Money, Class, Politics and Foster-Parenting

A superb article by Benjamin Dueholm in Washington Monthly about Foster Parenting and its connection to politics and a whole host of other things. Well worth a read:

In a way that we never really anticipated, welcoming Sophia into our home led us into the wilderness of red tape and frustration navigated every day by low-income parents who struggle to raise children with the critical help of government programs. That same week, the office of the bone specialist who had treated Sophia's broken leg at the hospital tried to get out of scheduling her for an urgent follow-up appointment. Like many medical practices, his endeavored at all costs to avoid working for Medicaid's paltry reimbursement rates. (The office went so far as to deny ever having treated her; eventually, however, they gave in.) We went through a similar amount of stress trying to put Sophia into daycare. We had to run down a pile of government paperwork, prove our employment, and then simply wait and hope that our daycare center would accept the state's stingy pay. And yet, frustrated as we were, we couldn't exactly blame the doctors and daycare providers for being heartless. As the state's stinginess pushes more of the costs of caring for foster children onto them, it's no surprise that they start to balk.

It's a major bureaucratic process to remove a child from her home and family. The state insures the child, pays for daycare, investigates the claims of abuse, and retains legal custody, but it cannot actually put a baby to bed at night. And so, on the other side of this most intimate public-private partnership are usually people like us, left alone with a stranger's child and a garbage bag full of clothes and wondering what's going to happen next. And what happens next depends, to a stomach-churning degree, on the state's willingness and ability to keep up its half of the bargain.

So it was with an unusual sense of urgency and dread that our family watched the 2010 Republican wave and the austerity budgeting that has followed in ceaseless progression. When Paul Ryan's budget, approved by 235 Republicans in the House, proposed dramatic cuts to federal Medicaid spending, it was as if they were trying to make it even more hopeless for us to find a doctor to treat Sophia's health problems. When Scott Walker in Wisconsin sought to cut the workforce that administers foster care in his state, we went up to Madison to join the protests in solidarity, because we knew how helpless we would be if there were no caseworker on the other end of the phone to answer our own urgent pleas for help and guidance. And the threats have continued, as House Republicans repeatedly propose cutting trillions of dollars in domestic spending to reduce the debt while making room for sustained upper-income tax cuts. The way this hits home for us is simple. A foster parent joins hands with the state in order to take care of a dispossessed child. For the last year, the state has been trying to slip free of our grasp.

This is not fully our experience so far, but we are already seeing the way that budgetary constraints are reducing our access to things that M. needs. In most ways he's doing very well, but we can already tell that coming into care in an economic downslope has its costs. Indeed, it already does - in many places in the nation, removals are down due to budgetary constraints. If this came with additional supportive services and the kinds of programs necessary to help kids stay in families of origin, that would be great - but in fact, what it means is that they simply raised the bar for removal. Instead of removing children from parents who give birth with drugs in their system, the county has to make a case that the drugs have caused the child to be neglected - virtually impossible in the case of a child who has just been born.

M.'s case is something I can't talk much about, but in order for him to meet the larger goal of going home to his family, things will have to change in deep ways - services that simply aren't available and don't exist would have to be provided to his parents. The likelihood that will happen in the near-term is small - that doesn't mean he will stay with us, he may go home anyway, into a situation that has been band-aided and may be no better. This is part of the deal with foster parenting. Indeed, losing a kid you love and can't keep safe because you have no right to them is something of a rite of passage - you become a "real" foster parent in the same way that wear and tear made the Velveteen Rabbit real. I'm not looking forward to that transition if it happens - but it is so often part of the process.

The article is well worth a full read, and the ties to the larger economic picture will onlyl get clearer as we go.


