Robert F. Kennedy Jr.’s Department of Health and Human Services has announced it will fund an expanded list of medications through the child welfare system for the thousands of parents accused each year of child maltreatment due to opioid addiction.
Monday’s policy change allows state and county child welfare agencies to seek federal reimbursement for the FDA-approved medications under Title IV-E, a key child welfare provision of the Social Security Act. The new funding will cover half the cost of buprenorphine and naltrexone. Methadone was eligible for this federal reimbursement previously, but with now-lifted restrictions.
“When we deny parents access to affordable, effective treatment for opioid addiction, we tear families apart,” Kennedy said in a press release. “Using Title IV-E funding to provide life-saving medications keeps families together and moves our system toward recovery and prevention.”
More than 62,000 children entered foster care in the 2024 fiscal year due to factors that included drug use by a parent or caretaker, a child, or prenatal drug exposure, according to federal data. Yet even methadone — which was partially funded for some parents — has been difficult to obtain due to stigma and strict prescribing rules. Some parents have even been investigated by social workers, or had their newborns removed due to their legally prescribed use of methadone and similar medications.
Medicaid has covered these treatments for years. But now child welfare agencies will be able to split the cost with the feds to pay for uninsured parents, if doing so could prevent the need to remove children.
In a “Dear Colleague” letter to professionals in the child welfare field, three top health and child welfare officials in the Trump administration emphasized the urgency of the issue. They noted that even though the three medications are “the evidence-based standard of care” for opioid use disorders, only “a small fraction” of the thousands of people who meet the criteria for that diagnosis received “evidence-based pharmacological treatment.”
Alex Adams, assistant secretary for the Administration for Children and Families, echoed the theme in a Monday op-ed written for The Imprint.
“This matters — especially for rural communities and families who are not Medicaid beneficiaries,” Adams wrote. The new federal funding, he added, “means expanded access to lifesaving care, delivered earlier, and in more places.”
“When we deny parents access to affordable, effective treatment for opioid addiction, we tear families apart. Using Title IV-E funding to provide life-saving medications keeps families together and moves our system toward recovery and prevention.”
— ROBERT F. KENNEDY, JR., SECRETARY, HEALTH AND HUMAN SERVICES
In its 2024 two-part investigation, Penalized for Their Prescriptions,The Imprint exposed widespread bias in the child welfare system against medication-assisted treatment, despite federal protections guaranteeing rights for patients and people with disabilities.
“They basically said I was still on drugs, I was still a drug addict,” a Southern California mom said in an interview.
An investigation published by Reveal and The New York Times Magazine quantified similar experiences, finding that 3,700 women were reported to CPS in a small sampling of states between 2016 and 2023 for using medication-assisted treatment during pregnancy.
Judge Anthony Capizzi, who recently retired from the Montgomery County Juvenile Court in Ohio, said that perception has changed in recent years; more judges and child welfare professionals have learned the medications save lives and can prevent the need for foster care removals. He praised Kennedy’s agency for further destigmatizing the treatment and making it more broadly available.
“For years, we thought it was a crutch, and we’re finding that if we use this treatment modality, people can change,” Capizzi said. “We have evidence-based examples of how it works. It’s a proven solution to help keep families together.”
The newly approved medications will be the first drugs considered for foster care prevention and eligible for Title IV-E funding as a result of the 2018 Family First Prevention Services Act. That reform aimed to boost spending on foster care prevention but has had a slow rollout.
“For years, we thought it was a crutch, and we’re finding that if we use this treatment modality, people can change,”
— Anthony Capizzi, retired Juvenile court judge
Assistant Secretary Adams detailed this in his Monday op-ed, noting that foster care prevention services still account for less than 2% of total Title IV-E spending. Through the end of 2023, most jurisdictions had “never submitted a single prevention claim,” and most of the federal reimbursements that were paid did not involve substance abuse treatment, Adams wrote.
But last month, Adams’ Administration for Children and Families announced it would fast-track Title IV-E eligibility for Food and Drug Administration-approved “Medications for Opioid Use Disorder.” This week, buprenorphine, methadone and naltrexone became the first such drugs to be deemed “well-supported” under the Family First law’s standard for prevention programs.
In an email sent to The Imprint, a spokesperson for the Administration for Children and Families said that given the high rates of drug-related child welfare cases, her agency will be “providing tools and resources to make it as easy as possible for states to integrate these new prevention services into their state plans.”
However, the statement acknowledged, it will be up to states to accept the offering. Child welfare agencies now have an option — not a requirement — to split the bill with the feds for parents who need buprenorphine, methadone, and naltrexone to help keep their kids out of foster care.
Emily Putnam-Hornstein, a professor of social work at the University of North Carolina at Chapel Hill, has criticized the lack of attention to drug-related infant mortality and inadequate treatment options for parents with child welfare cases. She praised the federal policy change, but said funding may not be among the top “logistical and geographic barriers” for parents who need such medication.
“Given how many children enter foster care because of parental substance use, I support anything that expands access to treatment,” Putnam-Hornstein said. “I suspect the real-world impact will be quite modest, but it shows an awareness of where we should focus our prevention efforts.”
Ahmed Eid, who leads the opioid response program at the Hazelden Betty Ford drug treatment center in Minnesota, said that including buprenorphine and naltrexone as approved addiction medications could address or offset some of the challenges to accessing methadone.
While methadone requires patients to travel and wait for clinicians to give them a dose, the other two newly approved drugs can be prescribed as pills and filled at a pharmacy like any other medication. This can make a difference for accused parents juggling court hearings, social worker check-ins and other court-ordered programs. It will also make treatment more accessible for people in remote communities without a nearby methadone clinic, Eid said.
“Giving people more options that don’t require them to get up, get them a car, drive to a methadone clinic — definitely buprenorphine opens many, many doors,” Eid said.
While some believe these medications replace “one drug addiction for another,” Eid said there’s nothing “inherent” about them that makes them unsafe for parents to use.
“The medication, if it is taken appropriately under supervision of a physician, should not have any effect or impact on an ability of the person to function on a day-to-day basis,” he said. “It’s not like they take the medication and then say “Oh, I’m feeling high,’ or ‘I’m feeling dizzy or drowsy.’”
Judge Capizzi’s family court, located in one of the nation’s counties hardest hit by the opioid epidemic, established a specialized docket that worked to keep children in the home while parents worked through addiction treatment. Due to the state’s Medicaid expansion last decade, Montgomery County also greatly increased residential and outpatient treatment with methadone, buprenorphine and naltrexone.
But other Trump administration moves threaten that access. The Congressional Budget Office estimates that the President’s signature “Big, Beautiful Bill” could result in 10 million people nationwide losing health insurance. That worries Capizzi, where in roughly 10 years of the practice, they never lost a child.
“If the current federal government’s position to restructure Medicaid takes other people off the rolls, that’s a terrible negative for us,” Capizzi said. “I have to hope our legislators do both things — they continue to support this effort, which is good for our country, but don’t forget those people who were receiving treatment of the Medicaid, Medicare options.”
