Medical Issues of Children in Kinship Care

States across the nation continue to focus on increasing the number of foster children placed with relatives as more studies are finding there to be benefits of kinship care over traditional foster care. A 2015 study by the Adoption and Foster Care Analysis and Reporting System (AFCARS) found that 30% of the total population of children in care consisted of children being raised by a family member or close family friend. While the long-term benefits of kinship care are well documented, the time following the child’s placement in the care of relatives can be turbulent as both adults and children face a complex challenge: the medical issues of children in kinship care. These troubles can result in undiagnosed physical disabilities and developmental delays that may be harmful to the child’s schooling and day-to-day life.

Medical Issues of Children in Kinship Care

Medical Issues of Children in Kinship Care


Most kinship cases happen unexpectedly, leaving caregivers with a short amount of time to take in all of the information covered during the licensing process. Even with the Fostering Connections to Success and Increasing Adoption Act (FCA) of 2008 easing the requirements for kinship caregivers, it can be a challenge for them to remember all of the intricacies of the policies.

In 2012, the US Census Bureau found that 21% of children living in both formal and informal kinship care lacked any form of health insurance coverage, more than doubling the 9% of children without coverage living with their biological parents. While the Patient Protection and Affordable Care Act made health care more accessible, it still doesn’t ensure that every child in kinship care receives adequate health care. Given the sudden nature of kinship placements, there’s a likelihood that not all caregivers have an in-depth knowledge of the insurance and benefits the children are eligible to receive.

A report by Casey Family Programs found that children in kinship care are more likely to be hyperactive, to have asthma, physical disabilities and poor eating and sleeping habits than those living with their biological parents. In 2007, the National Children’s Health Survey found that children in kinship care had more mental and medical needs than those living with biological parents. Children in kinship care are also almost half as likely to receive an outpatient mental health evaluation, and teenagers in kinship care were more likely to become pregnant or have issues with substance abuse as those in traditional foster care.

While kinship caregivers are gaining more rights to protect the well-being of the child, there are still areas where they face an uphill battle. Depending on local and state laws, medical care rights can be retained by the biological parents, the state agency, the caregivers or be left to a court decision. If the kinship caregiver is not given the right to make these decisions, they must obtain consent from the individual designated as legally responsible for the child for any nonemergency health care.

Even with the ability to make nonemergency medical decisions, there is still a gap in medical care for kinship children. Mark Testa, a professor at the University of North Carolina School of Social Work, told the Associated Press (AP) that this gap is due to the caregiver, “trying to navigate this system on their own, and there’s not a lot of knowledge about what benefits they’re eligible for.”

National Efforts to Address Medical Issues of Children in Kinship Care


A policy in the FCA allocates federal funding to establish kinship navigator programs that inform caregivers about various support services to help the children in their care. Furthering the awareness of similar services for kinship parents, the American Association of Retired Persons (AARP), Generations United, the Dave Thomas Foundation for Adoption and several other organizations work together to maintain an up-to-date database that features state specific information on resources and programs offered to kinship families.

New Jersey’s Efforts to Address Medical Issues of Children in Kinship Care


New Jersey’s Department of Children and Families has a Kinship Navigator Program that offers a wealth of information for kinship caregivers and lists a variety of support services throughout the state, such as Title IV-E Guardianship Assistance Program (GAP), that aid kinship families. Along with the state’s efforts to keep kinship families informed, the previously mentioned database contains statistics and detailed information on programs and benefits they’re eligible to receive.

All children in kinship care have health insurance, whether provided by the state or through their legal guardian. Those using the state’s insurance plan, Medicaid, can face difficulty in finding nearby specialty doctors. In 2015, the U.S. Centers for Disease Control and Prevention found that only 38.7% of physicians in New Jersey accepted new Medicaid patients, which fell well below the national average of almost 69%.

While this does not mean children in kinship care can’t receive necessary medical care, it does place an added financial burden on the caregiver as they may need to take extra time off from work to travel to a doctor that does accept Medicaid. The American Academy of Pediatrics found that, “Economic stress is highly prevalent among kin caregivers, who tend to be poorer than nonkin foster parents. Public benefits are limited but may be critical.” These stresses can lead to the child not seeing specialists as the caregiver does not have the means to afford frequent trips throughout the state.

Fortunately, under the FCA, children who were in the care of a licensed relative for at least 6 months and subsequently had the caregiver become their legal guardian are eligible to receive financial assistance under the GAP. The goal of GAP is to promote permanency and a sense of belonging while also helping the caregiver provide permanent care for the child. A 2014 report by Child Trends found that nationally, of the children in foster care whose most recent placement was with a kinship household, only 3.45% met the GAP requirements and went on to claim the financial assistance. New Jersey’s efforts to increase successful kinship placements shone through as it nearly doubled that statistic with 6.39% of children claiming the aid.

GAP can help kinship caregivers offset the financial strain of taking the child to a doctor that accepts Medicaid who may be miles away. It also helps kinship parents cover the cost of the co-pays at the numerous doctor appointments they may need to attend. Providing these caregivers with information and financial support can go a long way in addressing the medical issues of children in kinship care.

Donna Butts, the Executive Director of Generations United, told the AP, “We shouldn’t then just leave them alone…They need information, they need support, they need respite. Both the children and the caregivers need help.” Butts also pointed out that increasing assistance given to kinship caregivers not only helps the children but also the taxpayers. She estimates that kinship care saves taxpayers over $6 billion a year by reducing the expense of foster care on state and local governments.

To learn more about support in New Jersey, visit the Department of Children and Families’ Kinship Navigator Program page here.

If you reside outside of New Jersey, visit the U.S. Department of Health & Human Services’ Kinship Navigator Programs page to find services in your state here.

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