Senators Burr, Feinstein Introduce Legislation to Ensure Medicaid Access for Vulnerable Foster Care Children

August 10, 2021

Today, Senators Richard Burr (R-NC) and Dianne Feinstein (D-CA) introduced the Ensuring Medicaid Continuity for Children in Foster Care Act of 2021. This bipartisan legislation would clarify existing law to ensure that the care provided for certain foster children in need of a higher level of care are covered by Medicaid.

“Medicaid should not be a barrier for foster children with emotional or behavioral challenges to receive care in a setting that best meets their individual needs,” said Senator Burr. “It’s important that Congress continue to support these foster children by passing this legislation. I’m proud to work with Senator Feinstein on this important and commonsense initiative.”

“Children in foster care deserve access to high-quality care without being at risk of losing federal Medicaid coverage,” said Senator Feinstein. “I’m happy to join Senator Burr in introducing this legislation to ensure the best outcome possible for children in need of these critical services and support.”


The Family First Prevention Services Act of 2018 (FFPSA) created a federal category of residential settings called qualified residential treatment programs (QRTPs). These programs were designed to provide care for children in foster care with assessed emotional or behavioral needs in a residential setting.

The health care needs of children in foster care are covered by Medicaid. Today, however, QRTPs may not receive Medicaid financing because of the Institutions for Mental Disease (IMD) exclusion, a law that prohibits Medicaid payments to a hospital, nursing facility, or other institution with more than 16 beds that primarily provides care for people with mental health conditions.

Under current law, all states are required to be FFPSA compliant by October 1, 2021. Recently, the Centers for Medicare and Medicaid Services (CMS) indicated that QRTPs with more than 16 beds will be subject to the IMD exclusion, leaving many states at risk of not being able to continue providing services to this vulnerable population in QRTPs.

The Ensuring Medicaid Continuity for Children in Foster Care Act of 2021 would provide a narrow exemption from the IMD exclusion to ensure children in foster care receiving care in QRTPs can continue to receive care provided in these settings without losing their federal Medicaid coverage.

letter signed by over 500 organizations has been submitted to Congressional leadership in support of this effort.