Testimony Before the  
United States House Committee on Oversight and Reform 
 
 
 
 
HHS-OIG Oversight of the Unaccompanied Alien Children Program 
 
Testimony of: 
 
Ann Maxwell 
Assistant Inspector General 
Office of Evaluation and Inspections 
  Office of Inspector General    
U.S. Department of Health and Human Services 
 
 
 
 
 
July 12, 2019 
10 a.m. 
Location:  2154 Rayburn House Office Building 
 
 
 
 
 
 
 
 
     
   
 
 Testimony of: 
Ann Maxwell 
Assistant Inspector General for Evaluation and Inspections 
Office of Inspector General, U.S. Department of Health and Human Services 
 
Good morning, Chairman Cummings, Ranking Member Jordan, and Members of the Committee.  
I am Ann Maxwell, Assistant Inspector General for Evaluation and Inspections for the Office of 
Inspector General (OIG), Department of Health and Human Services (HHS or Department).  
Thank you for the opportunity to testify this morning.  I am here today to discuss HHS-OIGs 
published work examining the Unaccompanied Alien Children (UAC) Program, which is 
administered by the Office of Refugee Resettlement (ORR) within HHSs Administration for 
Children and Families (ACF), specifically our January 2019 data brief, Separated Children 
Placed in Office of Refugee Resettlement Care.   
HHS-OIG takes very seriously its responsibility to protect the health and welfare of children 
in HHS's custody.  It is a core part of our mission to protect vulnerable children.  As such, 
we have been conducting oversight of UAC program since responsibility for caring for 
unaccompanied children was transferred to HHS by the Homeland Security Act of 2002.  
Our most recent series of work was launched in the summer of 2018 in response to the 
serious concerns about separating children and the numerous allegations that were raised 
regarding the treatment of children in HHS care.  This extensive body of work addresses a 
wide variety of health and safety issues in HHS-funded care provider facilities (facilities).  
We are also examining HHS efforts to identify and reunify immigrant children who were 
separated by immigration officials. 
Given that this work is not public yet, I cannot speak to the findings of these reports or address 
conditions within HHS-funded facilities beyond what is contained in already published reports.  
HHS-OIG findings regarding HHS-funded facilities are anticipated to be released in a series 
of reports over the next 6 months.  HHS-OIG would be happy to return to testify about these 
reviews once they are completed.  
Further, I cannot speak to conditions in border facilities funded or operated by the Department of 
Homeland Security (DHS) given that HHS-OIGs oversight jurisdiction is limited to HHS-
funded facilities.  The Office of Inspector General for DHS (DHS-OIG) is the inspector generals 
office with oversight jurisdiction for those facilities.  HHS-OIG coordinates with DHS-OIG, as 
well as with other oversight and law enforcement agencies on matters of common interest, as 
appropriate.  
HHS-OIG Oversight of UAC Program 
HHS-OIG is charged with overseeing all HHS programs and operations.  HHS-OIG works to 
combat fraud, waste, and abuse in those programs; promote their efficiency and effectiveness; 
and protect the beneficiaries they serve.  To accomplish this, HHS-OIG employs an array of 
tools, including audits, evaluations, and investigations.  
1 
   
 
The UAC program serves children who arrive in the United States unaccompanied, as well as 
children who are separated from their parents or legal guardians by immigration authorities 
within DHS after entering the country (separated children).  Separated children are considered to 
be unaccompanied because their parents or guardians are in Federal custody and therefore not 
available to provide care and physical custody for their children.  By law, DHS must transfer 
unaccompanied children to ORR within 72 hours unless there are exceptional circumstances.  A 
child remains in ORR custody until an appropriate sponsor (usually a parent or close relative) is 
located who can assume custody, the child turns 18 years old and ages out of the UAC program, 
or the childs immigration status is resolved.  
HHS-OIGs oversight of the UAC program has been broad and multi-faceted.  For example, we 
have audited grantee expenditures and assessed their internal controls for administering UAC 
program funds; we have also examined whether ORR grantees met health and safety standards 
for the care and release of children in their custody.  Through these efforts, HHS-OIG has sought 
to ensure financial accountability in the UAC program and to promote the protection and well-
being of children in the Departments care. 
As previously mentioned, OIG launched a series of reviews in 2018 after numerous stakeholders 
raised serious concerns about the health and safety of immigrant children at HHS-funded 
facilities.  These reviews examine a variety of safety issues, including:  (1) the background 
screening of facility staff who work with children, (2) the challenges that care facilities face 
in ensuring that children are safe, and the (3) physical security of the facilities.  We are also 
examining the challenges that facilities face in meeting childrens mental healthcare needs.  
Finally, we are conducting a review to identify challenges that affected the Departments and 
facilities efforts to carry out the Court-ordered reunification of separated children with their 
parents.  These reviews will be issued over the next 6 months.  
In addition to the data brief that is the focus of this testimony and is discussed at length below, 
we have released an early alert from this body of work, The Tornillo Influx Care Facility: 
Concerns about Staff Background Checks and Number of Clinicians on Staff, which highlighted 
two significant vulnerabilities we identified during our review of the Tornillo influx facility, 
operated by BCFS Health and Human Services: (1) required Federal Bureau of Investigation 
fingerprint background checks were not conducted for staff, and (2) insufficient number of staff 
clinicians to provide adequate mental healthcare for UAC.1   
Data Brief: Separated Children Placed in Office of Refugee Resettlement Care   
As part of HHS-OIGs oversight, we are paying particular attention to the subset of children who 
were separated from a parent or guardian by DHS and referred to HHS for care.  Consistent with 
that focus, in our January 2019 issue brief, Separated Children Placed in Office of Refugee 
Resettlement Care, we sought to determine the number and status of children in ORR care who 
had been separated from a parent or guardian by immigration authorities. 
                                                           
