Fact Sheet
- “AFCARS Report,” U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, August 2020. https://www.acf.hhs.gov/sites/default/files/documents/cb/afcarsreport27.pdf
- “Child Population: Number of Children in the United States by Age, 1950-2018 and Projected 2019-2050,” U.S. Census Bureau, July 2018. https://www.childstats.gov/americaschildren/tables/pop1.asp
- Children’s Bureau, “AFCARS Report”
- “Health-Care Coverage for Youth in Foster Care-and After,” U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, May 2015. https://www.childwelfare.gov/pubPDFs/health_care_foster.pdf
- Patient Protection and Affordable Care Act (ACA, P.L. 111-148 as amended).
- “Health Care Issues for Children and Adolescents in Foster Care and Kinship Care,” Council on Foster Care, Adoption, and Kinship Care and Committee on Adolescence, and Council on Early Childhood, American Academy of Pediatrics, October 2015, 136 (4) e1131-e1140; DOI https://pediatrics.aappublications.org/content/136/4/e1131
- Lucy A Bilaver, Judy Havlicek, Matthew M. Davis, “Prevalence of Special Health Care Needs Among Foster Youth in a Nationally Representative Survey,” JAMA Pediatrics 174, no. 7. May 2020. https://doi.org/10.1001/jamapediatrics.2020.0298
- “Key facts about children and youth with special health care needs,” Child Trends. Accessed July 22, 2020. https://www.childtrends.org/indicators/children-with-special-health-care-needs – :~:text=Key facts about children and, as reported by their parents.
- American Academy of Pediatrics, “Health Care Issues for Children and Adolescents in Foster Care and Kinship Care”
- “All Children in Foster Care Who Were Enrolled in Medicaid Received Required Health Screening,” U.S. Department of Health and Human Services, Office of Inspector General, March 2015. https://oig.hhs.gov/oei/reports/oei-07-13-00460.pdf
- American Academy of Pediatrics, “Health Care Issues for Children and Adolescents in Foster Care and Kinship Care”
- Children’s Bureau, “AFCARS Report”
- “Number of children in foster care continues to increase,” U.S. Department of Health and Human Services, Administration for Children & Families, November 2017. https://www.acf.hhs.gov/media/press/2017/number-of-children-in-foster-care-continues-to-increase
- Georgia, Illinois, Indiana, Tennessee, Texas, Washington, Wisconsin, and West Virginia
- “State Approaches to Serving Children and Youth in Foster Care Through Specialized Managed Care Programs,” National Academy for State Health Policy, February 2021.
- “Texas Healthcare Transformation and Quality Improvement Program (THTQIP-11-W-00278-6),” Texas Health and Human Services, June 2020. https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/tx-healthcare-transformation-pa-16-amendment-06022020.pdf
- “CARE4Kids Program,” Wisconsin Department of Health Services, May 2020. https://www.dhs.wisconsin.gov/care4kids/index.htm
- “Wisconsin State Plan Amendment Transmittal Number 13-034,” Department of Health and Human Services, Centers for Medicare and Medicaid Services, April 18, 2014. https://www.medicaid.gov/sites/default/files/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/WI/WI-13-034.pdf
- “Types of Managed Care Arrangements,” Medicaid and CHIP Access Payment Commission, Accessed August 1, 2020 https://www.macpac.gov/subtopic/types-of-managed-care-arrangements/
Chart
Children and youth in foster care often require targeted services and supports, however many receive fragmented or limited access to care, contributing to higher rates of unmet health needs.[1] This largely results from complex factors that precede and often endure in foster care, which may include foster care placement disruptions, incomplete or unavailable health information, and difficulty authorizing consent for services.[2] As the number of children entering foster care has increased in the past decade,[3] states are increasingly designing and implementing specialized Medicaid managed care programs to better address their unique needs and circumstances. This table highlights key components and features of seven state approaches to specialized managed care programs serving children and youth in foster care.
- “Health Care Issues for Children and Adolescents in Foster Care and Kinship Care,” Council on Foster Care, Adoption, and Kinship Care and Committee on Adolescence, and Council on Early Childhood, American Academy of Pediatrics, October 2015,?136?(4)?e1131-e1140;?DOI Accessed July 22, 2020. https://pediatrics.aappublications.org/content/136/4/e1131
- American Academy of Pediatrics, “Health Care Issues for Children and Adolescents in Foster care and Kinship Care”
- “AFCARS Report,” U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau, August 2020. https://www.acf.hhs.gov/sites/default/files/cb/afcarsreport27.pdf
- Children and youth enrolled in specialized managed care programs serving children in foster care receive access to traditional Medicaid benefits covered under their state’s respective state plan, including those under the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. Services listed in this table reflect the enhanced benefits that are unique to these specialized managed care programs.
- Unless indicated otherwise, the rate referenced in this column represents the average capitated rate, or per member per month (PMPM), for children and youth enrolled in these specialized managed care programs. Capitated rates may vary by individual due to a number of factors influencing the PMPM, such as the child or youth’s gender, region, and/or age.
- Georgia Medicaid. Georgia Families 360. Accessed June 29, 2020. https://medicaid.georgia.gov/programs/all-programs/georgia-families-360deg
- “Georgia Managed Care Program Features,” U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, Accessed June 22, 2020. https://www.medicaid.gov/medicaid/managed-care/downloads/ga-2018-mmcdcs.pdf
- Many state Medicaid agencies provide fixed periodic payments, referred to as capitation payments, to managed care organizations (MCO) in exchange for rendering a defined package of benefits. Capitation payments are typically made on a PMPM basis.
