Assessing the Physical Health and Well-Being of Older Foster Care Youth: A Review of Michigan's Medicaid Managed Care Enrollment Initiative

Background & Purpose:  The purpose of this study is to examine the plight of older foster youth in the context of their physical health and well-being; specifically, the study’s focus is on child well-being visits/physical check-ups of older foster youth.  Foster care youth face great health disparities.   Between 87-95% of foster care youth have at least one physical health condition, and greater than 50% experience multiple morbidities.  Children in foster care account for 25-41% of expenditures within the Medicaid program despite representing less than 3% of all enrollees.  Foster care youth living with chronic and severe health conditions (both physical and mental) are at very high risk for dropping out of high school and/or college, unemployment, homelessness, incarceration, and dependence on public assistance.

As a cost cutting measure in 2010, Michigan changed health care services from fee for service to managed care system.  This is the first systematic examination of the results of this change on health service delivery to be conducted.  Specifically, this study will examine the timeliness of comprehensive medical examinations, which are mandated by the State’s child welfare policy to be completed within 30 days of initial foster care entry.

Methods: This longitudinal cohort study used matched administrative data provided by the State’s Departments of Human Services and the Community Health, Medicaid data warehouse collected between 2009 and 2012. Data was analyzed with SPSS using descriptive and multivariate statistics. 3430 foster care youth (58% males and 42% females; 54% white, 37% African American, and 9% other) between the ages of 14 and 20 years met the criteria for inclusion in this study. The median number of placements in the sample was 2.

Results:There was a statistically significant difference in timeliness of access to well-child visits between foster care youth who were enrolled in fee for service and those enrolled in a Medicaid HMO.  The median time foster care youth waited for a well-child visit at foster care entry on fee for service Medicaid was 81 days vs. 33 days for foster youth enrolled in a Medicaid managed care plan. The odds of timeliness in access to well-child visits for youth covered by managed care plans is 2.8 times (CI= 2.2-3.5; P< .001) that of those enrolled in a fee for service plan.  This difference remained significant even after controlling for age, gender, race, and number of living arrangements while in care.

Conclusions & Implications: The number of days to a well-child visit significantly decreased in the managed care period compared to fee for service period.  Even with the significant strides in access to timeliness of care, foster youth have significant health needs, with many continuing to have irregular access to routine health care services. Implications for policy and practice include the need to ensure comprehensive evaluation, routine medical care, & timely follow up.  There is also a need to create cross-system data systems that preserve and track health information of foster care youth and to increase Medicaid reimbursement rates for physicians.