For many children with significant behavioral health needs, the inability to obtain funding for adequate behavioral health care through private means results in parents “voluntarily” placing their child in the state’s child welfare system. This study investigated the association between states’ use of 1915(c) Medicaid waivers for children with behavioral health needs and state rates of voluntary foster care placements. This study used data from the Children’s Bureau Adoption and Foster Care Analysis and Reporting System (AFCARS), from 2010 to 2019. Multilevel, linear regression models with state-year fixed-effects assessed the relationship between states’ use of a 1915(c) waiver and their total new entry voluntary foster care placement rates for children with behavioral or developmental health care needs, controlling for a variety of state-level policy and demographic characteristics. States’ use of 1915(c) waivers is significantly associated with lower total voluntary placement rates, both in total (β= -1.51 [-2.82, -0.21]) and proportionally (β=-1.03 [-2.07, 0.02]). HCBS Medicaid waivers targeting children with complex behavioral health needs may reduce state rates of voluntary foster care placements.

对于许多有重大行为健康需求的儿童来说，无法通过私人方式获得足够的行为健康护理资金，导致父母“自愿”将他们的孩子安置在该州的儿童福利系统中。本研究调查了各州对有行为健康需求的儿童使用 1915（c） 医疗补助豁免与各州自愿寄养安置率之间的关联。本研究使用了 2010 年至 2019 年儿童局收养和寄养分析和报告系统 （AFCARS） 的数据。具有州年固定效应的多级线性回归模型评估了各州对 1915（c） 豁免的使用与其对有行为或发育健康护理需求的儿童的新入学自愿寄养安置率之间的关系，控制了各种州级政策和人口特征。各州使用 1915（c） 豁免与较低的总自愿安置率显著相关，无论是总的 （β= -1.51 [-2.82， -0.21]） 还是比例 （β=-1.03 [-2.07， 0.02]）。针对有复杂行为健康需求的儿童的 HCBS 医疗补助豁免可能会降低各州自愿寄养安置的比率。