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 coverage and 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.
The Colorado Medicaid program asserts that EPSDT is only a benefit if people know how to use it, so program staff train foster parents directly about EPSDT to ensure foster families can maximize the benefits for children in foster care.
The Special Kids Special Care (SKSC) program in Massachusetts is a complex care management program that is administered through an exclusive contract with Neighborhood Health Plan. This program is for children and youth up to age 21 and a half with serious medical needs that are in the care or custody of the Department of Children and Families (DCF) and who reside in a foster home or other group home setting. Additionally, to be eligible for SKSC, the child must meet certain clinical criteria, be eligible to enroll in MassHealth (Massachusetts Medicaid), and MassHealth must be the child’s sole payer for health services.
STAR Health is the Texas Medicaid managed care model for all children in state conservatorship. This ensures children in the foster care system have access to more enhanced care coordination, especially for behavioral health needs. Their internet-based health record, called the Health Passport, is a record of their providers and services. It travels with the children as they move placements.
Utah’s Fostering Healthy Children is for children in foster care. Through this program, children are assigned a nurse case manager that works with them throughout the time they are in foster care to make sure that they are accessing and getting quality services and care in a timely manner.
Children in foster care is one of the aid categories for Virginia Medicaid. There are approximately 5,500 foster care members and 7,800 adoption assistance members in Virginia. As part of a strategic initiative, Virginia began enrolling foster care children into managed care. They worked with the VA Department of Social Services (VDSS), Local Departments of Social Services (LDSS), and the contracted Managed Care Organizations (MCOs) to implement a statewide regional roll-out so they could focus attention in each area of the state, identify eligible children, and provide training to local staff and foster care parents. The Department hired a full-time foster care coordinator that managed the transition, worked with directors and workers from LDSS agencies to provide training and resolve issues, and assisted with enrollment into managed care. The coordinator continues to serve as a liaison between VDSS, LDSS, the MCOs, and parents. In addition, Virginia participated in the Three Branch Institute that focused on the social and emotional well-being of children in foster care. The six managed care plans partner with the Department to manage the foster care population. Both the Department and the MCOs ensure that these members are assigned to a primary care physician and a case manager if necessary, and receive their annual examinations and specialty care visits. The Department and the health plans also manage member drug usage, especially anti-psychotics and psychotropic medications. Both parties require prior authorizations for these lines of medications and the prescribing doctor is required to submit proper paperwork in order for the prescription to be filled. Virginia, through its contracted External Quality Review Organization, conducted optional focused studies for foster care members for the past two years. The focused studies determined the extent to which foster care members were receiving preventive and therapeutic care in the first year of managed care enrollment and provided quantitative information about foster care members receiving medical services through the MCOs and fee-for-service. The Department has integrated a contractual requirement for managed care plans to assess every child in foster care within 60 days of enrollment and tie the assessment to the performance incentive award process.
Wisconsin used the authority under the Affordable Care Act’s Section 2703 to implement a Medicaid Health Home for AIDS/HIV patients and used their benchmark authority to initiate a Medicaid Health Home for foster youth, called the Care for Kids Foster Care Health Home. It includes an enhanced schedule for the EPSDT benefit with appropriate payment.
Wyoming Medicaid tracks data for children in foster care separately and partners with the medical school in Seattle, Washington to compare the rates of psychotropic medication prescriptions and usage compared to children enrolled in Medicaid who are not in foster care. According to the state, children in foster care were taking too many psychotropic medications at an early age. They used the data to help significantly reduce the medication rates by requiring mandatory second opinions based on the number of medications prescribed and the dosage.