Complex Needs = Complex Care Management For Children In Foster Care

Executive Briefing | by | January 18, 2017


Monica E. Oss
Monica E. Oss

Children in the foster care system are one example of a population that has traditionally been excluded from managed care, but no longer. Recently, we’ve seen state Medicaid programs undertaking new initiatives to better manage care for this population (see The Impact Of Health Homes For Children). Just this month, we’ve seen two states launch new programs to include children in foster care in their care coordination initiatives.

In Ohio, all new children entering foster care or eligible for adoption assistance are being enrolled in mandatory Medicaid managed care as of January 1, 2017 (see Ohio Medicaid Moving Children In Foster Care To Managed Care). This move is part of the state’s expansion of mandatory managed care to new populations, which was started in 2015. The transition affects approximately 12,000 children in foster care and about 17,000 adoptees receiving adoption assistance payments.

In Texas, the state is launching a pilot program to provide integrated coordinated care for high-needs children in foster care (see Texas To Launch Integrated Coordinated Care Pilot For High-Needs Children In Foster Care). Through this project, approximately 500 of the 1,000 children in foster care housed in residential treatment centers and hospitals will be placed in less-restrictive specialty housing and wraparound care.

Paul Neitman

Mr. Neitman

As my colleague Paul Neitman, Senior Associate, OPEN MINDS noted, these moves aren’t surprising in a market that is moving towards value-based care. Paul explained:

State movements toward enrolling foster youth in managed Medicaid programs and establishing integrated care arrangements is in recognition of the fact that the children in our foster systems often experience multiple chronic health care issues, combined with mental health issues related to the abuse, neglect, and trauma they have experienced in their young lives. These children have very complex support needs and utilize a disproportionate share of health care resources.

A 2015 report from the American Academy of Pediatrics report noted that children removed from their families due to abuse and/or neglect often have heath care issues that have not been addressed or are treated inconsistently (see Children In Foster Homes Need Better Health Care). The report notes that between 30% and 80% enter foster care with at least one untreated physical condition and about 80% have a “significant mental health need.”

The complex nature of this population’s chronic health/behavioral health issues, coupled with a health care system that often operates in “silos” and the multiple moves from one placement to another that many children experience, has created barriers that keep these children from receiving the kinds of comprehensive care they need. Responses from states like Ohio, Texas, and the children’s health home initiative in New York are a recognition that we have to do something dramatically different to serve these children (see The Impact Of Health Homes For Children).

What does this shift mean for the children’s services provider network? As more and more public children services initiatives are directed at keeping children out of residential care and even foster care, those children remaining in the system are likely to have even more challenging health and behavioral health needs. At some point, these children’s organizations are going to have to reexamine how they respond to these children by developing more integrative, evidence-based models of care. Failure to do so may result in poor results that harm children and organization’s resultant reputations, or the “business” decision to close programs because the types of children they traditionally serve are now being served in more community based settings.

Within this changing system, opportunities exist for a limited number of children’s services organizations to develop the competency to provide intensive, coordinated, short-term residential care. And for many more children’s organizations, opportunities are becoming available to offer evidence-based, intensive, coordinated community-based care that is designed to meet the needs of these children with chronic health and behavioral health issues. As we move to more integrated care models, there is also a need for children’s service provider organizations to work collaboratively with primary care, behavioral health, and other “safety net” organizations in order to meet the complex needs of these children and their caretakers.

Finally, these organizations must have the willingness and ability to enter into “shared risk” funding arrangements that are value and performance based, in a way that supports sustainability.

The children’s services field has and continues to change significantly at a rapid pace. While this has often created upheaval in the service provider network, the potential of these new, integrated care models to more adequately address the needs of an ever increasing chronic and complex group of children, in my opinion, offers a sense of hope that we truly can improve the lives of these children as has always been our goal.

Mr. Shiffman

And OPEN MINDS Senior Associate Howard Shiffman added that states that are moving to managed care for children in foster care are doing so to comply with the federal regulations to improve services – a move that will make this move more likely in more states. He noted:

We all know that children in the foster care system throughout our nation have unique and complex health care needs. Children in state care usually were victims of abuse or neglect and have experienced trauma that may have resulted in mental and behavioral health disorders. Additionally, children in foster care do not get optimal physical and behavioral health care because of frequent changes in placements that often results in inconsistent access to appropriate care, and sometimes lengthy delays in Medicaid certification.

Provider organizations will experience a new player at the table when it comes to decision making if managed care is implemented in their state. Representatives of the managed care entity will want to direct and authorize care and ensure that the child and their families are receiving appropriate preventative care, access when needed, and follow up care to limit future episodes. A major task will be to keep children out of the emergency rooms, to have shorter hospital stays, and to manage the future physical and behavioral health that seems to plague children in the foster care system as they grow toward adulthood.

As executives of provider organizations we need to embrace this new player at the table and recognize that their role is commensurate with ours – to improve the physical and behavioral health of our clients. Managed care should bring with it better access to services, more integrated care, and improved oversight of team decision making. Ultimately managed care should reduce the financial expenditures of this population and improve overall health and well-being of foster care children.

For more, register to join Paul and Howard on February 15 in Clearwater Beach, Florida, for The 2017 OPEN MINDS Next Generation Forum On Children’s Services Annual Summit, where we will explore the emerging opportunities available to children’s services provider organizations.


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