Published December 02, 2011
| The Wall Street Journal
Foster children on Medicaid received psychotropic drugs—including antipsychotics and antidepressants—at a higher rate than other children covered by the government insurance program, according to a federal report released Thursday.
The study by the Government Accountability Office is raising concern among lawmakers and medical experts that doctors are overprescribing psychiatric drugs to treat children in the foster-care system.
Foster children are wards of the state placed in the homes of certified caregivers, or foster parents, often on a short-term basis until a permanent situation can be arranged.
While such children often struggle with emotional problems, medical experts say some are receiving the medications at unjustifiably high levels.
The report found that drug amounts exceeding maximum doses for a child's age were many times more likely to be prescribed to foster children than to other children in the federal-state program for lower-income people. The GAO, which submitted its findings as part of a Senate hearing, also found that foster children were several times more likely than other Medicaid youngsters to be taking five or more psychotropic drugs at the same time.
Among the drugs analyzed were antipsychotics such as Abilify and Risperdal, antidepressants such as Cymbalta and Paxil, and attention-deficit hyperactivity-disorder drugs such as Ritalin and Strattera. The GAO found that foster children were between 2.7 and 4.5 times as likely to be on psychotropics as non-foster youngsters in Medicaid, depending on which state they lived in.
Foster kids often have more emotional troubles and painful pasts than other Medicaid children, but both groups can be overmedicated because they're often seen by general doctors rather than getting counseling.
"The high-risk practices identified by the GAO study raise significant concerns regarding the treatment of severely mentally ill and vulnerable youth," child psychiatrist Jon McClellan of the University of Washington told lawmakers Thursday.
Senators in both parties said federal and state agencies supervising Medicaid need to curb overprescription of the drugs.
"There is no evidence for use of five mind-altering medications in an adult, let alone a child," said Democratic Sen. Tom Carper of Delaware. Sen. Scott Brown, a Massachusetts Republican, called the findings "shocking."
Bryan Samuels, a senior official overseeing Medicaid at the federal Department of Health and Human Services, agreed that "the current use of psychotropic medications among children, particularly children in foster care, goes beyond that which is supported by empirical research." He said his department has written to state Medicaid agencies "to raise awareness of these issues."
The GAO study focused on Medicaid programs in Florida, Massachusetts, Michigan, Oregon and Texas in 2008. The GAO said 1,752 children in those programs were getting five or more such drugs at the same time.