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I just posted on my blog about this article, too, but here is my comment on Dueholm's original article. Forgive me, it's long:

Thank you for this excellent article. It was, indeed, like reading our own story. We have been fairly lucky with Medicaid, but with a foster child with serious behavioral and emotional and learning issues and a foster child with medical issues we have found that at times it can be VERY challenging to have such a small selection of specialists and therapists, many of whom are frankly awful, inconsistent, or ultra-rushed. We have also seen our children be treated badly by some professionals because of their race or because they were foster children. Apparently foster children are society's garbage and can be treated accordingly, in the view of some of the privileged in our country.

Because Medicaid does not travel well from state to state, as you mentioned, when we are out of state for whatever reason we must pay OUT OF POCKET for their (expensive, multiple) meds. Meds which treat issues that are organic but also issues that were created by the trauma someone else inflicted on these children. Our older child is regularly hospitalized in psychiatric hospitals because of his mental health and trauma issues, yet we have *no choice* but to send him to an awful Medicaid hospital which is an entirely untherapeutic environment, rather than to the excellent private psych hospital right over the state border that takes Medicaid but just happens to not take Medicaid from *our* state. If our foster son could go to that hospital, he might have been accurately diagnosed and treated long ago but instead we are in the revolving door of the local Medicaid hospital and there's no hope to get out until/unless we adopt him and can put him on our own insurance. It drives me crazy that we cannot have these children on our private insurance which would allow for their needs to be met more adequately, but it drives me crazier that poor children (and foster children in particular) do not get to have access to the quality care they need and deserve to address their copious developmental, mental, emotional and physical health issues. In our family, the stress of parenting a child who has extreme acting out behaviors and a child who has medical issues that require him to frequently not be able to go to daycare has resulted in my being forced to stay home. We would be a comfortably middle class family if not for the fact that we've chosen to commit (for the long haul, whatever that looks like) to two children with special needs. Due to these needs I have no choice but to stay home, and I do whatever work I can do from home in between doctor's visits and therapist visits and PTSD-fueled tantrums. Because of this, even with the check from CPS (and we live in one of the more generous states in terms of stipends) we barely make ends meet... and some months have to put child-related expenses on credit cards that who knows when we'll pay off.

But you know how I know we are still middle class? Because of the guilt and discomfort I feel using those WIC checks. Using WIC has been incredibly humbling. I am a healthcare professional, and sitting through those nutrition classes is nothing short of humiliating. Yet I have the privilege to only have to use services like WIC for my foster children rather than to rely upon them for my own survival, and when/if we stop fostering I can step back into the world of people who don't regularly have to wait for hours in crowded public health clinics or hold up the grocery line for an hour because the cashier can't figure out how to process WIC checks. It is crazy to think that if our foster children are not adopted by us but instead reunified with birth family, we will return to the world of "nice respectable people" whose kids do not run out in the middle of the street in traffic to try to get what they want due to no one ever teaching them they could get their needs met without doing drastic and dangerous things or threatening suicide. That I would likely never step foot in a WIC office again. But I would never take anything back any of this crazy fstering process that has caused us so many tears due - I love these kids like I've never loved anything before, and I will gladly push aside my white middle class privilege to love and parent them and to help fight for all poor and abused kids (and adults) to have access to healthcare and dignity

As a chronically ill mother on disability and Medicare I look at the looming future with complete panic. My husband and I married late in life and he raised four sons alone as a poor single father and his only retirement is social security, something he is eligible for in three more years. My illness interrupts me too often during any day for an employer to ignore it and causes enough sick days that I would be lucky to have any understanding employer keep me longer than 90. When I look at the demands of international banking on Ireland, Greece and Italy I realize that we will be surprisingly lucky as a country to still have social security and Medicare in any real form left by the time my husband retires.

I honestly do not know what we will do at that point. The job he works now is getting too hard for him physically and I can't picture us being able to pay taxes, utilities, insurance and food with part-time minimum wage jobs.

I know that studies show that the richest among us have accumulated wealth at an increasing pace all the while being CEOs, etc., who assure us there are no jobs for them to create and they must reduce staff further and further to stay profitable. When I bring that up, and that in the 1950s there were much higher taxes and a much stronger economy I'm told that I'm a socialist and that it is wrong to expect something to eat if I wont work for a living.

