What your State Legislator needs to know:

how to save your tax dollars,

create safer communities,

better quality of life,

and keep children safe

Facts: About 80,000 children are report to CPS in MN annually (7.8 million nationally). Between 5,000 and 7,000 children / year pass pass through CPS each year. These numbers don’t include the many children that are never seen or reported because child abuse is invisible.

Because data concerning the level of trauma suffered by these children is rarely gathered or reported by CPS, we must rely on research estimates that 100% of foster youth have 2 or more ACEs and 80% have 6 or more ACEs.  This is research‑based estimates rather than official DHS reporting.

The metro’s Children’s Hospital boarded 1200 children with mental health in Emergency Rooms last year. This was because no foster care, qualified group homes, or inpatient care were available (Star Tribune 12.8.25).

How many more children are kept in hospital emergency rooms for emergency psychiatric issues statewide? A few years ago, Hennepin County Medical Center (Hennepin Healthcare) reported  receiving 1000 emergency psych visits monthly. There are at least a dozen MN hospitals that accept pediatric emergency psychiatric patients. The Minnesota Department of Human Services does  not include a routine breakout of “the number of CPS‑involved children in mental‑health crisis” or “psychiatric hospitalizations of CPS‑involved children” per year.​

This is a number that will surprise policy makers once it becomes available. We could then know how serious this crisis is and consider costs and options.  SAMHSA Uniform Reporting System shows over 2.2 million child clients served in Minnesota’s public mental‑health system in 2024, but no CPS breakouts.

Cost per patient is conservatively estimated at between $1800 and $4200/day not including extra direct costs to hospitals and the revenues lost from cancelled other procedures.

If 80% of fosters have 6 or more ACEs) and only 6000 of the 80,000 child maltreatment reports receive CPS intervention, it is likely that these 6000 children score 6 or more trauma scoring ACEs. It seems reasonable to assume that the vast majority of child emergency psych hospital visits are children passing through CPS and this article assumes that most are foster children.

If we assume that the other 11 pediatric mental health emergency hospitals see only half the number (1200) being brought to Children’s = 6600 (660*11)  +1200 = 7200 emergency room visits the direct cost to medical providers likely exceeds 30 million dollars annually – national numbers are off the charts high (national healthcare cost podcast). This would not include multiple day stays or the common additional costs that come with this treatment.

Imagine how sad and terrifying it is for a child alone in a hospital setting after being removed from a birth home. No family, a strange and lonesome setting, and sterile hospital surroundings. This adds trauma to trauma, and more trauma.

This CASA Guardian ad Litem’s first visit to a four year old was at a suicide ward of a local hospital. It’s a scary visit to make.

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In the read more below, there is a deep dive into cost breakdowns in this article and a one page note for you to send to your State Representative (please do this).

Here’s a short letter for you to send to your State Rep to help them understand how to create a long term solution that would create more healthy children, healthy communities, and end the wasteful and painful housing of children in hospital emergency rooms:

Minnesota’s Kids Are Sleeping in ERs: Redirect $30 Million to Real Care

Minnesota is spending millions of dollars each year “boarding” children with serious mental health needs in hospital emergency rooms because there is nowhere else to send them. Boarding means children stay for days in an ER or medical bed while they wait for an appropriate psychiatric bed, residential program, or qualified group home slot that does not exist. Research on pediatric boarding shows these stays are long, dangerous, and extremely expensive, often adding thousands of dollars per child in extra costs while tying up scarce hospital capacity.​

At the same time, Minnesota has roughly 6,000 children in foster care on any given day and thousands more in the child protection system who need stable, trauma‑informed mental health care—not ER cots and hallway chairs. State reports and provider testimony document a shrinking supply of children’s residential treatment and qualified mental health group homes, forcing hospitals and counties to use ERs as a last‑resort placement.​

What’s broken

• Children in crisis are boarding in ERs and medical beds for many extra hours or days because there are not enough children’s residential treatment beds, psychiatric residential treatment facilities (PRTFs), or high‑quality group homes that will accept high‑needs CPS youth.​

• Boarding drives up hospital costs and diverts staff from other emergencies; national data show that ED boarding nearly doubles daily hospital costs and contributes to staff burnout and worse outcomes for kids.​

