Kansas foster kids get too little behavioral and mental health treatment, audits find, but expanding those services can prove so costly that it slows expansion of those programs. 

Foster kids got mental and behavioral health treatment just 70% of the time in 2022, a lawsuit settlement found. That’s well below the 85% court-mandated requirement. The lawsuit was from groups trying to reform the state’s foster care system in hopes of improving outcomes for kids. And it’s the second year in a row the audit found that the state failed to help enough kids. 

One foster child took his own life in October. 

Mental health care remains in short supply for all children. But foster agencies deal with kids with higher rates of mental health problems. Just entering foster care is traumatic — and it typically means the children already come from unstable homes.

The private agencies that manage these children want to help, so some hire in-house therapists. At KVC Kansas, that means a team of around 20 therapists help more than a third of the children the agency manages — around 1,500 total kids. But covering just a portion of its cases costs KVC over $300,000 a year. 

“Even if every (therapist) hit their full caseload … we’re still going to be losing tens of thousands of dollars,” said Matt Arnet, director of outpatient services for the nonprofit KVC Kansas. “There’s simply no way to even break even when Medicaid is the primary insurer for the clients that you’re seeing.”

Some foster children are covered by their parents’ health insurance. But the overwhelming majority are covered by Medicaid while they’re in state custody. A private therapist may charge $120 to $175 per hour without insurance. Medicaid pays agencies $65 to $100 for that same appointment, and that doesn’t account for all the traveling from therapy offices to foster homes before appointments. 

That not only means the agencies get less money coming in, but it also means those therapists could leave and make more in private practice. Arnet said specialists with the same workload could make $30,000 a year more working in private industry. 

The agencies can ask the state for more money to offset the cost, and some are getting funding that way. However, requesting more money to fully cover the cost of expanded services isn’t a guarantee. 

Adjusting Medicaid reimbursement rates offers one exception — at a higher cost to taxpayers. Some health services reimbursement rates were raised by 4% in 2022, but those increases haven’t silenced foster agency concerns. 

Democratic Gov. Laura Kelly has long pushed for Medicaid expansion, saying it not only gives uninsured people medical coverage but also provides more funding to medical providers like rural hospitals. 

In Kansas, nearly 60% of rural hospitals are at risk of closing, a study by the Center for Healthcare Quality & Payment Reform found. The nationwide report said rural hospitals don’t have enough money coming in to keep doors open. 

The Republican-controlled state Legislature has opposed expansion, saying it’s too expensive. Kelly will push for expansion this upcoming session, though it’s unlikely to pass. 

Aside from funding headaches, finding the specialists for the work is difficult. At KVC, pre-pandemic, a therapy position could get filled in a few weeks. Now it takes half a year. 

The foster care agency St. Francis Ministries said in an email it also “grapples with workforce shortages, aligning with prevailing state and national trends.” The nonprofit has a team of 13 licensed providers at its outpatient behavioral health clinic. 

Amanda Pfannenstiel, chief clinical officer at St. Francis, said her agency wants to fill gaps, rather than duplicate services already available in communities. So it offers psychological testing, trauma assessments, therapy, substance use disorder treatment, peer mentorship and medication management.

The agencies don’t have to offer all these services, and they often rely on community services such as mental health centers. But agency officials said they are trying to offer these services because it’s best for the kids.  

A 2005 study found that 24% of people who attempted suicide and survived spent only five minutes thinking about taking their life before trying. 

Kansas has the 12th highest suicide rate in the country, and suicide is the second leading cause of death for Kansans 10-24 years old. In 2021, 67.26% of Kansas communities did not have enough mental health providers, the American Foundation for Suicide Prevention found. 

Pfannenstiel said increasing providers could hold more families together, wherever they get the help.

“Prevention is a crucial aspect of care,” she said. “If more families can access services sooner, it helps divert them from coming into care.”