1 The Tornillo influx facility is now closed. 
2 
   
 
In this review, HHS-OIG found that more children, over a longer period of time, were separated 
by immigration authorities and referred to ORR for care than had been commonly discussed.  In 
fact, the true number is unknown. 
Pursuant to a June 26, 2018, Federal District Court order, HHS had, at the time of our review, 
identified 2,737 children who had been separated from their parents and were in ORR care as of 
the date of the Court order.2  However, prior to that Court order, HHS was not required to 
identify or track separated children.  HHS officials estimated that thousands of additional 
children may have been separated from a parent or guardian during an influx that began in 2017 
but were released from ORR care prior to the official accounting required by the Court.   
After HHS-OIG issued our report, the Court cited our finding that ORR had observed a steep 
increase in separated children as early as the summer of 2017 in requiring the Government to 
identify children who had been separated as early as July 1, 2017, regardless of whether or when 
they had been discharged from ORR care.  The Governments efforts to account for these 
children are ongoing. 
Further, ORR has continued to receive children who have been separated since the June 2018 
Court order, and DHS has provided limited information to ORR about those separations which 
may impede ORRs ability to appropriately place children. 
Limited Data Complicated HHSs Efforts to Identify Separated Children To Be Reunited 
With Their Parents as Required by a June 2018 Court Order  
On June 26, 2018, in ruling on a class action lawsuit, Ms. L v. ICE, a Federal District Court 
ordered HHS to identify and reunify children who were in ORR care as of that date and who had 
been separated from a parent by immigration authorities.3  Historically, such separations had 
been rare and were typically done for reasons related to the childs best interest, such as a 
parents injury or illness or a DHS determination that the parent was a danger to the child.  
However, during a recent period of increased enforcement of immigration laws, large numbers of 
families were separated, with parents taken into Federal custody to await prosecution for 
immigration offenses and their children transferred to ORR care.   
Prior to the Court order, HHS had never been required to identify, categorize, or track separated 
children as distinct from any other children entering ORR care.  No integrated HHS-DHS data 
system existed to comprehensively identify and track separated children, nor did either agency 
independently maintain data about them.   
The absence of data about separated children severely complicated HHS efforts to comply with 
the Court order, and led to the development of a three-step process for identifying every child 
who had been separated from a parent and was in ORR care as of June 26, 2018:   
                                                           
2 See Ms. L v. Immigration and Customs Enforcement (ICE), (S.D. Cal. June 26, 2018 (Order Granting Plaintiffs 
Motion for Classwide Preliminary Injunction). 
3 Subject to certain exceptions, such as when the class member parent is unfit, poses a danger to the child or if the 
parent voluntarily declines to be reunited. 
3 
   
