Increasing attention currently is being focused on the health care needs of children in foster care. There is considerable interest in developing performance measures to track the effectiveness of child welfare services, including outcomes of child well-being. This study has provided examples of how health care measures can be operationalized using Medicaid enrollment and claims data.
More recent data are required, however, to determine how children in foster care are faring in the "new millennium." States are developing initiatives to improve the continuity and comprehensiveness of care received by children in foster care. A recent survey of 35 states revealed (Rawlings-Sekunda 1999):
- Twenty-four states now have policies or procedures to reduce delays in determining Medicaid eligibility when placing a child in foster care and 25 have policies or procedures to reduce delays in determining Medicaid eligibility when returning a child home.
- Twenty-seven states have screening or treatment standards for children in foster care.
- Thirty-three states provide training to educate case workers and foster parents about the health needs of children in foster care; few provide training to managed care organizations or health care providers.
The effectiveness of these initiatives is unknown. Additional analysis based on more recent data would be useful to determine whether children in foster care are now receiving more continuous coverage and more comprehensive care as a result of recent efforts.
1. A related issue, but one that was not addressed by this study, is the lack of health insurance coverage for the parents of foster care children. Anecdotal evidence suggests that barriers to mental health and substance abuse treatment because parents are uninsured (and not eligible for Medicaid) often serves as an obstacle to preserving or reuniting families.
2. Beginning in 1999, states are submitting claims data through the Medicaid Statistical Information System (MSIS) that conform with UB-92 and HCFA-1500 billing standards. The expanded data reporting will capture more procedures and diagnoses and will be an important data source for future research.