Health Conditions, Utilization, and Expenditures of Children in Foster Care. Discussion

This study has confirmed findings from previous research showing that children in foster care utilize behavioral healthcare services more frequently than other Medicaid children. This study shows clearly that not only were foster care children more likely to be diagnosed with mental health or substance abuse conditions, but they also were more likely to use such services compared to other groups of Medicaid children (including children who were eligible for Medicaid through SSI due to disability).

Children in foster care also were more likely than the Medicaid population as a whole to have physical health conditions documented in Medicaid claims data, but not surprisingly, they had fewer such conditions than children who were eligible for Medicaid coverage through SSI. Levels of utilization in the foster care population generally followed this pattern as well, that is, higher than the Medicaid population overall, but lower than the SSI population. This is consistent with previous research by Rymer and Adler (1987), based on Medicaid data for four states from 1985.

Children in foster care typically were more likely to receive preventive and dental care through Medicaid than other groups of Medicaid children (including those receiving SSI benefits). Nevertheless, the rate of health assessments was still well below the level recommended by the CWLA guidelines, especially during the period immediately following placement (CWLA 1988; AAP 1994). Simms and Halfon (1994) speculate that the reasons for poor compliance with recommendations include limitations in staffing and funding, which impede implementation of the standards; lack of research justifying the recommendations; and a general lack of understanding concerning their rationale.

This chapter discusses the results of this study in terms of the implications for policymakers, areas for further research, and limitations of the research due to data constraints.