Texas Foster Care: $260M Spent, 99 Children Dead

Federal judge removed after ruling against state; child dies six weeks later at troubled facility with 84 violations

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AUSTIN, Texas — An 11-year-old autistic boy collapsed at a movie theater in November 2024, bleeding from his nose. Staff at Thompson's Residential Treatment Center had forced him to attend the outing despite his complaints of severe stomach pain. By the time the credits rolled, O.R. was dead.

His death came six weeks after a federal appeals court removed the judge who had overseen Texas foster care reforms for 13 years — and declared the state in "substantial compliance" with constitutional requirements.

The numbers tell a different story. Texas spent more than $260 million between 2021 and 2023 managing a crisis it calls "Children Without Placement" — kids sleeping in state offices guarded by police because the system has nowhere safe to put them. The state paid $35 million for those police guards. It spent $137,000 on nurses for the same children.

That's a 255-to-1 ratio: security over healthcare.

A Crisis Declared Unconstitutional

In 2015, U.S. District Judge Janis Graham Jack issued a scathing ruling in the case M.D. v. Perry (later M.D. v. Abbott). She found Texas foster care unconstitutional, writing that "rape, abuse, psychotropic medication, and instability are the norm" for children in state custody.

The lawsuit, filed in 2011 by Children's Rights and other advocacy groups, documented systemic failures: caseworkers carrying excessive caseloads when federal standards recommend 12-17, children disappearing into sex trafficking, psychiatric drugs used as chemical restraints, and placement instability so severe that some children moved dozens of times.

Judge Jack ordered sweeping reforms. Texas refused to settle. Instead, the state has spent more than $100 million fighting the case in court — while 99 children died in fiscal year 2024 alone.

The Death of O.R.

O.R. entered Thompson's RTC just two weeks before his death. He had autism, a gastrointestinal birth defect, and was prescribed four psychotropic medications. His medical needs were complex. Thompson's had a documented history of problems.

State records show 84 deficiencies at the facility. Previous investigations found staff running "fight clubs" where children were forced to assault each other. In one incident, a child required hospitalization after staff used excessive restraint.

On the day of his death, O.R. complained of stomach pain. Staff ignored him and required him to attend a movie theater trip. Security footage obtained by investigators shows him struggling to stand, unable to walk without assistance. Staff did nothing.

When the movie ended, O.R. was unresponsive, bleeding from his nose. He was pronounced dead shortly after. A criminal investigation was opened. It closed with no charges filed.

Thompson's RTC remains open and licensed by the Texas Department of Family and Protective Services.

The Judicial Shuffle

For nearly a decade, Judge Jack presided over the M.D. v. Abbott case. She held Texas in contempt and ordered $100,000-per-day fines. The state appealed.

In October 2024, the Fifth Circuit Court of Appeals removed Judge Jack from the case, vacated the contempt fines, and declared Texas in "substantial compliance" with constitutional requirements. The court reassigned the case to a new judge.

Six weeks later, O.R. died.

The Fifth Circuit's October 2024 opinion acknowledged ongoing problems but ruled they did not rise to the level of constitutional violations. The court cited reduced child fatality numbers and improvements in caseworker ratios.

Advocates appealed to the U.S. Supreme Court. In May 2025, the case was appealed to the Supreme Court, where it remains pending as of January 2026.

Manipulated Fatality Data?

Texas reported 99 child maltreatment fatalities in fiscal year 2024. That's down from a peak of 199 deaths in 2021 — a 50% reduction the state touts as evidence of progress.

But in September 2022, DFPS quietly changed how it investigates child deaths. The agency stopped investigating deaths where "there is no evidence or report of abuse or neglect." This policy shift led to a 43% reduction in investigations.

Fewer investigations means fewer confirmed fatalities. The children didn't stop dying. Texas just stopped counting.

DFPS's own FY 2024 Child Maltreatment Fatalities Report shows the decline began precisely when the investigation policy changed. Advocacy group TexProtects has questioned whether the state is deliberately undercounting deaths to avoid federal oversight.

The Children Without Placement Crisis

In 2021, Texas faced a new emergency: "Children Without Placement" (CWOP). These are kids removed from dangerous homes but stuck in the system because no foster home, group facility, or residential treatment center will take them.