- State of Georgia, Contract Between the Georgia Department of Community Health and Amerigroup Georgia Managed Care Company for Provision of Services to Georgia Families 360°, Effective June 30, 2017, page 224.
- The information NASHP compiled about Illinois’s YouthCare program was not confirmed by the state’s Medicaid agency.
- “HealthCare Choice Illinois Children with Special Needs,” U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services, December 6, 2018. https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Downloads/IL_Special-Needs-Children_IL-02.pdf
- “Member Handbook,” YouthCare HealthChoice Illinois, July 1, 2020. https://www.ilyouthcare.com/members/youthcare/resources/member-handbooks-forms.html
- The Medicaid agency will use a risk corridor mechanism with the MCO, which will ensure that the MCO shares the risk of deviations from the estimated pattern of DCFS YouthCare enrollees’ utilization of covered services used to develop the capitation rates.
- Illinois Department of Healthcare and Family Services, Amendment No.6 to the Contract for Furnishing Health Services by a Managed Care organization. Effective December 13th, 2019, https://www.illinois.gov/hfs/SiteCollectionDocuments/REDACTED201824401402KA6IlliniCareDCFSYouthAddendaUpdate1fullyexec12132019.pdf
- Illinois Department of Healthcare and Family Services, Amendment No.6 to the Contract for Furnishing Health Services by a Managed Care organization. Effective December 13th, 2019, https://www.illinois.gov/hfs/SiteCollectionDocuments/REDACTED201824401402KA6IlliniCareDCFSYouthAddendaUpdate1fullyexec12132019.pdf
- State of Tennessee, Division of TennCare. TennCare Select Contract, https://www.tn.gov/content/dam/tn/tenncare/documents2/vshp.pdf. Amendment 45, Page 18.
- In June 2020, Texas submitted an 1115 amendment, effective September 2020, that will allow children in Adoption Assistance (AA) and Personal Care Attendant (PCA) Medicaid who are receiving Social Security Insurance (SSI), 1915(c) waiver services, or Medicare to have the choice between STAR Health and STAR Kids, instead of being mandatory for STAR Kids. Additionally, children in AA and PCA Medicaid who had been receiving SSI but lost SSI upon becoming eligible for AA or PCA will have the option of enrolling in STAR Kids or STAR Health. If no choice is made, the child will be enrolled in STAR Kids. p. 3 – Texas Healthcare Transformation and Quality Improvement Program Section 1115 Amendment
- “STAR Health: A Guide to Medicaid Services at CPS,” Texas Department of Family and Protective Services. Accessed June 29, 2020. https://www.dfps.state.tx.us/child_protection/Medical_Services/default.asp
- “State of Texas Medicaid Managed Care Star Health Rate Setting, State Fiscal Year 2020,” Texas Health and Human Services Commission. Accessed September 8, 2020. https://rad.hhs.texas.gov/sites/rad/files/documents/managed-care/2020/2020-09-star-health.pdf
- “STAR Health Contract Terms,” Texas Health and Human Services Commission. Effective, March 1, 2020, https://hhs.texas.gov/sites/default/files//documents/services/health/medicaid-chip/programs/contracts/star-health-contract.pdf.
- “Washington State Integrated Community Behavioral Health Program,” U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services. Effective January 1, 2019. Accessed July 22, 2020. https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/Downloads/WA_Washington-Integrated-Community-Mental-Health_WA-08.pdf
- Washington State Health Care Authority. Apple Health – Integrated Managed Care Contract. https://www.hca.wa.gov/assets/billers-and-providers/ipbh_fullyintegratedcare_medicaid.pdf. Page 135.
- “Proposal for a Section 1915(b) Capitated Waiver Program,” State of West Virginia, Department of Health and Human Resources, Bureau of Medical Services, November 20, 2019. https://dhhr.wv.gov/bms/Members/Managed%20Care/Documents/WV%20Specialized%20Managed%20Care%20Plan%201915b%20Waiver%20Clean_3-10-20.pdf
- “State Fiscal Year 2020 Mountain Health Promise Specialized Managed Care program Foster Care Contract Draft,” West Virginia Department of Health and Human Resources, Bureau for Medical Services. Accessed July 22, 2020. https://dhhr.wv.gov/bms/Members/Managed%20Care/Documents/SFY20%20Draft%20MCO%20Foster%20Care%20Contract%20v23%20Clean_1-9-20%20-%20ABH%20signed%20(2-3-20).pdf
- Wisconsin Department of Health Services. Care4Kids Program. Accessed July 10, 2020. https://www.dhs.wisconsin.gov/care4kids/index.htm
- Department of Health and Human Services, Centers for Medicare and Medicaid Services. Wisconsin State Plan Amendment Transmittal Number 13-034. April 18, 2014. https://www.medicaid.gov/sites/default/files/State-resource-center/Medicaid-State-Plan-Amendments/Downloads/WI/WI-13-034.pdf
- Under a fee-for-service (FFS) model, the state Medicaid agency pays providers for each covered service received by a Medicaid enrollee.
Acknowledgements: This document is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS) under grant number UD30A22891, National Organizations of State and Local Officials. This information or content and conclusions are those of the speakers and should not be construed as the official position or policy of, nor should any endorsement be inferred by HRSA, HHS, or the US government.
