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

09/19/1999

This chapter presents a profile of children in foster care in three statesВ  California, Florida, and PennsylvaniaВ  who were enrolled in Medicaid.(1) Children in foster care comprised between 1.1 and 3.3 percent of the children enrolled in Medicaid in 1994, but accounted for a disproportionate share of Medicaid expenditures, ranging from 3.6 to 7.8 percent (Table III.1 and Figure III.1).

 

Table III.1:
Comparison of Enrollment and Expenditures,
by Category of Medicaid Eligibility
В  Enrollment in 1994 Expenditures in 1994
Number of
Children
Percent of
Total
Expenditures
(in millions)
Percent of
Total
California
Total 3,603,056 100.0% $2,375.3 100.0%
Foster Care 111,236 3.1 161.1 6.8
Adoption Assistance 18,922 0.5 7.5 0.3
AFDC 2,095,890 58.2 1,197.1 50.4
SSI 68,667 1.9 366.2 15.4
Other 1,308,341 36.3 643.4 27.1
Florida
Total 1,247,470 100.0% $1,419.10 100.0%
Foster Care 14,011 1.1 50.6 3.6
Adoption Assistance 6,545 0.5 9.4 0.7
AFDC 638,259 51.2 540.2 38.1
SSI 60,813 4.9 376.7 26.5
Other 527,842 42.3 442.1 31.2
Pennsylvania
Total 860,223 100.0% $1,160.70 100.0%
Foster Care 28,390 3.3 90.5 7.8
Adoption Assistance 3,847 0.4 6.2 0.5
AFDC 456,127 53.0 567.0 48.8
SSI 38,177 4.4 196.7 16.9
Other 333,682 38.8 300.4 25.9
SOURCE: HCFA State Medicaid Research Files.

 

Figure III.1
Comparison of Medicaid Enrollment and Expenditures Across Categories of Medicaid Eligibility, 1994.

Figure III.1a: Comparison of Medicaid Enrollment and Expenditures Across Categories of Medicaid Eligibility, 1994, California.

Figure III.1b: Comparison of Medicaid Enrollment and Expenditures Across Categories of Medicaid Eligibility, 1994, Florida.

Figure III.1c: Comparison of Medicaid Enrollment and Expenditures Across Categories of Medicaid Eligibility, 1994, Pennsylvania.

California had the highest number of children in foster care per 1,000 children in the state (12.8 per 1,000) followed by Pennsylvania (9.8 per 1,000), and finally, Florida (4.3 per 1,000). Children receiving SSI benefits due to disability also were a relatively small proportion of the enrolled population (2 to 5 percent), but were responsible for between 15 and 27 percent of total expenditures. Children receiving AFDC comprised the largest share of children (51 to 58 percent across the three states), but represented a far smaller share of expenditures (38 to 50 percent). Children receiving adoption assistance accounted for one-half of 1 percent of the enrolled children and less than 1 percent of expenditures.(2)

Because children in foster care account for a small share of both Medicaid enrollment and expenditures, few studies highlight their health care experiences under Medicaid. Yet, this is a highly vulnerable population about which little is known. This chapter describes their demographic characteristics, the dynamics of Medicaid enrollment, utilization patterns, and Medicaid expenditures. Children in foster care are compared to children receiving adoption assistance, AFDC, and SSI. In general, we present findings first for the foster care population, then we compare these children to other Medicaid children, and finally, we examine subgroups within the foster care population. Most of our results are for 1994 (the common year of data across the three states), except for analyses involving the construction of episodes of enrollment and utilization across the two-year study period.