Foster Care

Children and youth in foster care are an often overlooked subpopulation of children and youth with special health care needs (CYSHCN). State Title V Maternal and Child Health (MCH) and CYSHCN programs can play a significant role in improving the system of care for this group of vulnerable children. State Title V and Medicaid agencies have programs that support the needs of children in foster care to ensure they receive timely health care services, have a comprehensive health care record, are not overmedicated (with special attention to mental and behavioral health), and have the supports they need to transition to adult systems of care.

Under the Affordable Care Act, former foster youth who were in care when they turned 18 are eligible for Medicaid until they turn 26. Section 1002 of the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) included updates related to former foster youth and Medicaid coverage, including a requirement that all states must provide Medicaid coverage to former foster youth who age out of foster care in any state. The law was passed in 2018; the provisions related to former foster youth took effect on January 1, 2023.

Ensuring Consistent Medicaid Coverage Through Age 26 for Former Foster Youth

The Title V CYSHCN Director in Oklahoma has developed a strong relationship with staff in the state’s Child Welfare department. Through this partnership, Child Welfare staff notify the CYSHCN Division when youth are close to aging out of foster care. The CYSHCN division then pairs the foster youth with a case worker who supports them in enrolling in Medicaid as they age out to prevent a gap in coverage.

When a young person ages out of the CYSHCN program in Tennessee at age 21, if they were in foster care, the CYSHCN program refers them back to the Department of Children’s Services, which can support them in keeping their Medicaid coverage.

In New Mexico, the state Title V CYSHCN program is collaborating with the state’s child welfare agency to ensure that former foster youth are referred to the Title V CYSHCN program. Youth with special health care needs in New Mexico are also eligible for CYSHCN program services until age 21, and this referral helps ensure continuity of coverage and services.

Education and Support for Foster Families

Florida’s Medical Foster Care program is administered by the state’s Children’s Medical Services program. This program helps provide children with complex medical needs who are involved in the foster care system with the services they need. An interdisciplinary team of providers is available to medical foster parents, and the program helps support training for medical foster parents, follows up with children after they leave foster care, and offers training to biological families and/or adoptive families.

Including Foster Children in the State Title V Definition of CYSHCN

West Virginia has opted to include children and youth in foster care in their definition of CYSHCN. The state’s Title V program was heavily involved in the procurement and design of a Medicaid MCO program specific to children and youth in foster care, kinship care, and adoptive care. West Virginia’s CYSHCN program has provided education to this Medicaid MCO to ensure that they are familiar with EPSDT and that the benefit is applied appropriately for families raising CYSHCN.  The state Medicaid agency received a 2022 Medicaid Innovation Award from the Robert Wood Johnson Foundation and National Academy for State Health Policy for this program.

In Kansas, the CYSHCN program expanded their eligibility criteria to automatically qualify children in foster care who meet medical eligibility criteria. This has resulted in an increase in enrollment in the CYSHCN program and increased collaboration between the CYSHCN program and the foster system, including between KS-SHCN Care Coordinators and Foster Care Case Managers.

The Montana General Financial Assistance Program serves CYSHCN and children in foster care. Gap-filling funds from this program can be used to cover enabling services and treatments not covered by Medicaid or private insurance, such as home visiting, respite care, and specialized daycare or preschool. Title V CYSHCN program staff have conducted specific outreach efforts to ensure that foster families are aware of this benefit.

Facilitating Access to Services for Children and Youth in Foster Care

The CSHCN program in Utah operates Fostering Healthy Children, which aims to “facilitate and advocate for excellence in medical, dental, mental health, and overall wellbeing for children in Utah’s foster care system” (Utah Children with Special Health Care Needs Program). Nurses from Utah Department of Health and Human Services collaborate with caseworkers from the Division of Child and Family Services to coordinate medical, dental, and other care for children involved in the foster care system.

In New Hampshire, Title V CYSHCN coordinators work closely with the child welfare organizations to provide services to children and youth in foster care and those who are in the care of relatives. The Title V CYSHCN program leads a quarterly “Learning Exchange” to share information across other state agencies that serve children and families. This encourages collaboration and increased awareness of services that are available.

Colorado’s Title V CYSHCN program is a voting member of the Colorado Medicaid’s Program Improvement Advisory Committee. Through this role, the Title V CYSHCN program has fostered relationships with Colorado’s Regional Accountable Entities (RAEs), which are responsible for coordinating care for Medicaid enrollees in the state. The RAEs each identified children and youth in foster care as a key population they would like to serve better. The Title V CYSHCN program had collaborated with the Court Appointed Advocates for Children (CASA) in the state to better understand the needs and barriers faced by families, children, and foster caregivers involved in the child welfare system. The Title V CYSHCN program is exploring mechanisms to build cross-sector partnership between CASA and the RAEs to increase access to intervention for children and youth in foster care.