California Clears Way for Increased Use of Therapeutic Foster Care

California counties will now be able to offer a therapeutic treatment model in a supportive family setting through its Medi-Cal services, thanks to an agreement with the Centers for Medicare and Medicaid Services (CMS).

On February 16, CMS approved a state plan amendment that would allow the Department of Health Care Services (DHCS) to offer therapeutic foster care as an allowable expense under Medicaid.

Therapeutic foster care is a specialized treatment model aimed at providing care to children with serious emotional and behavioral issues who cannot safely remain with their birth families. Specially trained foster parents provide intensive treatment to youth with significant mental health needs in a family setting in the hopes of avoiding more restrictive out-of-home placements such as group homes and mental institutions.

Previously, California counties were unable to seek reimbursement for therapeutic foster care services with money from Early Periodic Screening, Diagnosis and Treatment, a Medicaid program that mandates funding for mental health services for low-income children and foster youths.

Nationally, therapeutic foster care has been used by a few child welfare jurisdictions, though it has been implemented more often for youth involved in the juvenile justice system. The DHCS announcement clears the way for therapeutic foster care to be offered as part of a menu of intensive services aimed at youth in the foster care system with the most significant mental health needs, as defined under the terms of the Katie A. vs. Bonta class-action lawsuit.

Initially filed in 2002, the 2011 Katie A. settlement improved access to intensive and community-based mental health services for children already in California’s child-welfare system or at risk of being placed in foster care. (For more about the Katie A. settlement, check out The Chronicle’s three-part series here.)

Health Law Program Attorney Kim Lewis, who was a lead attorney on the settlement, says that therapeutic foster care fills a gap that could stabilize some youth with serious mental health needs who experience high rates of placement instability.

“[Therapeutic foster care] is an important piece that I think doesn’t exist now for some kids who blow out of foster homes and go to a group home, or go to a hospital and then go to a group home,” Lewis said. “We would hope that this could be an intervention that would avoid that trajectory.”

Several implementation issues remain to be resolved before a therapeutic foster care program can be rolled out in California’s 58 counties, including reaching agreements on the criteria for youth to be placed in a therapeutic home, required qualifications for therapeutic foster care parents and statewide licensing standards.

“Ultimately, if it’s a state-blessed Medicaid service, it’s got to be available statewide,” Lewis said. “There has to be a continuity of practice all over the state, and the service has to be the same wherever you go.”

Guidelines and rates for therapeutic foster care are expected to be finalized by the end of the year, according to advocates.

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Jeremy Loudenback, Senior Editor, The Chronicle of Social Change
About Jeremy Loudenback, Senior Editor, The Chronicle of Social Change 351 Articles
Jeremy is a West Coast-based senior editor for The Chronicle of Social Change. Reach him at

1 Comment

  1. This is potentially a move in the right direction, as long as the definition of therapeutic includes the problems faced by 15% of California children (and larger %s of foster children) who were born exposed to drugs or alcohol. Mental health and prenatal exposure issues overlap, but not all children’s mental health or developmental programs even screen for or attempt to treat the issues relating to fetal alcohol and other prenatal exposure issues. If this is another silo reform, it will miss the overlapping issues of substance use disorders, which foster care programs desperately need to pay more attention to, based on the data.

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