Mental Health on the Hill: Structural Barriers and Emerging Opportunities

By Doug Steiger, MPP

Mental Health on the Hill: Structural Barriers and Emerging Opportunities

By Doug Steiger, Child Welfare Wonk Senior Contributor

The findings from this Data Drop on mental health need and foster care underscore what those in child welfare already know intuitively: children in foster care face a growing mental health crisis. 

Despite bipartisan expressions of concern and frequent hearings over the past five years, no comprehensive federal strategy has emerged. The explanation is structural, not cynical.

Why the Structure of Government Matters

Congressional outsiders focus on leadership and personalities. Insiders know that Congress’ circulatory system rests on committee jurisdictions; who “owns” what issues.

Readers will know that these committees tend to focus on what they oversee, rather than viewing the needs of foster youth holistically. 

Understanding this dynamic unlocks deeper insight into why policy moves or stagnates, and how to navigate this terrain effectively.

The House

Key levers for addressing children’s mental health are spread across multiple committees, which often have different incentives, expertise, and goals:

• Ways & Means 

  • The Power: Congress’ oldest committee has jurisdiction over foster care funding, including Title IV-E.

  • The Imbalance: Members seeking spots here are more likely to want to flex tax, trade, and tariff chops than safety net expertise.

• Energy & Commerce 

  • The Power: E&C oversees Medicaid and most public health and mental health programs.

  • The Imbalance: Major health resources flow through E&C, but there’s no required connection to child welfare financing.

• Education & the Workforce 

  • The Power: Ed & Workforce has jurisdiction over the Child Abuse Prevention and Treatment Act (CAPTA).

  • The Imbalance: CAPTA’s requirements on states make it a driver of policy, but its lack of relevant open-ended funding constrains its leverage.

The Senate

Senators’ representation of states provides disproportionate rural influence, shaping how the Senate sees issues. 

Jurisdiction is more consolidated, driving broader perspectives and coordination, while simultaneously making it challenging to map policy and process to what the House does.

• Finance Committee

  • The Power: Finance oversees most health financing, including Medicaid, and most foster care and safety net programs.

  • The Imbalance: Health financing policy alone is so large that it takes significant bandwidth and focus.

• Health, Education, Labor, and Pensions (HELP)

  • The Power: HELP oversees public health and mental health programs, as well as CAPTA.

  • The Imbalance: HELP has authority over the agency infrastructure of most of HHS, but not the core resource flows that Finance controls.

The Administration

In the absence of legislation, the executive branch, particularly the Department of Health and Human Services (HHS), tends to act at the margins: through guidance, grants, and regulatory tweaks.

One angle to watch is Secretary Kennedy’s interest in reducing the use of psychotropic medicine for children, which could lead to a coordinated effort.

However—with proposed budget cuts, a shift toward block grants, and increased fiscal pressure on states—the Administration’s tools may be shrinking just as the need grows.

What Lies on the Horizon for Mental Health on The Hill

Budget reconciliation will reduce Medicaid spending by nearly $1 trillion over the next decade.

As a result, state Medicaid programs will face serious fiscal pressures just to keep the status quo, making expanding their mental health supports or improving their quality a serious challenge.

But there are federal resources for mental health in public health programs. 

The House has passed the SUPPORT for Patients and Communities Reauthorization Act which renews a host of public health programs with modest changes, including for children’s mental health programs.

The bill passed the House on a bipartisan vote of 366-57, but faces headwinds from Democrats uncomfortable with the Administration’s changes to the agency implementing the law.

Conclusion: What Could Change the Game

In Washington, legislation passes when it is either politically important to the majority party or is bipartisan. 

Foster care issues are never that important politically, so a bill addressing the mental health needs of foster youth needs to be bipartisan – and if it’s comprehensive, it will need to be bipartisan across multiple committees. 

It’s hard to negotiate meaningful bipartisan policy in one committee, let alone more than one.

That’s why structural leadership matters, and often requires White House pressure. 

This is rare but not unheard of – 1997’s Adoption and Safe Families Act became law in part because Hillary Clinton and House Majority Whip Tom DeLay collaborated on its policies to promote adoption. 

First Lady Melania Trump has repeatedly expressed interest in older youth in foster care, which could be a structural pressure for progress. 

Substantive progress is possible despite these architectural barriers, but anyone who wants to advance it needs to be aware enough to navigate them effectively.

Doug Steiger is a Child Welfare Wonk Senior Contributor and public policy consultant.

He served as a Counselor to the HHS Secretary during the Obama Administration and was a Senate staffer for 12 years.