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A bipartisan bill introduced by Rep. Gus Bilirakis (R-FL) and Rep. Julia Brownley (D-CA) seeks to close a long-standing Medicaid gap that child welfare advocates say has disrupted mental health services for some of the most vulnerable children in foster care.
Under current law, Medicaid cannot pay for care in most facilities with more than 16 beds, a rule known as the Institutions for Mental Disease (IMD) exclusion.
Some Qualified Residential Treatment Programs (QRTPs) have been classified as Institutions for Mental Diseases (IMDs) based solely on their size, despite being federally authorized foster care placements.
When this occurs, Medicaid funding may be cut off just as children are entering intensive treatment.
The bill would permit states to obtain federal Medicaid reimbursement for services delivered to foster children in QRTPs which use trauma-informed treatment approaches for children with significant emotional or behavioral disorders.
Who Qualifies for Free or Low-Cost Treatment
Foster youth are among the populations most likely to rely entirely on Medicaid as their only source of health coverage. Foster youth face mental health challenges at significantly higher rates than other children.
According to the National Conference of State Legislatures, as many as 80% of children in foster care have significant mental health conditions compared with about 18–22% of children in the general population.
Given that most foster children rely on Medicaid for health coverage, any gap in eligibility can create immediate barriers to care particularly for intensive services that are already in short supply.
If this bill becomes law, foster youth placed in QRTPs would maintain uninterrupted Medicaid rehab coverage meaning residential mental health and substance use treatment would remain fully funded through the program, at no cost to the youth or their guardians.
Why Medicaid Coverage Gaps Put Youth at Risk
Mental health experts consistently stress that stability in placements, caregivers, and treatment is essential for children recovering from trauma.
Interruptions in therapy or medication can derail progress and raise the risk of hospitalization, emergency intervention or symptom worsening.
Representative Brownley stated that children in foster care deserve stability and consistent access to the mental and behavioral health services that support their well-being.
He argues that because of how certain programs are classified, children placed in clinically appropriate settings can lose access to Medicaid coverage for the very care they rely on.
The Bilirakis-Brownley bill is part of a broader push to make residential treatment accessible without financial disruption, a goal that aligns directly with expanding free rehabs and low-cost mental health services for at-risk youth.
How to Access These Resources
If you are a foster parent, caseworker, or a young person aging out of the foster system, here are steps to access free or low-cost rehab centers and mental health treatment:
- Check Medicaid eligibility: Most youth in foster care qualify automatically. Contact your state Medicaid office to confirm coverage for residential treatment.
- Ask about QRTPs in your state: These federally recognized programs are designed to serve youth with acute mental health needs and may now be covered under proposed Medicaid rehab coverage rules.
Rehabs.org lists low-cost and free rehab options nationwide. Call
800-914-7089
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to find affordable care for yourself or a young person in your life.
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