Conclusion
States can use policy options under Medicaid to alleviate the problems
for families of children with mental and emotional disorders who cannot
obtain the services they need to keep their child at home. However, these
tools—the TEFRA eligibility option and the home- and community-based
waiver—are greatly underutilized.
Many more states could utilize the home- and community-based waiver,
and state concerns about implementation of such a waiver are not borne
out in practice by the three states that have them. Waiver costs can be
modest and controlled, and can easily offset alternative institutional
costs, while helping families who might otherwise be forced to give up
custody of their child to the state.
The TEFRA option provides another important tool to avoid custody relinquishment.
It could benefit even more families than a home- and community-based waiver
because it is an entitlement for all eligible children. Yet few states
have the TEFRA option and even those that do could improve their policies
to help more families. Few children benefit from TEFRA and children with
mental or emotional disorders benefit even less, whether because of state
rules, omissions in state policy, deficient parent-education materials
or misinformation from state officials who do not understand the program.
The purpose of this guide is to give family advocates and policymakers
the information they need to change this bleak picture. We hope they will
use this report, and the attached fact sheets and other information, to
educate state decision-makers on how TEFRA or a home- and community-based
waiver can benefit many children and families while still being a cost-effective
approach for the state.
Federal Medicaid law offers the states options that could greatly alleviate
the inhumane practice of sending parents and children to court and putting
them on trial for their inability to get help for a mental health problem.
Children and their families should not be punished for having a mental
health condition. Instead, states should make full use of federal Medicaid
options and waivers to serve children with mental and emotional disorders
in their homes and communities.
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