Skip to main content
U.S. flag

An official website of the United States government

Official websites use .gov
A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS
A lock () or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

May 2003Vol. 4, No. 4Alternatives for Accessing Mental Health Services for Children

A report released in April by the U.S. General Accounting Office (GAO) estimates in 2001 alone more than 12,700 children were placed in the child welfare system simply because their families did not have the insurance or resources to access mental health treatment for them. Once in the State's custody children become eligible for Medicaid, which covers a wide range of services. However, this practice does not always work--foster care systems also can face difficulties accessing limited treatment slots for seriously mentally ill children--and it can be emotionally devastating for families.

The Bazelon Center for Mental Health Law recently released a report on States' options for increasing access to mental health care without forcing parents to relinquish custody. The report, Avoiding Cruel Choices: A Guide for Policymakers and Family Organizations on Medicaid's Role in Preventing Custody Relinquishment, discusses two options:

  • Under the Tax Equity and Financial Responsibility Act of 1983 (TEFRA), some States can cover children in the community if the child would be eligible for Medicaid institutional services but can be cared for at home.
  • States can pursue a home- and community-based services (H&CB) waiver under Section 1915(c). This waiver allows home-based services for children with mental and emotional disorders instead of institutional placement.

Currently, only 12 States use either option to cover mental or emotional disorders. The report includes information about how TEFRA or the H&CB waiver can benefit States, and four companion fact sheets provide information for States and families interested in learning more about these options.

The report and fact sheets can be obtained on the Bazelon website at

The GAO report, Child Welfare and Juvenile Justice: Federal Agencies Could Play a Stronger Role in Helping States Reduce the Number of Children Placed Solely to Obtain Mental Health Services, can be accessed on the GAO website at

Related Item

Read more about mental health services for foster children in "New Jersey Taking Integrated Approach to Mental Health Needs of Children and Families" in the January 2002 issue of Children's Bureau Express.