So Texas put them in state offices. CPS caseworkers supervised them around the clock in makeshift "placements" — sometimes for weeks or months. The state hired off-duty police officers to stand guard, paying them overtime rates.

Between 2021 and 2023, Texas spent more than $260 million on this crisis. Budget documents show $35 million went to police guards. Just $137,000 went to nurses and medical staff for children with serious health needs.

State records obtained through open records requests document 2,100+ serious incidents at CWOP locations — an average of 60 per month. These include suicide attempts, sexual assaults, physical altercations, and escapes.

Some children ran from these offices straight into sex trafficking. At least seven victims were later recovered.

The Refuge Scandal

In 2022, federal investigators raided The Refuge, a DFPS-licensed residential facility in Bastrop, Texas. The facility specialized in housing sex trafficking survivors — girls rescued from commercial sexual exploitation.

Instead, staff at The Refuge were trafficking them.

Federal prosecutors charged nine individuals, including facility staff and outside perpetrators. Seven child victims were identified. The abuse had occurred over an extended period while The Refuge held an active state license and received taxpayer funding.

DFPS had conducted routine inspections. The agency found no violations serious enough to shut down the facility. It took a federal investigation to expose the trafficking operation.

Texas vs. Every Other State

When faced with similar foster care lawsuits, most states enter consent decrees — negotiated agreements to implement reforms under court supervision. Texas refused.

The state is also one of only three states that has not submitted a Title IV-E Prevention Plan to the federal government. This plan is required to access federal funding for family preservation services — programs designed to keep children safely at home rather than removing them into foster care.

Texas chose litigation over reform. The state's legal strategy succeeded in October 2024 when the Fifth Circuit removed Judge Jack and declared substantial compliance.

O.R. died six weeks later.

Following the Money

Texas DFPS has an annual budget exceeding $4 billion. The agency receives significant federal funding through Title IV-E of the Social Security Act, which reimburses states for foster care maintenance payments, adoption assistance, and administrative costs.

Between 2021 and 2023, DFPS spending on the CWOP crisis alone totaled $260+ million. That money paid for police guards, not therapeutic services. It paid for office supervision, not foster family recruitment.

TexProtects, a child welfare advocacy organization, has documented the spending disparity: $35 million for security, $137,000 for nursing care. The state prioritized containment over treatment.

Meanwhile, caseworker turnover remains high. Starting salaries for CPS investigators remain low relative to the cost of living in most Texas metro areas. Workers carry caseloads well above what federal standards recommend.

What Happens Next

The M.D. v. Abbott case is now before the U.S. Supreme Court on appeal from the Fifth Circuit's October 2024 ruling. Advocates are asking the Court to review whether the appeals court improperly removed Judge Jack and whether Texas truly meets constitutional standards.

Meanwhile, Thompson's RTC remains licensed. DFPS has not publicly disclosed what reforms, if any, were implemented after O.R.'s death.

Texas lawmakers return to session in 2027. Child welfare advocates are pushing for legislation to:

• Restore robust child death investigations
• Mandate public reporting of all fatalities involving children known to CPS
• Increase caseworker salaries and reduce caseloads to federal standards
• Require independent oversight of residential treatment centers
• Ban the use of office-based "placements" for children

But Texas has a pattern. In 2017, the legislature passed Senate Bill 11, a sweeping foster care reform package. Funding for key provisions was never appropriated. Many reforms exist on paper only.

TexProtects and Children's Rights continue to push for federal intervention. They argue that without judicial oversight, Texas will revert to the conditions Judge Jack found unconstitutional in 2015.

"This is not substantial compliance," said one advocate who requested anonymity due to ongoing litigation. "This is a shell game. They moved the judge, changed how they count deaths, and declared victory while children keep dying."

Sources

This investigation drew on DFPS budget documents, federal court filings in M.D. v. Abbott, Texas open records responses, the FY 2024 Child Maltreatment Fatalities Report, reporting by the Texas Tribune, legal analysis published in the Stanford Law Review, and advocacy research by TexProtects and Children's Rights. Additional documentation includes the Fifth Circuit's October 2024 opinion and Supreme Court petition filings. Full source documentation is available in the original investigation report.