By Kamala Allen, Director of Child Health Quality at the Center for Health Care Strategies

We know that many children in child welfare have significant health care needs – often exacerbated by trauma, abuse, and neglect – and that most are eligible for coverage through Medicaid. We also know that it can be difficult to ensure that these children receive needed health care, given the instability and uncertain nature of their circumstances.

States are in the unique position to create linkages among child welfare, behavioral health, and Medicaid agencies and leverage resources across these systems to improve care for this population. Yet it is not always easy for states to determine how to achieve the critical linkages.

Several leading states – Arizona, Massachusetts, Michigan, and New Jersey – have made considerable strides in enhancing care for the child welfare population. Their best practices are worth a closer look. A new Center for Health Care Strategies report, authored by Sheila Pires and Beth Stroul and made possible by the Annie E. Casey Foundation, synthesizes strategies from these states within eight key areas. Following is a sampler of strategies, with state examples for each:

1.         Medicaid Financing – States can use child welfare funds as Medicaid match to expand home- and community-based services. Arizona’s child welfare system contributes funds to the behavioral health system as Medicaid match, so the state can draw down federal Medicaid dollars and support the expansion of home- and community-based services.

2.         Eligibility, Enrollment, and Access – Medicaid-funded health and behavioral health liaisons can be placed in child welfare offices to facilitate on-the-spot eligibility, screening, consultation, and other services. New Jersey’s nurse-run Child Health Units are co-located in regional child welfare offices across the state, and work with case workers, foster parents, and other caregivers to ensure timely health care access.

3.         Screening and Early Intervention – States should require a strict timeframe for physical, behavioral, and dental health screenings  for children in child welfare. In Michigan, children must receive a full medical examination – including a behavioral health component – within 30 days of entering foster care. 

4.         Covered Services – Medicaid agencies can expand the array of services covered to include additional evidence-based practices. Michigan Medicaid covers trauma-focused cognitive behavioral therapy under billable service codes for home-based therapy or individual or family therapy.

5.         Individualized Service Planning – States may consider covering the wraparound process to improve care delivery and coordination for at-risk children and families. Arizona mandates the wraparound process for all children in Medicaid who receive behavioral health services and covers it under case management and family support billing codes.

6.         Psychotropic Medications – States should monitor the use of psychotropic medications and provide consultation to prescribers and child welfare workers. Massachusetts’ Medicaid behavioral health managed care organization consults with primary care practitioners on psychotropic medications use, and the state monitors pharmacy data for children in child welfare to identify outliers.

As states implement health reform, they should consider ways to make their Medicaid programs work better for current and expansion populations – including children in child welfare. Looking to the experiences of other states in doing so can provide valuable insights into this process.

(For more information, read previous blogs on this topic.)