the next phase of their lives without a traditional family network to rely on.

Health Care Coverage for Emancipated Foster Youth

In order to alleviate some of the difficulties that emancipated youth face, the state of California has implemented a federal Medicaid option that provides Medi-Cal for youth who age out of foster care. Under this option known as Extended Medi-Cal Eligibility for Former Foster Care Children (FFCC), youth in foster care on their 18th birthday are eligible for Medi-Cal coverage with no share of cost (free to the youth) until their 21st birthday, regardless of income, resources, or living arrangement. The county must transition youth to the extended Medi-Cal program without requiring completion of an application. The purpose of FFCC is to provide continuing health coverage and continuity of care for youth who have been in foster care.

Nevertheless, Medi-Cal has been denied to youth who did not return re-determination forms on time, failed to fill out the forms correctly, or never received the papers because they were sent to the wrong address. The current re-determination process interrupts health care coverage for youth and also wastes valuable resources. Furthermore, the current budget cuts that are slated to go into effect on July 1, 2009 will dramatically change the care that is offered through Medi-Cal. Some changes include the elimination of dental, podiatry and psychological care among other benefits that will no longer be available to adults who qualify for Medi-Cal, including emancipated foster youth15. These youth need us to advocate for them so they can receive the health care they need and deserve.

Recent Legislative Developments

In October 2008, the federal government enacted the Fostering Connections to Success and Increasing Adoptions Act (Public Law 110-351). This new law gives states the ability to establish relative guardianship programs with federal financial participation in the costs. It also makes federal funds available for foster care, kinship-guardianship, and adoption assistance benefits to youth who meet certain conditions (e.g., employment and education-related requirements) until age 21. This legislation provides California with an unprecedented opportunity to access federal funding to improve the lives of our state's most vulnerable youth.

The California Fostering Connections to Success Act (AB 12) was introduced on December 1, 2008, by Assembly Speaker Karen Bass and Assemblymember Jim Beall, Jr., with several additional co-authors. AB 12 would ensure that California opts into the essential federal funding opportunities offered through PL 110-351. AB 12 would: 1) re-enact our existing Kin-GAP program, which exists to provide essential support for foster children who live with relative guardians; and 2) provide transitional support to qualifying foster youth until age 21. These changes represent both fiscally and socially responsible improvements to California's foster care system. As a result, California would utilize federal funds to meet costs currently borne by the state and counties, and would realize proven savings from declines in unemployment, homelessness, teen pregnancy, public assistance, and the other costly outcomes for young adults who "age out" of foster care.

In April, the Assembly Committee on Human Services voted unanimously in favor of AB 12 and re-referred the bill to the Committee on Appropriations. In late May, the Appropriations Committee hearing was postponed. If you are in support of this legislation, now is the time to let your legislators (including members of the Assembly Appropriations Committee) know. Amidst the budget crisis facing our state, we must be sure to advocate for the issues about which we feel strongly.


The foster care system is failing our children and impeding the health and wellness of Black women and Black families. Families are being torn apart, leaving children with physical, emotional and mental health problems that need prompt medical attention. Foster youth are OUR youth and the Black community needs to prioritize the needs of these young people (before and after they emancipate.) We must fight to ensure that they have safe and positive living conditions that are free from exposure to violence, sexual abuse, homelessness and incarceration. We must continue to educate policymakers and the community about their needs. The recent federal and stage legislation discussed above is a step in the right direction. However, we must continue to advocate on behalf of foster youth for more policy solutions to improve their lives before and after they "age out" of the system.



1 "Improving the Lives of California's Children: Child Welfare in California, Facts at a Glance" http://www.chhs.ca.gov/initiatives/CAChildWelfareCouncil/Documents/ImprovingTheLivesOfCaliforniaChildrenAndFamilies.pdf

2 "Improving the Lives of California's Children: Child Welfare in California, Facts at a Glance" http://www.chhs.ca.gov/initiatives/CAChildWelfareCouncil/Documents/ImprovingTheLivesOfCaliforniaChildrenAndFamilies.pdf

3 "Improving the Lives of California's Children: Child Welfare in California, Facts at a Glance" http://www.chhs.ca.gov/initiatives/CAChildWelfareCouncil/Documents/ImprovingTheLivesOfCaliforniaChildrenAndFamilies.pdf

4 "Improving the Lives of California's Children: Child Welfare in California, Facts at a Glance" http://www.chhs.ca.gov/initiatives/CAChildWelfareCouncil/Documents/ImprovingTheLivesOfCaliforniaChildrenAndFamilies.pdf

5National Incidence Study of Child Abuse and Neglect (NIS), "Black Children in the Foster Care System" http://www.gao.gov/new.items/d07816.pdf

6 African American Children in the Foster Care System http://www.gao.gov/new.items/d07816.pdf

7 African American Children in the Foster Care System http://www.gao.gov/new.items/d07816.pdf

8 Health Care for Young Children in Foster Care http://aappolicy.aappublications.org/cgi/content/full/pediatrics;109/3/536

9 "Our Children: Emancipating Foster Youth," 4 http://www.ccspartnership.org/pdf/OurChildrenActionGuide.pdf

10Adoption and Sexual Abuse http://foster-child.adoption.com/parents/sexual-abuse-2.html

11 "Our Children: Emancipating Foster Youth," 4 http://www.ccspartnership.org/pdf/OurChildrenActionGuide.pdf

12 "Our Children: Emancipating Foster Youth," 3 http://www.ccspartnership.org/pdf/OurChildrenActionGuide.pdf

13 July 12, 2007 Statement of the Record, House Committee on Ways and Means http://waysandmeans.house.gov/hearings.asp?formmode=printfriendly&id=6359

14 "Our Children: Emancipating Foster Youth," 4 http://www.ccspartnership.org/pdf/OurChildrenActionGuide.pdf

15 Western Center on Law and Poverty: "The State Budget's Impact on the Medi-Cal Program and Other Services for Poor Californians" http://www.wclp.org/Resources/WCLPContent/WCLPContentSearch/tabid/1131/smid/3613/ArticleID/236/reftab/1133/Default.aspx