Children and youth who are placed in foster care and are eligible for Title IV-E supports are automatically eligible for Medicaid. While they represent less than 2 percent of all children enrolled in Medicaid, children and youth in foster care are an especially vulnerable population whose safety and well-being are the legal responsibility of the state, specifically the Medicaid and child welfare agencies. Children in foster care have higher rates of physical and behavioral health care needs compared with children without a history of foster care involvement[1]. A variety of opportunities exist within Medicaid to address the unique health care needs of youth in foster care, including dedicated managed care plans, care coordination models, and enhanced provider rates.
To identify and meet the often complex health care needs of this population, children and youth should receive comprehensive health assessments shortly after entry to foster care. Within a few days of placement in foster care, children should receive an initial assessment of acute needs, followed by a comprehensive visit similar to a well-child visit. This visit serves to identify pre-existing physical and behavioral health needs, new needs that might have arisen during the situation that led to foster placement, and connect children to services to meet their needs. The Centers for Medicare & Medicaid Services (CMS) offers quality improvement (QI) technical assistance, developed as part of the Foster Care learning collaborative, to help states improve timely health services for children and youth entering foster care. The technical assistance has two components:
- “Getting started with QI” resources to help state Medicaid and child welfare staff and their QI partners get started on improving timely health services for children and youth in foster care.
- Background materials, including approaches to improving coordination between Medicaid and child welfare and state examples of strategies to support improvement of timely completion of comprehensive health assessments.
For more information on these materials and other QI technical assistance, please email MedicaidCHIPQI@cms.hhs.gov.
Getting Started with QI
Here are some technical assistance tools to help states get started in developing their own foster care-related QI projects:
- Improving Timely Health Care for Children and Youth in Foster Care: Getting Started on Quality Improvement This video provides an overview of how Medicaid and child welfare agencies can start a QI project to improve timeliness of health services for children and youth entering foster care. The Model for Improvement is built on small tests of change, enabling state teams to “learn their way” toward strong programs and policies.
- Improving Timely Health Care for Children and Youth in Foster Care: Driver Diagram and Change Idea Table. A driver diagram is a visual display of what “drives” or contributes to improvements in a process, in this case timeliness of health services for children and youth in foster care. This example of a driver diagram shows the relationship between the primary drivers (the high-level elements, processes, structures, or norms in the system that must change) and the secondary drivers (the places, steps in a process, time-bound moments, or norms in which changes are made to spur improvement). The document also includes change idea tables, which contain examples of evidence-based, evidence-informed, or expert-informed QI interventions related to improving timeliness of health services for children and youth in foster care. The change ideas were tailored for Medicaid and child welfare agencies.
- Improving Timely Health Care for Children and Youth in Foster Care: Measurement Strategy. This measurement strategy provides examples of measures that can be used to monitor QI projects related to improving timeliness of health services for children and youth in foster care.
For more information on these materials and other QI technical assistance, please contact MedicaidCHIPQI@cms.hhs.gov.
Improving Timely Health Care for Children and Youth in Foster Care: Background Materials
In 2021, CMS collaborated with the Children’s Bureau within ACF to launch the Improving Timely Health Care for Children and Youth in Foster Care learning collaborative. The learning collaborative included a webinar series and an affinity group that aimed to support state Medicaid and child welfare agencies’ efforts to improve timely health services for children and youth in foster care.
The webinar series consisted of presentations from experts in the field and described approaches that states can use to improve coordination between Medicaid and child welfare to support timely access to health services for children and youth in foster care. States interested in acting on the concepts and tools introduced through the webinars could participate in an action-oriented affinity group, which supported states designing and implementing their own QI projects. Learnings from states that participated in the affinity group can be found in the highlights brief and state spotlights webinar (below).
Webinar Series
- State Spotlights: Improving Timely Health Care for Children and Youth in Foster Care (video, slides, transcript). From July 2021 through July 2023, the CMS Medicaid and CHIP quality improvement technical assistance program supported eleven states participating in the Improving Timely Health Care for Children and Youth in Foster Care affinity group with information, tools, and expert support to improve timeliness of health services for children and youth in foster care. This August 2023 webinar spotlighted several state QI projects from the affinity group, highlighting their strategies, partnerships, and lessons learned.
- The Role for Medicaid in Improving Outcomes for Children and Youth in Foster Care (audio, slides, transcript). This May 2021 webinar explored the health care needs of children and youth in foster care, the role that Medicaid plays in meeting those needs, and federal resources that states can use to improve the quality of care. Speakers from CMS, the Agency for Children and Families’ Children’s Bureau, and state Medicaid programs discussed innovations and managed care strategies that helped improve health care services for their foster care populations.
- Establishing and Using Bidirectional Data Sharing (audio, slides, transcript). This May 2021 webinar discussed establishing and maintaining data sharing between Medicaid and child welfare agencies to support timely health care for children and youth in foster care. Speakers from Medicaid and child welfare agencies in two states shared promising data practices to (1) initially identify children and youth in foster care and (2) facilitate ongoing data sharing to assure timely information exchange for ongoing health care needs.
[1] Turney, Kristin and Wildeman, Christopher. Mental and Physical Health of Children in Foster Care. Pediatrics 2016, 138 (5) e20161118. https://doi.org/10.1542/peds.2016-1118