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To save money, Missouri Department of Social Services, MO HealthNet Division (DSS/MHD) wants to add behavioral health care services for foster and adopted kids to the “managed care” model under Medicaid instead of the current “fee-for-service” model. This change will shrink access to already limited behavioral health care services for our kids.

Among many problems with the proposed change, we highlight three:

  • Children will experience a disruption in care. With this change, children will only be able to receive care from “credentialed” practitioners within their managed care plan, regardless of whether their current provider accepts Medicaid. This complicates an already complicated issue for parents searching for mental health providers.


  • Children will experience a reduction in services. The managed care model will “approve” a certain amount and type of services, regardless of the needs or circumstances of each individual because its goal is to reduce costs. Regardless of how extensive a child’s needs may be, a predetermined amount of care is approved based on the needs of “average” children who do not represent the foster children and children adopted from foster care who have significantly greater mental health care needs because of abuse and neglect they have experienced. For example, a child in foster care is referred for therapy and receives approval for 8 therapy sessions. Regardless of how extensive this child’s needs may be, they are only approved for 8 sessions because this is the predetermined amount of therapy needed for the average child. Parents will have to fight a complicated bureaucracy to increase the amount of sessions approved.


  • Across the state, children are currently struggling to access services because of long wait-lists and strict enrollment processes. This change will increase the lack of access, especially for children in rural areas of Missouri where providers are scarce.


Share your experience accessing mental health services for your foster and adopted children

Contact your elected officials

  1. Find your district’s officials here: DISTRICT MAP
  2. Find contact information for your officials here: CONTACT INFORMATION
  3. Copy the sample email content below and paste into an email.
  4. Make calls and send emails to Ask.MHD@dss.mo.gov and elected officials to let them know this decision is bad for kids!

Sample Email Content

SUBJECT LINE: “Public Comment for Behavioral Health Services Carve-In”


Mr. Richardson,

Children who have experienced abuse and neglect often require significant mental health care services. Allowing the transition for behavioral health care for foster children from fee-for-service to managed care will hurt our access to the timely care children need. The limited access to mental health care services is already marked by long wait-lists and complicated enrollment processes. Please do not add even more barriers to quality mental health care services that will hurt Missouri children and families.




Children in the foster system are amongst the neediest, requiring timely, individualized behavioral health care to address their unique mental health needs. This population of children and teens have such specific history of trauma and loss, often combined with significant family history of mental illness, that to further delay their care by those best trained and equipped, reduces the opportunity for supporting them in optimizing their well-being and positive functioning.

~ Dr. Michele Kilo, Developmental Pediatrician