Aid cuts would hurt home’s mission

Eighteen-year-old Juanita Gray’s early life was shaped by abuse and neglect so severe she was never able to return home to her parents. That changed when she was 12, after Clark County Family Services took her into protective custody and eventually placed her at St. Jude’s Ranch for Children in Boulder City.

For six years, St. Jude’s provided a troubled girl with the support and counseling she needed to overcome the trauma of her early life. Without that assistance, Gray said, she knows exactly where she would be now.

“I’d still be on the street with no food,” Gray said.

Instead, Gray is a freshman studying early childhood education at the College of Southern Nevada. She still lives at St. Jude’s, which is helping her make the transition to living on her own.

“It’s a safe environment,” Gray said. “People here care about me. If I need help, I can ask somebody.”

St. Jude’s is a not-for-profit organization that relies on charitable donations, state and federal funding to maintain treatment foster homes for severely emotionally disturbed children. It’s also one of the local providers being buffeted by the uncertainties surrounding the future of Medicaid.

Nevada’s $16 million for treatment foster care is made up of Medicaid dollars matched by the state. The agreement that supported that arrangement was set to expire Dec. 31, 2007. The Centers for Medicare and Medicaid Services granted Nevada a six-month extension, but providers of therapeutic foster care know the arrangement is just a reprieve and not a long-term solution.

Medicaid is still moving toward phasing out payments for a host of services, including treatment foster homes. That was made clear in a letter received by Nevada Health and Human Services officials on Dec. 17. Linda Minamoto, Medicaid associate regional administrator, reminded state officials that new regulations limiting what Medicaid will pay for are set to take effect throughout 2008.

“CMS will abide by the time frames specified by the statute,” Minamoto said in the letter. “Approval of the subject State plan amendment does not relieve the State of its responsibility to comply with changes in federal laws and regulations.”

That leaves child welfare officials in a quandary: Without Medicaid’s $8 million contribution to therapeutic foster care, Nevada’s severely emotionally disturbed foster children will lose the middle range of services that allows them to live in familylike settings while receiving behavioral and psychological assistance. The only remaining options for them would be either commitment to a psychiatric hospital or placement in a regular foster home.

“Ultimately, I think the state needs a new funding strategy,” said Clark County Director of Family Services Tom Morton.

That’s likely going to have to be a mix of state money and other federal funds, Morton said. There is no backup plan as of yet for how to finance treatment foster care should Medicaid disallow payments for it. At the end of November, Clark County had 362 children in treatment foster care, with 33 other foster children in psychiatric hospitals.

“I don’t think that CMS wants to see these kids on the street and will work to see that this doesn’t happen,” Morton said. “The state and CMS need to find a workable solution.”

St. Jude’s Chief Executive Officer Christine Spadafor couldn’t agree more. Children who come to St. Jude’s typically arrive after being unsuccessful in other foster home placements. They have behavioral and emotional problems related to abuse, neglect and a lack of parenting. They’re generally about two years behind where they should be academically.

Without intervention, these are youngsters who will end up living tragic lives caught up in a cycle of victimization or violence, Spadafor said.

“It truly is pay now or pay later,” Spadafor said. “And this truly is a good investment. They leave here equipped to be full, productive members of the community.”

St. Jude’s per child funding model is roughly 50/50 — half the cost of care comes from the state and includes Medicaid funding, the other half is supported by donations. Children in therapeutic foster care live in cottages, which have room for six to eight children.

Girls and Boys Town of Nevada is also a provider of therapeutic foster care. Like St. Jude’s, Girls and Boys Town supplements the cost of care with donations. About 80 percent of the cost of treating a severely emotionally disturbed child placed at Girls and Boys Town is paid through state and federal funds. The remaining 20 percent comes from private donations, Executive Director Tom Waite said.

The uncertain future of Medicaid funding is casting a shadow over plans to expand services at both St. Jude’s Ranch and Girls and Boys Town. Waite said that although Girls and Boys Town now absorbs 20 percent of the cost of care for treatment foster care, the not-for-profit is in no position to pay for 100 percent of the cost.

Waite and Spadafor said that Clark County already has identified a shortfall in services for troubled foster children. About 10 to 12 percent of the juveniles in foster care require treatment for mental illness, depression, violent behavior and suicidal tendencies.

They’ve had a hard life, Spadafor said, but with help, they can recover.

“We can’t think of them as throwaway kids.”

Contact reporter Lisa Kim Bach at lbach@reviewjournal.com or (702) 383-0287.

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