 
  First, an HHS-led data team (with support from DHS sub-agencies) mined more than 
60 HHS and DHS databases to identify indicators of possible separation, such as an adult 
and child with the same last name apprehended on the same day at the same location.    
  Additionally, ORR and other HHS staff, including agency officials and senior leadership, 
manually reviewed case files for each of the approximately 12,000 children in ORR care. 
  Finally, ORR asked all HHS-funded shelters to attest to any separated children they 
reasonably believed to be in their care.   
This effort resulted in an initial list of 3,600 potentially separated children (i.e., children for 
whom HHS found any information in any data source indicating that the child may have been 
separated from a parent).  On July 11, 2018, after conducting additional reviews, ORR certified a 
list of 2,654 children that it believed met the Courts criteria.  ORR determined that the 
remaining 946 children (from the original list of 3,600) did not meet all of the Courts criteria.  
Of the 946 children, approximately 300 were not included on the certified list because they had 
been released through standard processes between the date of the Court order and the date the list 
was certified by ORR.  The remaining children were excluded because: (1) they had been 
separated from a nonparent relative; (2) the adult with whom they traveled was determined to 
have made a fraudulent claim of parentage; or (3) the information in the childs case file was 
unclear, and the ORR Director determined that the balance of evidence did not support including 
the child on the certified list. 
HHS Has Revised the Number of Separated Children Who Meet the Courts Criteria 
Several Times 
Even as the initial list of 2,654 children was being certified, some HHS staff believed that 50 to 
100 additional children should have been included.  At the same time, ORR began to receive new 
information (for example, from parents legal representatives contacting ORR) suggesting that 
some children excluded from the list had, in fact, been separated.  In the following months, HHS 
revised its initial number several times: 
  In October 2018, HHS added 13 children (all of whom were still in ORR care at that 
time) to the list, for a new total of 2,667. 
  In November 2018, HHS reported to the Court that 79 of the children previously reported 
as separated had not, in fact, been separated from a parent.  This reduced the count of 
separated children to 2,588. 
  In December 2018, HHS added 149 children to the list, bringing the number of separated 
children identified under the Court order to 2,737.  These 149 children had been in ORR 
custody on the date of the Court order and were then discharged before being identified 
as separated.4   
                                                           
4 In most cases, the children were released to a parent, guardian, or relative.  Nine children had been released to 
distant relatives or unrelated adults, five had been voluntarily repatriated to their country of origin, and one had 
 
4 
   
 
In a June 2019 Court filing, HHS reported that only one separated child eligible for reunification 
under the initial Ms. L v. ICE Court order remained in ORR care. 
Many Separated Children Were Not Covered by the June 26, 2018 Court Order; Efforts to 
Account for These Children Are Ongoing  
The June 2018 Court order in Ms. L v. ICE required HHS to identify only those separated 
children who were in ORR care as of June 26, 2018.  However, HHS officials estimated that 
thousands of additional children were separated by DHS, referred to ORR care, and released 
through standard ORR processes prior to that date.   
HHS officials based this estimate on ORR staff observations and informal monitoring.  
Specifically, in the summer of 2017, ORR noticed a steep increase in the number of separated 
children being referred by DHS.  Overall, ORR staff noted that the proportion of separated 
children (relative to all children) entering ORR care rose from approximately 0.3 percent of all 
intakes in 2016 to 3.6 percent in August 2017, a more than tenfold increase.  
The increase in separated children posed operational challenges for the UAC program.  In a 
November 2017 email that HHS-OIG reviewed, an ORR official stated that separated children 
were often very young, that these younger children required placement at specially licensed 
facilities, and that the numbers of these very young UAC resulting from separations has on 
some dates resulted in shortfalls of available beds.     
HHS was not able to provide a more precise estimate than thousands because, as previously 
noted, ORR did not have formal tracking systems in place that consistently identified separated 
children.  HHS similarly could not provide information on placements of separated childrenas 
distinct from other unaccompanied childrenwho were discharged from ORR care prior to the 
June 2018 Court order (e.g., released to relatives vs. nonrelatives or foster care).  
On March 8, 2019, the Ms. L court cited HHS-OIGs report in an order expanding the class 
definition, recognizing that family separation had begun much earlier than had been previously 
acknowledged.  The Ms. L class now includes parents who entered the U.S. on or after July 1, 
2017 and were separated from their children by DHS, regardless of whether or when their 
children were released from ORR care.  On April 25, 2019, the Government submitted a plan to 
identify separated children of Ms. L class members under the expanded definition.  The Court 
has ordered the Government to complete this effort by October 25, 2019.   
According to media reports, on May 17, 2019, HHS stated to the Court that it had thus far 
identified 1,712 children who entered ORR care during the class expansion period and had 
indications that they were possibly separated.  HHS is working with DHS to confirm if these 
children were, indeed, separated from a parent and the circumstances for that separation. 
Specifically, HHS reported that staff had reviewed a preliminary set of 4,108 childrens cases; 
these children were prioritized for review because of factors such as appearing on a Customs and 
Border Protection list of children separated after April 19, 2019; appearing on an informal 
                                                           
turned 18 years old in ORRs care (which means the individual aged out of the UAC program and would typically 
transfer to DHS custody). 
5 
   
