In 2018, the Maryland General Assembly enacted HB 1582, which established the position of Medical Director for Children Receiving Child Welfare Services within the state Department of Human Services (DHS). The legislation was passed in response to an audit of DHS and a report by the Citizen’s Review Board for Children that found significant deficiencies in tracking and monitoring the health of children in the department’s custody. DHS filled the position of medical director in February 2019. The legislation tasks the medical director with data collection on provision of health services; tracking of health outcomes; assessing the competency of health care providers; assessing supply and diversity of health care services for children in foster care; identifying systemic problems affecting health care for children in out-of-home care; and ensuring best-practice medical review and evaluation of cases of suspected child abuse or neglect. The legislation also requires the medical director to develop a centralized comprehensive health care monitoring program. The bill’s preamble cites the health care monitoring program in Baltimore called Making All the Children Healthy (MATCH), in which a non-profit organization works closely with the Baltimore City Department of Social Services to ensure that children in foster care and kinship care receive medical assistance coverage, health care coordination, individualized health care plans, and case management or care coordination services. Finally, the bill expresses the General Assembly’s intent that DHS establish a centralized data portal to provide the department with integrated health information on children in out-of-home placement and create an electronic health passport for such children.
The Virginia General Assembly enacted SB 1339 in 2019 that, among other things, requires the state Department of Social Services (VDSS) to establish the office of Director of Foster Care Health and Safety. The director’s duties include, among others, identifying local boards of social services that fail to ensure the health, safety and well-being of children in foster care; ensuring that local boards remedy such failures, including those related to physical, mental and behavioral health screenings and services; and tracking health outcomes of children in foster care. The legislation also requires that VDSS regional offices be equipped with sufficient staff to provide oversight of foster care and adoption services, including reviewing the medical necessity of placement of children in residential facilities and monitoring children’s health issues such as medication management, frequency of visits with health care providers, and use of psychotropic medications. Amendments to the state’s biennial budget included funding for 18 new positions to monitor the health and well-being of children in foster care, including the Director of Foster Care Health and Safety.