Restoring Decency to the Care of Undomiciled Foster Youth

In April 2023, a distinguished panel of scientists, advocates, and child health policy experts convened by the American Enterprise Institute (AEI) issued a report entitled, "Why Foster Children Are Sleeping in Offices and What We Can Do About It."¹ It concluded that the 2018 Family First Prevention Services Act (FFPSA), which was intended to protect children and adolescents from hazards of institutional care, precipitated a cascade of unintended consequences resulting in large numbers of foster children and adolescents with higher levels of need living in a range of inappropriate settings, including child welfare offices, emergency rooms, hotels, and homeless shelters. Across the United States, FFPSA resulted in severe shortages of placement options for undomiciled foster youth, which were precipitated by constraints in the following: (1) resources, (2) qualifications for reimbursement eligibility, and (3) numbers of beds (by broad extension of the institutions for mental disease [IMD] exclusion in Medicaid restricting bed capacity to 16) for congregate care settings that could otherwise be providing compassionate, qualified, appropriate care to this vulnerable population.