ATLANTA - Dozens of Georgia’s most troubled foster children are housed in hotels or state offices each night, because the state can’t find a better place for them to stay. But officials trying to end the practice face fights with the state’s own insurer and a lack of treatment beds.
Lawmakers and officials call the practice "hoteling," with Division of Family & Children Services workers often assigned to stay with children. The practice has been under scrutiny for years, not only because it typically costs $1,500 a night, but also because children lack a stable environment and often aren’t getting needed treatment.
"We have been hell-bent on ending hoteling, a practice born out of necessity, but one that contradicts our mission, crushes our workforce and derails lifesaving work," Department of Human Services Commissioner Candice Broce, who oversees the child welfare agency, told lawmakers on Jan. 17.
That goal may require more money, new treatment models, better oversight of health insurers and limits on parents and juvenile judges placing children into foster care.
Broce said the state spent $28 million on hoteling last year. She said Georgia has made progress by paying providers more to care for children with complex problems in exchange for agreeing to keep children at least six months.
Foster parents, group homes, crisis stabilization units and psychiatric treatment facilities may be refusing such children because they are too difficult to care for or because the state doesn’t pay enough.
"Everyone is saying ‘No, we don’t have a bed; we won’t approve that service; we won’t accept that kid,’" said Audrey Brannen, a Department of Family and Children Services worker who tries to find permanent placements for children, at a Senate hearing on Wednesday.
But advocates also point to a Medicaid insurance plan that makes it hard to find treatment before children spiral into crisis. Georgia’s Department of Community Health contracts with Amerigroup, a division of insurance giant Elevance Health, for managed care. The state pays Amerigroup a fixed amount per foster child to provide coverage and hold down costs.
But providers and state officials say Amerigroup fails to authorize needed care. The Department of Family and Children Services has hired a team of lawyers to appeal coverage denials, and Broce said the division has never lost an appeal. In the meantime, Broce said the Department of Family and Children Services advanced $57 million last year to cover treatment Amerigroup denied.
Foster parents and physicians also told lawmakers that they struggle to get approvals from Amerigroup.
"Why can’t kids be served with the goal of increasing access instead of decreasing costs?" asked Dr. Michelle Zeanah, a Statesboro pediatrician. She suggested the state pay through a traditional fee-for-service arrangement, saying more providers accept that form of Medicaid payment than managed care.
Brian Pettersson, a lawyer who oversees appeals for the Department of Family and Children Services, said Amerigroup had failed to provide required screening to more than 2,000 foster children statewide as of September.
The state is preparing to rebid Amerigroup’s contract, and Broce and others say better rules and oversight could improve care availability.
Amerigroup says it works closely with the state.
"I’ve never made a decision about how to treat anyone, particularly a foster care kid, that was related to cost, and I never will," Mel Lindsey, president of Amerigroup Community Care of Georgia, told lawmakers Wednesday.
But others suggest that Amerigroup may be earning excessive profits.
Mike Dudgeon, a foster parent and former policy director for Lt. Gov. Geoff Duncan, said data showed the state paid Amerigroup $136 million in 2018, but that Amerigroup paid only $70 million in claims. Dudgeon said that suggests Amerigroup earned a 35% profit after expenses that year.
"There’s a lot of smoke there that this money is not being appropriately spent," Dudgeon said.
Amerigroup officials declined to comment, saying they needed to examine the figures.
Broce also said some juvenile court judges are improperly placing children in state custody. She said the foster care system isn’t set up to care for minors accused of violent crimes. She also accused some parents of jettisoning difficult children into foster care.
"From the parents’ perspective, these children have become far too inconvenient and uncontrollable to stick around," Broce said, promising legislation to restrict judges and parents.
Finally, leaders say Georgia may lack available beds in psychiatric treatment facilities. Some witnesses told lawmakers that Georgia’s own facilities appear to be increasingly filled with children from other states, which may reflect that Georgia’s payment rates are too low. Kevin Tanner, commissioner of the Department of Behavioral Health and Developmental Disabilities, told lawmakers Jan. 17, that a study suggests Georgia needs to raise payments to behavioral health providers by up to 40%, which could cost an additional $180 million.