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Grandfamilies: Health & Nutrition
The caregivers and children in grandfamilies face physical and mental health challenges to a greater degree than the general population.

Caregivers’ Health
Grandfamily caregivers frequently experience stress that can lead to greater health challenges. They provide care for children at a time in their lives they did not expect to be. They are often socially isolated from their peers. They may feel a sense of shame and guilt about their own adult children who are unable to parent. Grandparent caregivers frequently suffer health problems including:
  • Depression
  • Diabetes
  • Hypertension 
  • Insomnia
  • Gastric distress
Furthermore, they are often unable to attend to their own medical needs due to a lack of daycare, respite care or adequate health insurance.

Children’s Health
Although several studies address the health of relative caregivers, relatively few study the overall well-being of children in relative care. The existing findings show that these children exhibit a variety of physical, behavioral, and emotional problems to a greater degree than the general population of children. These problems often stem from the difficult situations that caused them to be placed in a grandparent’s care.
 
Barriers to Accessing Health Care
For relative caregivers without a legal relationship – such as guardianship or adoption – to the children in their care getting parental consent to medical, dental or mental health care may be difficult, if not impossible.
Even if grandfamilies can consent to health care, obtaining the necessary insurance to pay for it may be out of reach. Some typical barriers include:
  • Relative caregivers who have private health insurance can add the children to their policy if they adopt them, but that is usually the only legal relationship recognized by insurers. For a variety of reasons, many relatives do not adopt the children in the care.
  • Public health insurance through Medicaid and Children’s Health Insurance Program (CHIP) covers some grandfamilies, but many do not meet the programs’ income and other eligibility requirements.
  •  For many children in grandfamilies that should qualify for public health insurance programs, their caregivers do not know how to apply for the programs or think they are not allowed to apply on behalf of the children.
Other federal programs, such as the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Food Program for Women, Infants and Children (WIC), can help address health issues related to nutrition.
 
Laws and Programs Responding to these Challenges:
Several federal programs and state laws can help grandfamilies respond to health challenges.
 
Medical Consent
Medical consent laws allow relative caregivers -without legal relationships to the children they raise-to give consent to health care for the children. More than half of states have these laws. One of the oldest is in California, where a relative caregiver without legal custody or guardianship of a child can submit the same affidavit to enroll the child in school and to consent to the child’s health care treatment.

Power of Attorney
Almost half of states have power of attorney laws that explicitly allow parents to bestow relatives with the power of attorney for the care of their children, and thereby consent to health care. These states typically allow the power of attorney to be designated for six months to a year, so it may not be the best option for long term caregivers.

Individuals with Disabilities Education Act
The Individuals with Disabilities Education Act (IDEA) funds:
  • Special education services for K-12
  • Early intervention services for children birth to three (Part C) 
  • Pre-school services (Part B)
Services can include speech, physical, and occupational therapies. Grandparents or other relatives are specifically included in the IDEA regulations as a “parent” and can access services on behalf of children (34 CFR 300.30(a)). Some jurisdictions reportedly require relative caregivers to go through a process to become a “surrogate parent” in order to be considered a “parent”. The plain language of the federal regulation provision above does not require this step for these caregivers.

“Child Find” is a part of the IDEA that requires states to identify, locate, and evaluate all children with disabilities ages birth to 21, who are in need of early intervention or special education services.

Kinship Navigator Programs
Kinship navigator programs provide information, referral, and follow-up services to grandparents and other relatives raising children to link them to the benefits and services that they or the children need. Navigators help relatives’ access programs, including medical and nutrition services.  A list of known navigators can be found here.

If you need additional information and support, visit the Grandfamilies State Law and Policy Resource Center or connect with support groups in your area.

Medicaid
Medicaid is a national health insurance program that covers most basic health care for children including: doctor visits, prescriptions, and hospital costs. Grandparents and other relative caregivers may qualify for Medicaid for the children they are raising, even if the children do not get TANF benefits. Most states will not count a grandparent- or other relative-caregiver’s income or the value of his or her assets in determining a child’s income eligibility for Medicaid. In addition, most states do not require grandparent- and other relative-caregivers to have court-ordered legal custody or guardianship to apply for Medicaid on behalf of the children they are raising.

Children’s Health Insurance Program
The Children’s Health Insurance Program (CHIP) provides insurance coverage for uninsured children in families with incomes too high to qualify for Medicaid. The law targets uninsured children under the age of 19 being raised in families with incomes below 200 percent of the federal poverty level.

The states, however, have a great deal of flexibility to set the eligibility rules, determine subsidy levels, define covered benefits, set payment rates, select health plans, and use managed care. CHIP permits states to cover only targeted low-income children and to establish additional eligibility standards, including:
  • Limiting the geographic areas served by the program
  • Setting age limits lower than age 19
  • Establishing time limits for coverage
  • Imposing state residency requirements 
The residency requirements can prove problematic for grandparents and other relative caregivers who are temporarily caring for a child who has moved from another state.

Most states will not count a grandparent- or other relative-caregiver’s income or the value of his or her assets in determining a child’s income eligibility for CHIP. In addition, most states do not require grandparent- and other relative-caregivers to have court-ordered legal custody or guardianship to apply for CHIP on behalf of the children they are raising.

Supplemental Nutrition Assistance Program (SNAP)
This program, which used to be know as food stamps, gives low-income individuals coupons or debit cards that can be used to purchase food from approved vendors. SNAP benefits are issued to households, rather than to individuals. The amount a household receives depends on the household size and income. Only households with a net income at or below 100 percent of the federal poverty level can qualify for SNAP. Unlike Medicaid, SNAP benefits cannot be obtained on behalf of the child alone.

The Special Supplemental Food Program for Women, Infants and Children (WIC)
Like SNAP, this program can help grandparents and other relatives purchase nutritious food for the children in their care. WIC offers food assistance and nutritional screening to low-income pregnant women, women with infants 11 months or younger, and children under the age of 5 who suffer from a nutritional problem as determined by a health care provider. Grandparents and other relatives can apply for WIC if they or the children they raise meet the eligibility criteria. WIC is federally funded and is administered by state and local agencies. To get additional information, go to www.fns.usda.gov/wic/Contacts/tollfreenumbers.htm for your state’s toll free phone number.

If you need additional information and support, visit the Grandfamilies State Law and Policy Resource Center or connect with support groups in your area.

Resources
The Grandfamilies State Law and Policy Resource Center 
Grand Resources: A Grandparent’s and Other Relative’s Guide to Raising Children with Disabilities
State Educational and Health Care Consent Laws: Policy Brief and Summary | Map
Healthy Ties: Ensuring Health Coverage for Children Raised by Grandparents and Other Relatives (PDF)
Healthy Ties: The Grandparent’s and other Relative Caregiver’s Guide to Health Insurance for Children (PDF)
Grandparents and Other Relatives Raising Children: The Second Intergenerational Action Agenda
Centers for Medicare and Medicaid Services, US Department of Health and Human Services
Child Welfare Information Gateway

Global Intergenerational Conference
June 13-16, 2017
Milwaukee, Wisconsin
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