NASHP

State Strategies to Serve Children and Youth in Foster Care through Specialized Medicaid Managed Care Programs

February 11, 2021/by Veronnica Thompson

  1.  “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
  2.  “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
  3.  Children’s Bureau, “AFCARS Report”
  4.  “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
  5.  Patient Protection and Affordable Care Act (ACA, P.L. 111-148 as amended).
  6.  “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
  7.  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
  8.  “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.
  9.  American Academy of Pediatrics, “Health Care Issues for Children and Adolescents in Foster Care and Kinship Care”
  10.  “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
  11.  American Academy of Pediatrics, “Health Care Issues for Children and Adolescents in Foster Care and Kinship Care”
  12.  Children’s Bureau, “AFCARS Report”
  13.  “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
  14.  Georgia, Illinois, Indiana, Tennessee, Texas, Washington, Wisconsin, and West Virginia
  15.  “State Approaches to Serving Children and Youth in Foster Care Through Specialized Managed Care Programs,” National Academy for State Health Policy, February 2021.
  16.  “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
  17.  “CARE4Kids Program,” Wisconsin Department of Health Services, May 2020. https://www.dhs.wisconsin.gov/care4kids/index.htm
  18.  “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
  19.  “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/

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.

Medicaid Managed Care Program Federal

Authority

Eligibility and Enrollment Requirements Services[4] Payment Structure Average

Rate[5]

Quality Measures for Specialized Managed Care Programs Serving Foster Children
Georgia Families 360[6],[7] Section 1932(a) State Plan Available statewide to children and youth enrolled in foster care, receiving adoption assistance, and select youth in the custody of the state’s Department of Juvenile Justice.

Enrollment is mandatory for children and youth in foster care or in the custody of the Department of Juvenile Justice.

Enrolled children and youth receive access to a care coordinator and services targeted to their unique needs, including clinical trauma screening, specialty medical services and hospital stays, wellness visits and other preventive services, and developmental screenings. Additional benefits include Boys and Girls Club membership, dental cleaning every six months, free weight-management program enrollment, free unlimited over-the-counter items, general education development (GED) assistance, pest control, and supports following an emergency. Capitated rate[8] N/A The organization the state contracts with to provide these services is required to “comply with the Georgia Families 360° Department of Community Health (DCH) Quality Strategic Plan requirements to improve the health outcomes for all members. Improved health outcomes will be documented using established performance measures.

DCH uses the Centers for Medicare & Medicaid Services (CMS) issued Children’s Health Insurance Program Reauthorization Act (CHIPRA) Core Set and the Adult Core Set of Quality Measures technical specifications along with the Healthcare Effectiveness Data and Information Set (HEDIS) and the Agency for Healthcare Research and Quality (AHRQ) technical specifications for the quality and health improvement performance measures. DCH will monitor performance measures and incent Contractor improvement through the value-based purchasing program.”[9]

Illinois YouthCare[10]

 

 

Section 1915(b) Waiver[11] Available statewide to children and youth currently in custody or who were previously in the custody of the Department of Children and Family Services (DCFS), including those who have been adopted, living with kinship providers, have returned to biological parents, and/or youth who have left the DCFS system as well as DCFS former youth in care receiving services under certain Home and Community-Based Services waivers.

Enrollment is mandatory for children and youth in foster care.

Enrolled children and youth receive access to a free gym membership, free after-school care, free school uniforms, My Health Pays (a reward program for healthy behaviors), and access to community health services.

Enrolled children and youth are also assigned a health care coordinator to coordinate services, conduct care planning, and conduct assessments.[12]

Administrative payment and capitated rate[13],[14] N/A The organization that the state contracts with is expected to prioritize the following outcome and performance measures for children and youth in foster care, including:

· Preventable inpatient hospitalizations;

· Discharge planning and identification of Medicaid community-based services;

· Improvements in HEDIS and CHIPRA measures (including Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) measures);

· Equal or increased engagement with behavioral health treatment;

· Equal or increased engagement with referrals to trauma assessments and trauma-oriented services; and

· Specialized care conferences for at least 80% of children and youth in foster care who are identified as hospitalized beyond medical necessity.[15]

TennCare Select Section 1115(a) Waiver Available statewide for certain populations, including children and youth in foster care, children receiving Supplemental Security Income, and children under age 21 receiving care in certain institutional settings. It also serves as a backup if other MCOs are not able to adequately meet the needs of their beneficiaries.

Enrollment is mandatory for children and youth in foster care.

