Stock image of young child
Proposed legislation would dramatically alter North Carolina’s child welfare policies.

With opioids abuse fueling a dramatic increase in children entering North Carolina’s foster care system, one child advocacy group is calling for Medicaid expansion as the best way to stifle this trend.

NC Child, a Raleigh-based organization that advocates for “public policies to ensure all children – regardless of race, ethnicity or place of birth – have the opportunity to achieve their full potential,” issued a  report Wednesday on the opioid-driven foster care crisis and its proposed solution.

“Substance use disorder is a tragic disease that can tear apart families and leave children without stable, nurturing homes,” said Whitney Tucker, research director at NC Child and the report’s author.

“The opioid epidemic is driving this crisis to a new level in our state. … Closing the health insurance coverage gap won’t end the opioid crisis, but it’s a powerful strategy that we can implement immediately to help thousands of uninsured parents get the treatment they need to keep their families together.”

NC Child compiled data showing that between 2007 and 2017, there was a 13 percent increase in cases in which parental substance abuse factored into out-of-home placements for children.

More than 16,500 North Carolina children were in Department of Social Services custody in 2017, with substance abuse cited as a factor in nearly 40 percent of those placements, according to NC Child.

Within the past two decades, the amount of time children in foster care typically spend in such placements increased from typically less than a year in 2000 to 15 months in 2016, with the median rising to 17 months for children younger than 6.

Falling into coverage gap

The report’s authors said North Carolinians with a mental health diagnosis or substance abuse issues who fall into the Medicaid “coverage gap” — those who make too much money to qualify for Medicaid but can’t afford to purchase insurance on their own and would be eligible for Medicaid if the program’s income requirements were expanded in the state — number nearly 145,000.

The report argues that expanding Medicaid eligibility in the state would benefit parents with substance abuse problems and, by extension, their children, providing greater access to treatment programs.

The report cites U.S. Government Accountability Office statistics that show that, of recipients of Medicaid under the program’s federally funded expansion in four of the states hit hardest in the opioid epidemic —West Virginia, Iowa, New York and Washington — 20-34 percent of beneficiaries were seeking mental health or substance abuse treatment.

The report’s authors supported HB662, a proposed North Carolina law that would expand Medicaid in the state under a program called “Carolina Cares.” That program would expand Medicaid coverage in the state to those earning 133 percent of the federal poverty limit and close the coverage gap.

The Carolina Cares program also includes a work requirement for recipients, which the NC Child report argues would be “an unnecessary bureaucratic hurdle for families in need of lifesaving insurance coverage.”

Tucker told CPP that, in addition to the Carolina Cares proposal, the child welfare reform bill that passed the state legislature in 2017 included some important provisions that would reform North Carolina’s child welfare system by allowing for changes to the structure of county-level DSS agencies, allowing those organizations to consolidate, if they chose to do so, by requiring social workers to observe a parent’s interaction with a child twice before reunification and by giving the state “greater authority to enforce performance standards.”

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Michael Gebelein was an investigative reporter with Carolina Public Press. To contact Carolina Public Press, email or call 828-774-5290.

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