Children in Foster Care in California: An Examination of Medicaid Reimbursed Health Services Utilization

Abstract

The number of children in foster care in California doubled from 27 534 in 1980 to more than 62 419 in 1988, representing approximately 1% of the child population in the state. Past studies have domonstrated that children in foster care have high rates of medical and mental health problems. An examination of all Medi-Cal-paid claims was undertaken to describe the utilization of health services by children in foster care. Although children in foster care represent 4% of Medi-Cal-eligible children younger than 18 years of age, they account for approximately 5% of children using Medi-Cal services and 6.7% of expenditures, representing a 23% greater utilization rate and 41% greater expenditure rate than all children covered by Medi-Cal. Using the entire Medi-Cal population younger than 18 years of age as a comparison group, examination of inpatient and outpatient service utilization for specific condition categories showed few differences between children in foster care and the comparison group except for mental health service utilization, where children in foster care were much higher users of services.

Mental health needs and treatment of foster youth: Barriers and opportunities.

“…By comparison, studies of community samples have estimated that mental health problems range from 16% (Roberts, Attkisson, & Rosenblatt, 1998) to 22% (Costello et al, 1996) among children in the general U.S. population. Even when children in foster care are compared with children with similar socioeconomic and demographic profiles, those in out-of-home care are found to be at greater risk for psychopathology (Halfon, Berkowitz, & Klee, 1992; Landsverk & Garland, 1999; Pilowsky, 1995; Swire & Kavaler, 1977).…”

“…Children entering foster care have often experienced socially and economically impoverished environments, inadequate access to health care, homelessness, and limited educational opportunities (Dubowitz et al, 1993; Garland et al, 2000; Hutson, 1991; Pilowsky, 1995). Further, many come from families with a history of domestic violence and criminal involvement (Garland et al, 2000), mental illness, and drug or alcohol abuse (Chernoff et al, 1994; Halfon et al, 1992; Pilowsky, 1995). These conditions are understood to be social risk factors, but some of these factors pose a biological risk for mental disorders as well (Pilowsky, 1995).…”

“…The health care system in the United States is a great barrier to the mental health care of children in foster care, as it is for children in the general population. Although most children in foster care automatically qualify for Medicaid health insurance (federally funded but state run), modest provider reimbursements, as well as bureaucratic inefficiencies, have resulted in few providers accepting this form of payment (Halfon et al 1992; Klee & Halfon, 1987; Simms et al, 2000). Even providers who do accept Medicaid are restricted in the number of sessions for which they will be reimbursed to treat foster children's complex needs (Simms et al, 2000).…”

Foster Care and Health in Medicaid-Enrolled Children Experiencing Parental Opioid Use Disorder

“…Third, we analyzed Medicaid claims, which are detailed, longitudinal, and nationwide. Importantly, Medicaid is a critical source of health insurance for children in the welfare system, 42 , 43 covering about 99% of children in foster care 44 , 45 and 85% of children who aged out of foster care. 46 We were therefore able to produce generalizable estimates for a comprehensive set of individual-level outcomes.…”

Examining the Social, Emotional and Behavioral Needs of Youth Involved in the Child Welfare and Juvenile Justice Systems

“…Youth in both systems have more mental health problems than youth in the general population and their mental health needs often go undetected and unaddressed (Halfon, Berkowitz, & Klee, 1992;Mears, 2001;National Justice Network, 2009). It has been estimated that between 50% and 80% of youth involved in the child welfare system suffer from moderate to severe mental health problems (dosReis et al, 2001;Halfon, Mendonca, & Berkowitz, 1995;Shufelt & Cocozza, 2006).…”