In the report accompanying the fiscal year 2019 Labor, Health and Human Services, and Education funding bill (P.L. 115-245), the House Committee on Appropriations requested that MACPAC examine the advantages of a universal definition of therapeutic foster care. This presentation reviews prior Commission discussions before presenting a recommendation, approved unanimously, directing the Secretary of the U.S. Department of Health and Human Services to issue guidance to assist states in understanding what therapeutic foster care services can be covered under Medicaid and how to coordinate services with other agencies.