• Minnesota’s own child welfare spending data show tens of millions already going to institutional and congregate care, but not in a coordinated way that builds a complete children’s behavioral‑health continuum.​

The opportunity: redirect boarding waste to capacity

Conservatively, Minnesota hospitals may be spending on the order of $30 million a year on avoidable boarding of children with mental health needs when you combine direct costs and lost revenue from occupied beds (using national per‑day cost estimates and the volume of boarded youth reported by major systems). Lawmakers can explicitly acknowledge this as “wasted care” and repurpose an equivalent amount in the state budget to build the services that would make boarding largely unnecessary.​

Key actions for legislators

1. Name and measure the problem

• Require all hospital systems (Children’s Minnesota, M Health Fairview, Mayo, PrairieCare, others) to report pediatric mental health boarding days, average wait times, and payer mix annually, with a breakout for CPS‑involved children.​

• Direct DCYF and MDH to publish an annual “Children’s ER Boarding and Behavioral Health Gap Report” estimating the total financial impact and detailing where capacity is missing (residential, group homes, step‑down services).​

2. Create a Children’s Behavioral Health Continuum Fund

• Establish a dedicated fund in statute, seeded with at least $30 million per biennium, to build and operate children’s behavioral‑health capacity: psychiatric residential treatment facilities (PRTFs), children’s residential facilities (CRFs), and trauma‑informed, clinically staffed group homes.​

• Protect this fund from being swept into general hospital or adult behavioral‑health spending; require that funded programs serve CPS‑involved and foster youth as a priority population.​

3. Use federal tools to stretch every state dollar

• Maximize the Family First Prevention Services Act (FFPSA) to draw federal matching funds for intensive in‑home and community services that prevent crises and shorten residential stays.​

• Pursue Medicaid options (including an 1115 waiver) to get federal participation in residential and step‑down care for children, and to raise outpatient/community mental‑health rates so providers can realistically divert kids from ERs.​

4. Tie investments directly to the 6,000 foster children

• Instruct DCYF to identify the subset of Minnesota’s roughly 6,000 foster children who show the highest mental‑health and placement‑instability risks and to guarantee them access to the new continuum: assessment, residential treatment if needed, high‑quality group care, and step‑down services.​

• Set clear metrics: reduce pediatric mental‑health boarding days by a defined percentage, reduce placement moves for high‑need youth, and shorten stays in expensive high‑end settings without discharging kids to nowhere.​

The message to lawmakers

Minnesota can keep paying hospitals tens of millions a year to warehouse traumatized children in ERs—or it can redirect that money to build a real children’s mental‑health continuum: residential treatment, qualified group homes, and strong community supports for the 6,000 abused and neglected children who need it most. The data and tools already exist. What is missing is a clear legislative decision to treat pediatric ER boarding as a preventable, budgeted problem and to invest those dollars upstream in safe, therapeutic places for kids to live and heal.

The Cost of Boarding Children in Hospital Emergency Departments

There is no single national “average cost” figure just for boarding children in hospital ERs, but available studies suggest that boarding pediatric psychiatric patients adds hundreds to thousands of dollars per child in direct hospital costs, and the true economic impact is higher when lost revenue is included.

What the Research Shows

A pediatric hospital case study cited by the Children’s Mental Health Campaign found that psychiatric boarding cost about 2 million dollars over 18 months, roughly $4,269 per patient, with boarded children occupying medical beds for 1,169 total days (Children’s Mental Health Campaign, “Pediatric Psychiatric Boarding”: https://www.childrensmentalhealthcampaign.org/wp-content/uploads/CMHC-Pediatric-Psychiatric-Boarding-Paper.pdf).

A broader emergency‑medicine cost study from the American College of Emergency Physicians (largely adult data) found that boarding nearly doubled daily hospital cost: about $1,856 per boarded patient per day versus $993 per day for similar inpatients not stuck in the ED, showing how expensive it is to hold patients in emergency departments instead of moving them to appropriate units (ACEP, “Boarding Patients in Emergency Departments Nearly Doubles Daily Costs”: https://www.emergencyphysicians.org/press-releases/2024/10-21-24-boarding-patients-in-emergency-departments-nearly-doubles-daily-costs-us-hospitals).

