A two-year investigation by the U.S. Senate Finance Committee has exposed systemic child abuse and neglect within youth residential treatment facilities (RTFs) that receive billions of dollars in federal funding, including Medicaid and child welfare dollars.
Systemic Abuse in RTFs
The investigation, released June 25, 2026, by Senate Finance Committee Chair Ron Wyden, D-Ore., examined four major RTF operators: Universal Health Services (UHS), Acadia Healthcare, Devereux Advanced Behavioral Health, and Vivant Behavioral Healthcare. The committee found that children in these facilities are regularly subjected to physical, sexual, and verbal abuse, as well as inappropriate restraints and seclusions.
According to the committee report, titled "Warehouses of Neglect," these harms are not isolated incidents but are inherent to an operating model designed to maximize profits by warehousing as many children as possible while keeping costs low. Wyden stated that the findings demand bold action, noting that abuse and neglect have become the norm at these facilities.
Failures in Care and Oversight
The report detailed several critical failures within the residential treatment industry, including the use of unqualified or inadequately trained staff and unsafe, unsanitary living conditions. In some instances, the committee found that staff ignored federal regulations regarding restraint and seclusion, leading to daily use of these practices on children.
Beyond physical harm, the investigation highlighted that many facilities utilize carceral technology to monitor children, creating environments that resemble detention centers rather than therapeutic settings. The report also noted that children often leave these facilities more traumately than when they arrived, with some deaths, including suicides, occurring due to the lack of necessary care.
Medicaid and Foster Care
The investigation's focus on Medicaid funding is particularly relevant to states like Utah, which utilizes federal funds to provide healthcare to vulnerable populations. According to the Utah Department of Health and Human Services (DHHS), the state provides full Medicaid coverage through the Foster Care Medicaid Program (Title IV-E) for children in the custody of DHHS agencies.
This program covers children for whom a foster care maintenance payment is made by DHHS, provided they meet specific eligibility requirements. Under these guidelines, children may continue to qualify for the program until age 18, or until the month of graduation if they are between ages 18 and 19 and attending school full-time.
State Medicaid Coverage Details
Utah's Medicaid framework also includes a Non IV-E program for children in DHHS custody who do not meet Title IV-E requirements but qualify under other criteria, such as Child Medically Needy or Disabled Medicaid. Additionally, the state offers a Custody Medical Care program, funded by state general funds, to ensure immediate healthcare access for foster children before their Medicaid eligibility is officially determined.
For those aging out of the system, Utah provides coverage through the Former Foster Care Individuals Medicaid program for those aged 18 to 26 who were concurrently enrolled in Medicaid and foster care at age 18. A Foster Care Independent Living extension is also available through age 21 for youth receiving services through the Division of Child and Family Services (DCFS).
Calls for Reform
In response to the investigation, the Senate Finance Committee has called for legislative action to raise health and safety standards, strengthen oversight, and increase investment in community-based alternatives. The committee recommended that Congress focus on raising the floor for congregate care standards and investing in services proven to help children effectively.
Furthermore, the report urged state and federal agencies, such as CMS and ACF, to work together to streamline oversight and prioritize spending on community-based behavioral health services as a safer alternative to placement in residential treatment facilities.
