Maryland foster children placed in hotels or left to linger in hospitals for days or weeks when no other options are available may soon see some relief.

Legislation passed by the Maryland General Assembly has child welfare advocates cautiously optimistic about efforts to increase options for children housed in hotels, office buildings, hospitals and other temporary settings when home isn’t safe.

“While it may not achieve every single thing we wanted, it’s lit a light — there’s some accountability,” said Judith Schagrin, a social worker who spent 20 years as the administrator of Baltimore County’s foster care program. “The workforce is poised to do the work that should have been done long ago, which is to look at the needs of children contrasted with our placement capacity.”

A bipartisan measure, sponsored by Sen. Pamela Beidle, Del. Joseline Peña-Melnyk and more than a dozen delegates, seeks to improve care and create a group to look at what’s needed to support the children who can’t return home. The bill passed at the end of the legislative session and now heads to Gov. Wes Moore’s desk.

The bill requires the Maryland Department of Health and the Department of Human Services to work together to ensure that people younger than 22 who are stuck waiting in hospital emergency rooms or inpatient units for more than 48 hours after being medically cleared to leave, also known as pediatric hospital overstay patients, head to the least restrictive settings possible for treatment.

Hospitals can explore placements both in Maryland and out of the state to find the least restrictive setting for these children, who can remain there for more than 48 hours after getting cleared to leave due to aggressive or sexually reactive behaviors, developmental disabilities or autism with psychiatric features or because they’re too old or young for available out-of-home placements.

Those patients, many of whom are waiting for placement in foster homes or treatment centers, face isolation, missing school and opportunities to get outdoors, according to bill testimony from the Maryland Hospital Association.

Keeping children who are medically cleared to leave in hospital beds can also prevent facilities from accepting patients who do have medical needs.

The Johns Hopkins Children’s Center in Baltimore, the only pediatric trauma center in Maryland, denied admission to 218 children in need of medical care last year due to the lack of available beds, Michael Huber, director of Maryland government affairs for Johns Hopkins University & Medicine, wrote in testimony to support the initial legislation.

Under the bill, the health and human services departments will need to have a pediatric hospital overstay coordinator to advocate for the child and their care. The coordinator is tasked with reviewing state agencies’ policies and procedures to make recommendations to improve care, as well as maintaining data on each patient.

The measure also mandates a 15-member workgroup, composed of people who have backgrounds working with children with behavioral health challenges, adverse childhood experiences and developmental disabilities, to assess and make recommendations on children in unlicensed settings and hospital overstays.

Children in unlicensed settings are those under age 21 in an out-of-home care placement who live in hotels, office buildings, shelters or other unlicensed settings that aren’t foster homes or treatment centers. It does not include people under 21 who receive self-independent living stipends or live with kin awaiting placement.

Long hospital, hotel stays drop

Housing foster children in hotels comes when no other options remain. The practice comes at a high price — DHS estimated that it costs about $1,400 per child per day for food, shelter, caregiving and more, according to figures in a Department of Legislative Services analysis of the agency’s budget.

However, one of DHS’s top priorities is working to bring the number of children living in hotels and hospitals down to zero, and the number of foster children housed in those settings has decreased.

As of April 10, there were 12 foster youth in hospitals, and as of Wednesday, there were 14 foster youth housed in hotels — figures gathered from manual calculations based on reports from hospitals and local offices, said DHS spokesperson Lillian Price. The numbers have dropped since Feb. 6, when there were 16 children in hospitals and 28 children in hotels.

“We do not believe that a hospital or hotel stay is acceptable for any child, and will continue to work on addressing this challenge,” Price said in a statement. “We are meeting with our partner state agencies and hospitals weekly and have taken steps to limit the number of youth who experience hospital overstays. This administration is committed to addressing the systemic gaps and increasing communication and collaboration.”

‘A positive direction’

Members of the Coalition to Protect Maryland’s Children, which advocates for child welfare reform, were pleased with the increased awareness of housing foster children in unlicensed settings among lawmakers this year, but are remaining realistic about what can be accomplished.

“I’m glad there’s more attention, I’m glad that there’s some movement in a positive direction,” said Robert Basler, associate vice president of Arrow Child & Family Ministries, which provides foster care and community-based services. “But we need to see what happens, because no real changes have happened yet.”

Group members, to include state secretaries or representatives from MDH, DHS and the Department of Juvenile Services, will be tasked with looking at the number, type and cost of additional beds and supportive services that are needed to place all children in hospital overstays and unlicensed settings in the least restrictive environments.

“People that aren’t in this kind of area, in this space, don’t understand how important it is to have a lot of people at the table from different areas because one group can’t solve it,” said Erica LeMon, advocacy director for children’s rights at Maryland Legal Aid.

The workgroup will also create a resource development plan to increase the number of licensed settings and end the use of pediatric overstays and unlicensed settings, as well as a data-informed implementation plan and a timeline for when placing children in unlicensed settings will end.

Jennifer Stine, executive director of Court Appointed Special Advocates of Baltimore County, said she was initially frustrated by the workgroup and had instead wanted a bill to resolve some of the longstanding issues. But having state agencies come together is also important, she said.

“I’m cautiously optimistic that at the very least, a report could say that each agency, everyone has a part in it, and that at least the next steps will include everyone doing something about it,” Stine said.

But solving the problems afflicting older foster youth is not simple.

“They are difficult, they are complex and it’s not just one solution,” LeMon said. “The solution today might not be the solution tomorrow, so it’s not an easy fix.”

Aside from foster placements, treatment and other resources, providing funding matters, too. Being able to adequately finance the foster care system, especially for children with more complex needs, is “vital” for placing them in the most suitable homes, said Basler of Arrow Child & Family Ministries.

However, the final fiscal 2026 budget passed by the General Assembly restricts $500,000 in funding for the Social Services Administration until DHS provides a report to the legislature’s budget committees with data on children in hospital and hotel stays, as well as children in out-of-home placements. The report is due Nov. 1.

Withholding that funding pending receipt of a report with data to show how widespread the problem is in Maryland is a positive outcome, and helps to hold DHS accountable, said Diana Philip, coordinator and consultant for the Coalition to Protect Maryland’s Children.

“We’re going to have to be creative in ways to meet complex kids’ needs, and as a system — and I include all of us providers to this as well — we have not been good at doing that,” Basler said. “If we’re going to solve this problem, we’re going to have to be creative, be flexible, and trust one another to make significant changes happen.”