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Witnesses tell Congress: certify adoption‑competent clinicians and raise Medicaid support to reach children in care
Summary
Witnesses urged Congress to expand adoption‑competency training, pursue certification and directories of qualified clinicians, and address Medicaid reimbursement to increase access to behavioral‑health services for foster and adoptive children.
Multiple witnesses told the subcommittee that insufficient clinician capacity and low Medicaid reimbursement rates limit access to adoption‑competent mental‑health care, which in turn increases the risk of disrupted adoptions and placement instability.
Debbie Riley described training programs (NTI and adoption‑competency curricula) that have trained thousands of clinicians and cited research showing better outcomes for families treated by clinicians with that training. "We want to expand this training, establish national standards, improve system integration, and secure post‑adoption funding," Riley said.
Committee members and witnesses discussed certification and directories so families and agencies can find qualified providers. McLean and Riley supported a national standard and directories to help families locate adoption‑competent clinicians; McLean called for incentives so states and managed‑care plans encourage that competency.
Several speakers described a reimbursement problem: private therapy rates can reach roughly $150 per hour while Medicaid rates for foster/adopted children are often below $65 per hour, creating a business case that deters providers from serving this population. "From a business standpoint, I'm always in the red... Medicaid pays less than $65 an hour for reimbursement," Lee Marshall said when describing her program's reliance on philanthropic support to cover the gap.
Witnesses recommended federal levers Congress could use: (1) increase Medicaid reimbursement and align payments to support trauma‑informed treatment; (2) fund certification and directories of adoption‑competent clinicians; (3) use Title IV and Family First authorities to expand post‑permanency services; and (4) invest in workforce pipelines via training partnerships with universities and the Title IV training programs.
Members expressed concern that proposed deep Medicaid cuts would harm services; witnesses warned that nearly all foster youth rely on Medicaid for behavioral‑health care and that reducing reimbursement undermines provider networks and care access. The committee requested additional information on how funding and reimbursement changes would affect service capacity.
