Children with disabilities and complex medical needs are being held in hospitals across the country after being medically cleared for discharge. The practice, called "social stays" or "hospital boarding," affects children with autism, complex medical needs, and psychiatric diagnoses who have nowhere safe to go once they're stable enough to leave.

Missouri alone reimbursed 19 hospitals $16.3 million for 9,943 boarding days last year, at over $1,600 per night. A 2017 Minnesota study found the cost runs as high as $3,932 per day for children with complex medical conditions. The problem spans Missouri, Illinois, Minnesota, Georgia, Colorado, Nevada, and Maryland, with other states likely affected.

What's Causing the Crisis

The root cause is a shortage of safe community placement options. Families can't access sufficient home health aide coverage. Group homes lack capacity. State care systems don't have training or resources for medically complex children.

Dr. Elaine Lin, a pediatrician at Boston Children's Hospital, told KFF Health News that "every state has different options...there's many of our kids with medical complexity who just don't have access to appropriate home nursing."

Hospitals become holding facilities by default. Some hire "sitters" to supervise children during extended stays. Others assign chaperoning to existing staff. Children sleep on emergency room stretchers in windowless rooms. Insurance won't cover post-acute hospitalization, so states foot the bill.

Who This Affects

In Illinois, 304 youth cases involved psychiatric hospitals holding children beyond medical necessity during the last fiscal year. Forty-three percent were ages 13 to 16.

Georgia reported 500 children "relinquished" by parents in 2025, families who couldn't manage behavioral or psychiatric needs at home and had no other placement options.

One Colorado case involved a 13-year-old with autism who spent weeks hospitalized after his father abandoned him at the hospital. No community placement was found.

Missouri's Mercy Hospital System alone logged 2,687 boarding days over 18 months.

What This Means for Families

Hospitals are not therapeutic environments for long-term stays. Children who need routine, familiar settings, and community integration are instead confined to medical facilities designed for acute care. The boarding delays access to appropriate services while running up costs states can't sustain.

Families often feel trapped. Bringing a child home without adequate home health support isn't safe. Keeping them hospitalized isn't helpful. The system offers no good options.

Proposed federal Medicaid cuts, potentially $1 trillion by 2034 under the One Big Beautiful Bill Act, would shrink community placement capacity even further.

Missouri's Failed Legislative Response

Sen. Jamie Burger introduced bills in 2026 requiring faster placement timelines and mandating state payment when children board in hospitals. The estimated annual cost was $148 million. Similar bills had failed in prior years. This year's legislation remained stuck in committee when the legislative session ended May 15, leaving the problem unresolved.

What Families Can Do Now

If your child is hospitalized and discharge planning isn't moving forward:

• Document everything in writing. Keep a written record of all unmet care requirements, discharge planning conversations, and placement options the hospital has explored. Request copies of all social work notes and discharge planning documentation.

The problem won't resolve without policy change, but families can reduce delays by staying visible, documenting gaps, and escalating to advocacy organizations early.