Why the Real Cost Is Even Higher

Boarding ties up scarce ED beds and staff, so hospitals lose potential revenue from patients who could have used those beds for planned admissions or procedures; one analysis estimated millions of dollars in lost revenue in a single year due to psychiatric boarding occupying inpatient beds that would otherwise be used for other patients (Children’s Mental Health Campaign paper: https://www.childrensmentalhealthcampaign.org/wp-content/uploads/CMHC-Pediatric-Psychiatric-Boarding-Paper.pdf).

Studies of pediatric mental health boarding highlight that beyond direct cost, prolonged stays (often many extra hours to several days) increase risk, worsen outcomes, and strain staff, all of which carry downstream financial and social costs that are hard to quantify in a single per‑day number (American Academy of Pediatrics, “Pediatric Mental Health Boarding”: https://publications.aap.org/pediatrics/article/146/4/e20201174/79659/Pediatric-Mental-Health-Boarding).

Additionally, research on prolonged ED length of stay for pediatric patients shows that extended boarding is associated with increased medical complications, psychological distress, and higher rates of adverse events (Prolonged ED Length of Stay for US Pediatric Patients: https://pmc.ncbi.nlm.nih.gov/articles/PMC8086002/).

How to Talk About Cost in Advocacy

For framing, it is reasonable to say that each boarded child can cost hospitals several thousand dollars in extra direct cost alone, not counting lost revenue or longer‑term system impacts, based on the per‑patient and per‑day cost estimates in these studies (Children’s Mental Health Campaign paper and ACEP boarding cost report: links above).

Because costs vary by hospital, payer mix, and length of stay, a state‑level estimate (for Minnesota, for example) would require combining (1) the number of boarded pediatric patients and average boarding duration, with (2) a per‑day cost estimate in the range reported in these national studies.

Minnesota Context

According to a Star Tribune article on the Washburn Center–Children’s Minnesota partnership, Children’s Minnesota ERs “boarded” about 1,200 children last year (Star Tribune, “Washburn Center–Children’s Minnesota partnership seeks end to youth ER boarding”: https://www.startribune.com/washburn-center-children-minnesota-er-emergency-boarding-mental-health-behavior/601540323). Using the $4,269 per‑patient estimate from the pediatric case study as a conservative benchmark, this could represent approximately $5.1 million in direct boarding costs annually at that single health system alone, not accounting for lost revenue or downstream system impacts (Children’s Mental Health Campaign paper: https://www.childrensmentalhealthcampaign.org/wp-content/uploads/CMHC-Pediatric-Psychiatric-Boarding-Paper.pdf).

Key Resources

• Children’s Mental Health Campaign – “Pediatric Psychiatric Boarding: Using Data to Develop Policy Solutions”:
  https://www.childrensmentalhealthcampaign.org/wp-content/uploads/CMHC-Pediatric-Psychiatric-Boarding-Paper.pdf

• American College of Emergency Physicians – “Boarding Patients in Emergency Departments Nearly Doubles Daily Costs for US Hospitals”:
  https://www.emergencyphysicians.org/press-releases/2024/10-21-24-boarding-patients-in-emergency-departments-nearly-doubles-daily-costs-us-hospitals

• American Academy of Pediatrics – “Pediatric Mental Health Boarding”:
  https://publications.aap.org/pediatrics/article/146/4/e20201174/79659/Pediatric-Mental-Health-Boarding

• Prolonged Emergency Department Length of Stay for US Pediatric Patients:
  https://pmc.ncbi.nlm.nih.gov/articles/PMC8086002/

• Star Tribune – “Washburn Center–Children’s Minnesota partnership seeks end to youth ER boarding”:
  https://www.startribune.com/washburn-center-children-minnesota-er-emergency-boarding-mental-health-behavior/601540323

• Minnesota Department of Children, Youth & Families – Child Safety and Family Preservation:
  https://dcyf.mn.gov/individuals-and-families/family-services/child-safety-and-family-preservation

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This article submitted by CASA volunteer Mike Tikkanen

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