Wyden Urges CMS, ACF to Act Now to Protect Kids in Residential Treatment Facilities from Taxpayer-Funded Abuse and Neglect

September 03,2024

Wyden Urges CMS, ACF to Act Now to Protect Kids in Residential Treatment Facilities from Taxpayer-Funded Abuse and Neglect

Washington, D.C. - Senate Finance Committee Chair Ron Wyden, D-Ore., today urged the Centers for Medicare & Medicaid Services (CMS) and the Administration for Children and Families (ACF) to use existing authorities to act now to protect and strengthen behavioral health services for children enrolled in Medicaid and who are in the child welfare system.

Wyden's letters to CMS Administrator Chiquita Brooks-LaSure and ACF Principal Deputy Assistant Secretary Jeff Hild follow his two-year investigation showing widespread abuse and lack of behavioral health care services inside residential treatment facilities (RTFs) funded by the child welfare system and Medicaid.

"I realize there are children whose needs are best served by residential care, but, in too many instances, children are not receiving that level of care nor an acceptable caliber of care in RTFs.Congress must legislate to address these harmful gaps and I am hard at work drafting legislation which will include provisions to: (i) invest in community-based alternatives for care, (ii) strengthen the oversight of congregate care facilities, and (iii) raise the floor for congregate care standards. Together, these policies will better ensure that every child across the country receives appropriate, high-quality behavioral health care in the setting that best fits their needs, as is their federally protected right," Wyden wrote in his letters to CMS and ACF. "In the meantime, I have identified meaningful actions that the ACF [and CMS] can immediately take that will improve children's lives. . . . I expect ACF and CMS to work in tandem on these efforts."

In June, Senator Wyden unveiled the finding from his two-year investigation of four major RTF providers - Universal Health Services, Acadia Healthcare, Devereux Advanced Behavioral Health, and Vivant Behavioral Healthcare - that uncovered widespread instances of abuse and neglect of children, despite receiving billions of dollars in federal funding from Medicaid and child welfare programs. Wyden's report, "Warehouses of Neglect" exposed the endemic harm to all children in RTFs created by these companies' business model which profits off of often keeping staff ratios low, hiring workers with inadequate educational backgrounds and training, and provisioning few services to children in order to maximize margins.

While Congress works to develop a long-term legislative solution that improves the lives of children covered by Medicaid and who are in the child welfare system, Wyden requested written updates from CMS and ACF by October 7 on how the agencies will work together to implement the following recommendations from Warehouses of Neglect:

• CMS and ACF can and should do more to prioritize and coordinate rules for spending on community-based behavioral health services as an alternative to placement in RTFs, if possible and safe.

• CMS and ACF should work together to clarify and streamline federal oversight requirements for RTFs.

• CMS and ACF can work collaboratively to center perspectives of youth with lived experience.

ACF should increase awareness for judges on the risks of improper placements in RTFs, the full continuum of care, and clinical best practices for treating children with behavioral health needs, particularly for children in foster care.

The letter text to CMS is available here.

The letter text to ACF is available here.

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