I really believe in my heart that the answer is that they really think we (poorer people) deserve to die.

I haven't known anyone who has done fostering JUST for the money- but I do have a few friends who had biological children already and then took on foster kids as a way to help facilitate being a stay at home parent. I would imagine that economies of scale kicks in and makes this easier to afford. I mean, obviously they also wanted to help children, because you'd have to be insane to think that fostering would be less work than just getting a part time job. And I am not saying they are rolling in excess state money or anything, but they do bring in more than they spend on the foster kids. I know that foster care payments vary from state to state, so this might be part of it- maybe we are just in a high paying state? In fact, some of our friends may be able to adopt the sibling group that they are currently fostering, and they have said that since the foster payments will stop once the adoption is final, the wife will have to go back to work if this does happen. The foster payments are helping to pay their mortgage right now.

Anyhow, I don't actually see anything wrong in people fostering for the money. Social workers work for money. Teachers work for money. Orphanage workers work for money. They do not work JUST for the money- obviously, they work hard, thankless jobs. But a paycheck for doing hard thankless work is not a bad thing. Require more training, require more screening- whatever. But raising foster care payments is a great idea. You are still not going to be overrun with people eager to take hurt children into their homes.

Tarynkay - If I remember correctly, DC is the only place in the US where reimbursements match costs, but what generally is found is that if you have 3-4 foster children, reimbursements often add up to enough to have a parent stay home - which is good, because often 1 child will have so many visitations and appointments that it is necessary to have a stay-at-home parent. Daycare reimbursements almost never cover good daycare.

In some ways, one foster child, like the author's situation, may be the hardest number to have. But of course, that also comes with pressure to take more children even if you don't want/can't handle them. And I don't know of any state where the daily reimbursements (except at the theraputic level for severely disabled kids with high needs) are enough to mean you would make more than you would doing in-home daycare, which also has lower barriers to entry (it is easier to get a daycare license than a foster license) and the kids go home at night - so yes, unless one is very dense ;-), it is likely those that use the fostering as an income stream also want to do it.

I also don't think there's anything wrong with parenting for money, and I'm going to write about that. But I do think that in many places you'll find that foster parents are definitely losing money, time and resources in a slow grind, unfortunately.



It seems that the answer is to change fostering, to not rely on Medicaid. Using any insurer, even Medicaid, is the driver for ever escalating costs we experience today. Leave care of the needy and foster care to local counties and cities, under loose state supervision, to discourage big money players and national strategists from exploiting a single, unified system. Reserve Medicaid or larger approaches for catastrophic need.

Hm. Local control of costs and foster care. That might almost be - dare I say it? - sustainable.

The current situation and outlook may make that a reasonable path forward for states that want to care for at-risk children in the face of failing Federal promises and an alienated health care community.

In fact, I wonder that many states haven't examined dissolving ties to Medicaid for that very reason. It cannot make sense to further alienate the health care community when you want to make health care available for identified at-risk children.

What Medicaid and Medicare does to providers is nothing less than punitive taxation. We would do well to see what the effect on the medical community is, and project that onto the general economy in the face of calls for additional punitive taxes.

Another viable choice will be for states to endorse, and re-pay, alternative providers -- doctors and facilities and other health care providers that aren't associated with the modern AMA/hospital/drug company/insurer-complex industry. I think this must happen, and the sooner the better.

Brad K.


Unfortunately, sharing the cost over larger populations is the only way to support some children with specialized needs. The medical costs of an extremely premature, drug-exposed infant would completely overwhelm the budget of a small city or county. Also, insurance can negotiate much more competitive rates for medical procedures. I received a dental bill recently that showed my insurance company negotiated a rate that was approximately one-THIRD the out of pocket cost that an uninsured patient would pay.