State child welfare budgets are under stress. The number of children in the child welfare system has risen (see Number Of Youth In Foster Care Up 1.5% In A Year; 36% Of New Entries Due To Parental Drug Use), in large part a byproduct of increasing rates of opioid addiction.
One policy change states are adopting to address the situation is changing how care for children in the system are financed and managed. We’ve covered recent developments in four states that illustrate this evolution.
Kentucky & West Virginia Are Developing Specialized Medicaid Health Plans For The Child Welfare Population—On May 16, Kentucky issued a request for proposal (RFP) for the state’s at-risk Medicaid health plans. As part of that RFP, Kentucky plans to contract with a single, statewide health plan to administer the Supporting Kentucky Youth (SKY) program. In addition to providing covered health services, the health plan will be responsible for population health management, care management, coordination of physical health, behavioral health, and social services, and wraparound services. Proposals are due July 5 and the new contract will go-live in July 2020 (see Kentucky Rebids Medicaid MCO Services, Creates One Specialized Contract For Youth Involved With Child Welfare Or Juvenile Justice). In creating a specialized plan, Kentucky will join the five other states with vertical carve-outs for the child welfare and juvenile justice population (see The Medicaid Vertical Carve-Out Landscape: The 2019 OPEN MINDS Update).
West Virginia is also planning to implement a specialized health plan for the foster care population. The move is a result of legislation approved in March 2019. Currently children in foster care are enrolled in the Medicaid fee-for-service program (FFS) to receive health care services. The state plans to release a request for proposal with more information this month and the contract will tentatively go-live on January 1, 2020 (see West Virginia Adding SED Child Waiver & Foster Youth Coverage To Medicaid Managed Care By January 2020).
New York Plans To Transition The Foster Care Population To Managed Care—In March, New York announced that it plans to move children in voluntary foster care agencies (privatized foster care) to managed care in October 2019 (after many years of delay). With the move, the state’s Medicaid health plans will be responsible for providing all health care services including the core set of services provided by the voluntary foster care agencies. The plan to move foster care children to managed care is part of a larger redesign of the children’s health care system in New York (see New York Medicaid To Transition Foster Children To Managed Care In October 2019).
Texas Is Expanding Its Foster Care Case Rate Model—At the beginning of May, Texas released a RFP to implement a single continuum of care contractor in the 27 counties that surround San Antonio. The contractor will receive a case rate for children referred from the Department of Family and Protective Services and will develop a local foster care continuum network and improve child safety and placement outcomes (see Texas DFPS Expanding Foster Care Case Rate Model To San Antonio Region). Texas has been slowly rolling this new model out across the state (see Texas Expanding Case Rate Foster Care Model To The Panhandle Region, Texas DFPS Selects Family Tapestry For Bexar County Foster Care Management Contract, Texas Releases Procurement For A Second Regional Foster Care Management Contract).
From the state perspective, these models bring service integration—for individual children and their families—with the potential for better outcomes and reduced service costs.
For provider organizations serving children, the potential changes depend on their current systems. For the child-serving organizations in traditional systems, there are many new factors—participation in managed care contracting, integrated service delivery models supported by information systems that are capable of data exchange, and an increased likelihood of contracting where reimbursement is contingent on value or involves some financial risk sharing.
To learn more about the key strategies for success in this changing landscape, check out the presentation, Succeeding In A Value-Based Health & Human Service Landscape: Keys to Balancing Performance, Measurements, Talent & Capital, given by my colleague, Monica E. Oss, OPEN MINDS Chief Executive Officer, this week at the i2i Center meeting in Raleigh, North Carolina.
For executive teams that want to assess their infrastructure, our team has developed two assessments—Managed Care Competencies Assessment and Value-Based Reimbursement Readiness Assessment . We also have developed resources to assist with planning, metrics-based management, and technology deployment, now available in the OPEN MINDS Circle Library:
- Ready For Risk? How Would Your Team Answer That Question?
- The 5-4-6 Formula
- Ready, Set, Managed Care!
- Managed Care In Child Welfare – An Encore
- Planning To Serve Foster Children In Managed Care
- Is Your Organization Managed Care Ready? An OPEN MINDS Executive Seminar On Provider Organization Planning & Positioning For Success
- How To Build Value-Based Payer Partnerships: An OPEN MINDS Executive Seminar On Best Practices In Marketing, Negotiating, & Contracting With Health Plans
- From Pain Point To Revenue
- 4 Lessons From ACOs For Managing Downside Financial Risk
- Your Organization Is Ready For VBR, Now What?
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For even more, join us at The OPEN MINDS Children’s Services Leadership Summit in Philadelphia on October 28. The summit will focus on the key drivers facing children’s services provider organizations and showcase organizations that are responding to these changes with innovative programs and solutions.