Enrolled children and youth receive specialized care coordination as soon as they become enrolled and are scheduled for immediate health care services as well as referrals to community resources. The Tennessee Department of Children’s Services (DCS) and TennCare Select coordinate daily regarding the care for DCS Children. TennCare, TennCare Select. The DCS participates in frequent coordinated meetings to assure TennCare Select is meeting all of the needs of DCS/foster care children. Administrative rate N/A The TennCare Select plan must be National Committee for Quality Assurance (NCQA) accredited and is held to the same quality standards as at-risk health plans. Likewise, TennCare Select is responsible for reporting on Consumer Assessment of Healthcare Providers and Systems (CAHPS) and HEDIS measures, and may qualify for incentive payments based on HEDIS results.[16]
Texas STAR Health[17] Section 1915(a) Waiver Available statewide for children and youth under age 18 in foster care, young adults who were previously in foster care and returned to extended foster care placements up to age 21, and young adults eligible for Medicaid for Transitioning Foster Care Youth up to age 21.

Enrollment is mandatory for children and youth in foster care.

Enrolled children and youth receive access to a specialized medical home that oversees coordinated access to primary care, behavioral health, specialists, dental and vision care, clinical case management, and access to a network of providers trained in trauma-informed services.[18]

Additional enhanced benefits include a free Boys and Girls Club membership as well as value-added services, such as cash grants for personal care items and rewards for accessing preventive services.

Capitated rate $986.42 in state fiscal year (SFY) 20[19] The organization the state contracts with to provide STAR Health services is required to develop and implement Quality Assurance and Program Improvement (QAPI) programs, which are designed to monitor and assess the clinical and non-clinical processes and outcomes.

The External Quality Review Organization collects and evaluates STAR Health quality using performance on administration data and surveys. Administrative data is used to calculate HEDIS measures, 3M measures of Potentially Preventable Events, and AHRQ indicators.[20]

Washington Integrated Foster Care Section 1932(c) State Plan Amendment [21] Available statewide to children under age 21 who are in foster care, children under age 21 receiving adoption support, and young adults ages 18-26 who aged out of foster care on or after the reach age 18.

Enrollment is voluntary for these populations. However, as the legal guardian, the Department of Children, Youth and Families selects Integrated Foster Care enrollment for children and youth in foster care.

Enrolled children and youth receive access to integrated managed physical and behavioral health coverage, known as integrated managed care. Under this program, the contractor coordinates access to services that address the child’s unique needs. Capitated rate $319.55 in SFY 21 The organization the state contracts with to provide these services must have a written QAPI for all services rendered. The QAPI must include the following:

· Assessment of the quality of care received by enrollees, as measured by HEDIS;

· Goals and interventions to improve the quality of care received;

· Assessment of health equity;

· Services to members with complex health issues;

· Patient safety initiatives;

· Inclusion of enrollee voice and experience;

· Inclusion of provider voice and experiences;

· Involvement of the designated physician in the quality improvement program; and

· A quality improvement committee that oversees the organization’s quality efforts.”[22]

The organization that the state contracts with is responsible for reporting on HEDIS measures. The state will monitor performance measures and incent contractor improvement through the value-based purchasing program.

West Virginia Mountain Health Promise 1915(b) Waiver[23] Available statewide for children and youth in foster care or receiving adoption assistance.

Enrollment is mandatory for children and youth in foster care.

Enrolled children and youth are assigned to a designated care manager to coordinate the child’s overall health under an individualized care plan. Capitated rate $528 in

SFY 21

The MCO must develop and implement written policies for an ongoing QAPI for the services rendered to children and youth in foster care. “QAPI strategies should include:

· Annual measurement of performance in specified areas (e.g., immunization rates);

· Multi-year performance improvement projects addressing clinical and non-clinical areas;

· An approach for addressing systematic problems;

· The development and usage of a sufficient health information system; and

· Proper administration of quality assessment and performance improvement activities.

The MCO must also meet all goals for performance improvement on specific measures, as established by the [state Medicaid agency].”[24]

Wisconsin Care4Kids[25] Section 1937 Alternative Benchmark Plan State Plan Amendment[26] Available in six southeastern counties of the state for children under age 21 in foster care.

Enrollment is voluntary for children and youth in foster care.

Enrolled children and youth receive access to a specialized medical home to coordinate comprehensive, timely access to health services, including a health screen within two business days of entering care; an initial health assessment within 30 days of entering care; mental health screening; dental and vision care; and ongoing health care for an additional 12 months after leaving foster care.

Enrolled children and youth also receive access to a dedicated care coordinator.

Capitated rate with certain community services carved-out as fee-for-service[27] $575.29 in SFY 21 Care4Kids has specific quality measures for the foster care children, such as timely completion of the initial health assessment within 30 days of entering care and several HEDIS measures, including Lead Screenings in Children (LSC), Childhood Immunization Status (CIS), and 30-Day Follow-Up After Mental Health Hospitalization (FUH-30).

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