Legislative Summary: The Keeping Families Together Act H.R. 3243/S. 1704 — Rep. Jim Ramstad, Sen. Susan Collins


Each year, thousands of parents are forced to relinquish their custody rights to the state in order to obtain mental health care for their seriously ill children. Services to treat serious mental disorders in children are extremely expensive and private insurance tends to run out after a few months, leaving parents unable to afford the cost. Yet affected children often remain ineligible for Medicaid because their parents' income and assets keep them from qualifying for assistance. With no other way to get their kids treatment, parents are forced to choose between custody or care. The GAO reported in April that parents in 19 states placed 12,700 children in state welfare or juvenile justice agencies in 2001 to obtain mental health services for them. That estimate is considered low, because 31 states did not respond to the survey.


The Keeping Families Together Act would keep these children in their families through three main components:

  • Grants to states to build new state-level infrastructure to more efficiently serve these children while keeping them in their families;

  • Establishment of a federal interagency task force to examine mental health issues in the child welfare and juvenile justice systems; and

  • Inclusion of eligibility of children and adolescents in residential treatment facilities for Medicaid home or community-based services waivers.

Family Support Grants to States

Competitive grants to states are conditioned on the existence of state laws or policies in effect to ensure that children receive appropriate mental health services so that parents do not have to relinquish custody of such children. The Family Support Grants will:

  • Keep children in their families by helping states establish interagency systems of care as an alternative to custody relinquishment;

  • Allow states, which already spend significant money serving children in state custody, to use resources more efficiently by delivering care to children while allowing them to remain with their families;

  • Facilitate the design of a state plan through a collaborative process involving state child-serving agencies, parents, providers, and other stakeholders;

  • Only fund activities which benefit children and youth who are in the custody of the state or who are at risk of entering into the custody of the state solely for the purpose of receiving mental health services; and

  • Require states to provide matching funds over the 6-year period of the program, ultimately equaling not less than $2 for each $1 of federal funds provided in the grant.


The bill requires states to report annually, beginning with the second fiscal year in which a state receives funding under a grant, on the success of the programs and activities carried out by the state under the grant. Not later than 3 years after the date of enactment, and after the full 6 years, a report to Congress is required evaluating the success of states in using the grants to eliminate the problem of custody relinquishment.


Grants to states authorized at $4.5 million for fiscal year 2004, $6.5 million for fiscal year 2005, and $11 million for each of fiscal years 2006-2009. Grants to establish the task force authorized at $1 million for each of fiscal years 2004 through 2009.