 
tracking list that ORR staff had maintained in 2017; or because they were younger than 13 years 
old and were referred to ORR during the class expansion period.   
In a June 6, 2019, Court filing, HHS stated that it had completed its initial review of all 32,972 
childrens files necessary to identify potentially separated children in the class expansion period.  
However, to our knowledge, the total number of children who were potentially separated has not 
yet been determined.  
DHS Has Provided ORR With Limited Information About the Reasons for Recent 
Separations, Which May Impede ORRs Ability To Appropriately Place Children 
In addition to requiring reunification of separated families who meet certain criteria, the June 
2018 Court order preliminarily enjoined the Federal Government from continuing to separate 
families entering the U.S. unless the parent has a criminal history, poses a danger to the child, is 
otherwise unfit, or consents to the separation.  According to ORR tracking documents, ORR 
received at least 118 children separated by DHS from July 1 through November 7, 2018.5, 6  This 
number includes only children identified by DHS as separated at the time the child was 
transferred to ORR.  The proportion of separated children relative to all referrals increased every 
month during this period, from 0.47 percent in July to 0.91 percent in the first week of 
November.  Overall, separated children made up 0.69 percent of referrals to ORR during this 
period, a proportion that is more than twice the rate that ORR observed in 2016 but far lower 
than the rate ORR staff observed in the summer of 2017.  
As described earlier, DHS sometimes separates children from parents for the childs safety and 
well-being.  DHS reported to ORR that 65 of the 118 children were separated because the parent 
had a criminal history, although the nature of the criminal history was not always specified.  
Other reasons provided to explain a separation included the parents gang affiliation, illness or 
hospitalization, or immigration history.  In some cases, little detail was provided to ORR by 
DHS.   
Incomplete or inaccurate information about the reason for separation, and a parents criminal 
history in particular, may impede ORRs ability to determine the appropriate placement for a 
child.  When a proposed sponsor (including a parent) has a criminal history, ORR policy is to 
evaluate the severity and type of crime and the length of time that has passed since the criminal 
act, along with any mitigating factors.  ORR officials and staff noted that, from a child welfare 
perspective, not all criminal history rises to a level that would preclude a child from being placed 
with his or her parent.  ORR officials stated that when DHS provided insufficiently detailed 
explanations for a childs separation, ORR staff would contact DHS for followup information. 
However, the tracking document we reviewed indicated that DHS did not always respond to such 
followup requests.   
   
                                                           
5 The newly separated children ranged in age from under 1 year old to 17 years old.  Of the 118 children, 82 were 
under 13 years old when transferred to ORR care, including 27 who were under 5 years old. 
6 In its comments to our report, HHS provided updated information about new separations, reporting that ORR had 
received a total of 218 separated children between June 26 and December 26, 2018.   
6 
   
 
ORR Has Taken Steps To Improve Its Ability To Track Separated Children 
At the time of the Court order, ORR had no reliable means of determining whether specific 
children in its care were separated.  To address this challenge moving forward, ORR has taken 
several steps to improve its ability to identify and track these children.  First, in July 2018, ORR 
modified its online case management system to include a checkbox that can be used to indicate 
whether a child was separated before referral to ORR care.  The checkbox is intended to be 
accessible to both DHS and ORR staff.  Additionally, the online referral DHS completes to 
transfer a child to ORR care now includes a notes section where DHS staff can enter 
information about a separated adult associated with a child; this information can also be entered 
into a parent/relative section of the referral.  Finally, in August 2018, ORR developed a 
tracking spreadsheet that draws information about separated children from its online case 
management system, enabling staff to produce a consolidated list of these children. 
Improved Tracking and Communication Will Better Enable ORR to Provide Appropriate 
Care and Placements for Separated Children 
Although HHS has taken several significant steps to better track separated children, it is unclear 
whether these recent changes will be sufficient to ensure that HHS can accurately identify these 
children in the future.  Therefore, HHS-OIG encourages continued efforts to improve 
communication, transparency, and accountability for the identification, care, and placement of 
separated children.  Maintaining accurate and comprehensive information about separated 
children would improve ORRs ability to ensure that children receive the most appropriate care 
and placement.  ACF agreed that improvements are always warranted and has committed to look 
for opportunities to improve interdepartmental data-sharing and operations with DHS.  
Conclusion  
In conclusion, the total number of children who were separated from a parent or guardian by 
U.S. immigration authorities and transferred to HHS for care is not known.  According to HHS 
officials, it is certainly morelikely thousands morethan the 2,737 who meet the criteria of 
the initial Ms. L v. ICE court order.  However, the Governments ongoing efforts, under the most 
recent Court order, will provide increasing visibility into the number of children who were 
separated by DHS and referred to ORR care from July 1, 2017 onward, as well as the extent to 
which those children have been reunited with their families. 
HHS-OIG is fully engaged in rigorous oversight work to ensure that children in HHS-funded 
facilities receive appropriate care and protection.  HHS-OIG appreciates the support we have 
received for our work from Congress, including the $5 million in additional funding included in 
the emergency supplemental appropriations bill signed into law on July 1, 2019, and will 
continue to conduct oversight of the UAC program. 
Thank you for the opportunity to testify today on this important topic. 
7