Abused and neglected children in Tennessee will suffer from Medicaid cuts proposed under the Senate health care bill, warned state child welfare advocates on Monday, painting a potentially dire picture of victims without access to treatment and a deepening of an opioid crisis that has pushed more kids into foster care because they lack a functioning parent.
TennCare, the state's version of Medicaid, is the principal provider of medical, mental health and special-needs services for about 8,000 kids in foster care, most as a result of abuse or neglect.
The Senate bill, unveiled Thursday, caps the amount of federal dollars sent to states to support their Medicaid programs. Proponents say the measure gives states more flexibility to decide how they spend those federal dollars, while detractors say it will require states to foot a larger share of the bill. Many states, including Tennessee, may be forced to make deep cuts in their Medicaid programs.
How the Senate health care bill impacts Tennessee and other states
Linda O'Neal, executive director of the Tennessee Commission on Children and Youth, foresees a "substantial impact on some of the children who are most vulnerable in Tennessee."
TennCare spending has been vital for substance abuse treatment and the care of babies born exposed to drug abuse in utero, O'Neal said. After years of alarmingly escalating numbers of babies born with neonatal abstinence syndrome after such drug exposure, those births are leveling off in part due to substance abuse services provided through TennCare, she said.
TennCare also funds substance abuse treatment programs for adults that can help keep families together, preventing a spiral into addiction that can lead to parents neglecting or abusing a child.
TennCare funding is intertwined in a broad swath of nonprofit, public policy, adoption, private and public services, including the Department of Children's Services, that is aimed at preventing child abuse and aiding its victims.
Those include services that the Davidson County Juvenile Court relies on, said Judge Sheila Calloway, who described as one example the recent case of a child she called "Baby M."
The 2-year-old was severely abused by parents and caretakers addicted to cocaine and heroin, and will need a lifetime of medical care, she said. Today the child is with a family pursuing adoption and is receiving treatment through TennCare. As it stands now, TennCare also will provide funding for adoptive families to care for their children that could be cut under the new plan, advocates said.
"If there are cuts, I can't imagine what would happen to Baby M or others like him," Calloway said.
Neither of Tennessee's two Republican senators made a final decision on whether they will cast their vote for the health care legislation. Sen. Bob Corker said his final decision would be based on whether the proposal was better than the Affordable Care Act, in place today. Sen. Lamar Alexander has said he believes thousands of Tennesseans will be better off under the bill, but he, too, wants more time to review the bill before making a decision.
Tennessee has just begun to create a series of programs to end the cycle of abuse and neglect caused by adverse childhood experiences such as trauma. Those programs rely, in part, on Medicaid funding.
"With these cuts ... we won't be able to implement any of that," said Lynne Farrar, executive director of the Tennessee CASA, which advocates for children in the court system. "That is very, very sad. It's very disappointing that we are making giant strides in the state of Tennessee ... only to face very deep, tragic cuts."