WASHINGTON – When a baby born in Minnesota suffers withdrawal or shows signs that its mother used illegal drugs during pregnancy, doctors must call the state welfare agency. The idea is to make sure newborns aren’t sent home with addicts who cannot care for them.

But only a handful of states have rules so clear, despite a federal law demanding them, which has led to concerns in Congress and among children’s advocates that some newborns who leave the hospital are in danger.

Missouri officials acknowledge their state has no reporting requirement.

Georgia doesn’t currently require doctors to report signs of drug use in newborns, either, even though the state has taken millions of dollars in federal funds tied to the regulation, said a children’s law expert.

Pennsylvania is another example of a patchwork of approaches. It requires social service workers to get involved in most cases were drugs are detected in newborns. But that doesn’t cover babies born with traces of prescription drugs including methadone, given to addicts to ease withdrawal symptoms, an exemption that advocates say violates the federal law.

Bills recently passed in Congress to deal with the country’s opioid crisis now require the Department of Health and Human Services to start checking up on states to see if they require doctors to report illegal drugs detected in newborns.

“These are the victims who are suffering through no fault of their own,” said Rep. Lou Barletta, R-Pennsylvania, who sponsored a House measure that calls for stricter enforcement.

In Pennsylvania, a coalition of children’s advocates say the state’s approach keeps welfare workers from getting involved when a mother has a history of drug use.

To illustrate the dangers, they point to the death of Brayden Cummings, who was 6 weeks old when he was smothered to death in 2014.

The baby’s mother, with methamphetamine and Xanax in her system, fell asleep in bed next to him and rolled over on top of him, according to police accounts. She had been taking methadone while pregnant, and no one contacted child welfare services when she was sent home with the baby to see if he’d be OK, according to a state assessment of its handling of the case.

Some disagree that social services should be contacted in all cases.

The group National Advocates for Pregnant Women warns that threats of involving welfare workers could deter women from getting medical care. Or it could dispatch babies to foster care, which poses its own problems for children, said the group’s executive director, Lynn Paltrow.

But without required reporting, a state cannot offer help or take steps to ensure a baby’s safety, said Cathleen Palm, founder of the Center for Children’s Justice, a Pennsylvania advocacy group. In extreme cases, she said, it’s a missed chance to remove a child from a life-threatening situation.

Congress has told state authorities to err on the side of requiring doctors to report.

But a Reuters investigation last year found only nine states and the District of Columbia comply, even though doing so is required for states to take some of the $296 million the federal government doles out for child protection services.

The federal Administration for Children and Families is responsible for putting into place the Child Abuse and Treatment Act, which says governors must certify in writing their state’s compliance with the rule, said agency spokeswoman Monique Richards.

The agency is now requiring state child welfare officials to describe their policies and procedures. States  not in compliance could lose funding.

In Missouri, officials would not say why the state does not require reporting by doctors.

Rebecca Woelfel, spokeswoman for the state Department of Social Services, noted federal officials have previously approved its child abuse prevention policies. She added that the state has a broad policy of accepting reports from doctors concerned about children’s welfare.

In Georgia, the Division of Family and Children Services has been working to meet the federal requirements since the Administration for Children and Families questioned its compliance.

State officials in 2013 agreed to draw up a plan to protect the safety of children when doctors do report, said Susan Boatwright, a spokeswoman for the state agency.

However, the plan did not deal with a requirement to report, said Melissa Carter, executive director of the Barton Child Law and Policy Center at Emory University. She said the state will comply with the federal rules on July 1, when a new law adds prenatal abuse to Georgia’s definition of child endangerment.

In Pennsylvania, Department of Social Services spokeswoman Rachel Kostelac said the exemption for mothers with prescriptions is meant to avoid disrupting a pregnant woman’s treatment. Doctors are required to report any other concerns, she said.

The Administration for Children and Families, she added, has said the state’s policies comply with federal law.

Palm said a pregnant woman may take methadone and do well. But her recovery may be “fragile” and survive just a few months after giving birth, she said.

Once mothers with addictions give birth and their babies are treated for withdrawal, she said, they’re told, “Here’s your baby. Now, go home.”

Welfare workers, in the meantime, dismiss calls from doctors concerned about new mothers on methadone who could relapse, she said. In those instances, case workers don’t visit, monitor the mother or child, or offer services.

“And then we act shocked when a baby like Brayden dies,” Palm said.

Kery Murakami is the Washington, D.C. reporter for CNHI’s newspapers and websites. Reach him at kmurakami@cnhi.com