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By Sarah C. Threnhauser, MPA

The number of children in foster care is rising—there was a 1.5% rise in youth in foster care, from 436,551 in 2016 to 442,995 in 2017 (see Number Of Youth In Foster Care Up 1.5% In A Year; 36% Of New Entries Due To Parental Drug Use). The increase in opioid addiction is one of the key contributors to this rise in out of home placements (see Opioid Clarity? and Opioid Addiction By The Numbers).

Children in foster care often have complex support needs, compounded by exposure to trauma (see The Child Mental Health Gap-More Prevalence, Less Treatment, More Opportunity?). Half of all youth have experienced at least one traumatic event in their lifetime, and 40% of adults also claim to have had at least one traumatic event during childhood-this percentage jumps to 90% when we look at youth in foster care (see Prior Trauma Exposure for Youth in Treatment Foster Care and Trauma-Informed Care For Youth In Foster Care). Of this group, 52% are at risk of a behavioral or emotional problem and 45% have received outpatient behavioral health services.

This complexity of the needs of foster children may be one of the reasons that the field is seeing more states moving the medical care of foster children into their Medicaid health plans. Traditionally, foster children’s health care needs have been poorly met (see Do New Foster Care Rules Move The Needle? and Child Welfare System Is Changing, But Slowly)—and managed care models have been held out as a possible solution to their care coordination and care access needs (see Making Foster Care & Managed Care Work).

Our recent coverage shows that more states are moving this population to managed care, including New York (see New York Medicaid To Transition Foster Children To Managed Care In October 2019), West Virginia (see West Virginia DHHR Evaluating Plans To Move Youth In Foster Care To Specialized Managed Care Plan; Draft RFP Released), and North Carolina (see North Carolina Proposes New Integrated Medicaid Managed Care Model). When it comes to enrolling foster care children in Medicaid managed care, the states fall into three main categories:

Mandatory enrollment in Medicaid managed care plans—Under this model, the state requires foster care children to enroll in the managed care delivery system, with almost no exceptions. There are 22 states that use this model. Within this enrollment policy there are two variations: Foster care children can be enrolled in managed care plans that serve the entirety of the Medicaid or they can be enrolled in specialty health plans specifically designed to meet the needs of foster care children (note that four states have specialty health plans for foster children).

Optional enrollment in Medicaid managed care plans—Under this model, foster care children can enroll in either the fee-for-service delivery system or the managed care delivery system. Delivery system choice for these children will be based on several different factors including geographic availability of plans, benefits the child will need to access, and stakeholder preference. There are 12 states that use this model.

Mandatory enrollment in fee-for-service (FFS)—Under this model, the state requires that foster care children receive services through the fee-for-service delivery system, with no exceptions. There are 14 states that use this model.

For a deep dive into the state of managed care in foster care, check out our Market Intelligence Report, How Many Foster Care Children Are Enrolled In Medicaid Managed Care?: An OPEN MINDS Market Intelligence Report.)

Paul Neitman

When I discussed this move to managed care for foster children with my colleague, OPEN MINDS Senior Associate Paul Neitman, he noted that a critical failing of the field remains an inability to find quality, timely behavioral health services for foster youth. He explained:

Placement instability and access issues related to the availability of quality outpatient and inpatient services are keeping foster youth from receiving the type of behavioral health services they need. In addition, many behaviorally challenging foster youths are not receiving the level and intensity of behavioral health services needed because provider organizations are unable to meet their needs while maintaining a safe treatment environment.

For provider organization executive teams in the 34 states where foster children are in managed care plans, providing specialized services focused on this high-needs population are a way of gaining preferred referral status. Paul identified a few factors that can help shape a programmatic approach for serving foster children. These included:

  1. Developing treatment models that can address the needs of behaviorally challenging youth in a safe, caring environment
  2. Making sure that all services and programs—from assessments to interventions—are trauma-informed
  3. Building in the ability to work with foster parents and other placement entities to improve placement stability for children – stability that will achieve health and behavioral health goals
  4. Creating a service delivery system that is ‘integrated’ with the relevant medical, behavioral, and social services programs

Medicaid health plan managers are concerned with finding service delivery models that can meet the needs of special populations like the foster care population—with an eye on improving health status and lowering the use of unnecessary hospitalizations. With the rising prevalence of complex behavioral conditions in children, new approaches developed for foster children will have resonance in the broader children’s services market. Looking for more? Check out these resources from the OPEN MINDS Circle Library:

  1. Managed Care In Child Welfare – An Encore
  2. Planning To Serve Foster Children In Managed Care
  3. Treating The Whole Child
  4. Big Changes In Federal Child Welfare Funding
  5. Why Children’s Crisis Response Services Should Be Paid With Case Rates
  6. Tennessee Children With Autism Twice As Likely To Be Involved In Abuse Allegations
  7. Among Children Served By Military Health Services, Mental Health Diagnosis Rose From 9% In 2003 To 15.5% In 2015
  8. Washington State DCYF Agrees To New Performance Measures On Foster Care Runaways
  9. New Jersey Autism Rate Among Four-Year-Olds Rose 43% Over Four Years
  10. North Carolina Sets 10 Statewide Goals To Improve Outcomes For Young Children

For more on how to partner with health plans in this changing market, join us in August in Long beach, California during Management Best Practices week for the seminar How To Build Value-Based Payer Partnerships: An OPEN MINDS Executive Seminar On Best Practices In Marketing, Negotiating, & Contracting With Health Plans, featuring OPEN MINDS Senior Associate Deb Adler.

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