Boarding Childhood: Maryland's Pediatric Hospital Overstay Crisis

CPMC intern blog February 26, 2026

I’m Elizabeth diTargiani, Public Policy Intern for the Coalition to Protect Maryland’s Children. I’m still workshopping a name for this blog — maybe Intern Insights or Learning Out Loud. But for now, there are more urgent things to talk about.

During a briefing on Children in Unlicensed Settings and Pediatric Hospital Overstays on January 21st, the Department of Human Services reported that seven youth were in “overstay” status. The Maryland Hospital Association (MDHA) later clarified during the briefing that this figure represents only youth in the direct care and custody of DSS, but not the full number of youth experiencing hospital overstays. A broader and more accurate count was shared: 

• 32 youth were experiencing hospital overstays. 

• 12 girls and 20 boys

• Ages ranging from 7 to 20, with an average age of 14

  
  

These numbers raise a critical question: when does DSS take responsibility for these children, whose need for placement is the result of intensive and complex behavioral health needs, not protection? 

If a child enters overstay while already in state care and custody, DHS is responsible. However, when a young person is first identified through an emergency room visit or hospital stay, they may initially come to the department’s attention without formal custody. In those cases, the department may pursue a Voluntary Placement Agreement (VPA) — and the moment that agreement is signed, the state assumes responsibility for the child’s care and placement. Parents retain legal, not physical custody. Senator Pamela Beidle, sponsor of 2025's SB696, personally visited several hospital overstays and shared firsthand accounts of what she witnessed. Some foster youth, particularly those whose needs are especially challenging to meet in the existing array of Maryland placements, have remained in hospital settings for as long as 100 days. Equally as horrifying, there are youth literally boarding in hospital emergency rooms, some for weeks or even months during that time experiencing:

• No schooling

• Interruptions in medication and mental health treatment

• No access to therapy or supportive services

• Inability to go outside or participate in normal daily activities.

These are some of the most vulnerable young people in our state. They did not choose to be in this position. They deserve safety, stability, and the chance to simply be kids. 

As Maryland entered this 2026 legislative session facing a $1.5 billion budget deficit, concerns grow about what can realistically be done. Yet it is impossible to ignore that legislation passed as far back as 2020 remains unimplemented:

• HB 322 (2023) - Home & Community-Based Services for Children

• HB 766 (2022) - Residential Treatment Centers Education Funding

• HB 1134 (2024) - RTC Accreditation Requirements

• HB 1121 (2020) - Mental Health Registry and Referral System

  
  

At the same time, progress deserves recognition. HB 962 (2025) - Pediatric Hospital Overstay Patients and Workgroup on Children in Unlicensed Settings and Pediatric Overstays. The law:

• Expands the Maryland Mental Health and Substance Use Disorder Registry to include both public and private inpatient and outpatient services

• Requires MDH and DHS, under certain circumstances, to ensure pediatric overstay patients are placed in the least restrictive setting when clinically appropriate

• Authorizes hospitals to concurrently explore in-state and out-of-state placements

• Establishes a Pediatric Hospital Overstay Coordinator within the Governor’s Office for Children

• Requires a rate study of residential treatment centers and respite facilities

• Establishes the Workgroup on Children in Unlicensed Settings and Pediatric Overstays

  
  

Maryland’s children need action now and cannot wait. Their mental and physical health, education, and future depend on it. As an intern, I am still learning the mechanics of policy, but this issue requires no learning curve to understand its urgency. Children do not stop needing care because systems are overwhelmed or budgets are tight. They do not pause their development while waiting for placements that never come. Maryland has named this problem, studied it, and legislated around it. Now, it must act. Our children deserve more than recognition of their suffering; they deserve solutions. And they deserve them now.

Reference:

Maryland General Assembly. (2026, January 21). Briefing on SNAP and the workgroup on children in unlicensed settings and pediatric hospital overstays [Committee Briefing]. Senate Finance Committee, Annapolis, MD.https://mgaleg.maryland.gov/mgawebsite/Committees/Media/false?cmte=fin&clip=FIN_1_28_2026_meeting_2&ys=2026rs