Executive Summary

Children and youth in foster care are among the most vulnerable populations covered by Medicaid. When children and youth enter the child welfare system, they are often not up to date on routine care, and many have unrecognized and untreated medical needs. In addition, the experience of removal from a child’s biological family, even when necessary for their safety, creates trauma which in turn generates additional health needs. Adverse events in early childhood including neglect, abuse, and toxic stress, can have long-lasting effects on children’s physical and mental health, especially if they go unaddressed. Given their circumstances, children and youth in foster care require access to a broad range of health and behavioral health services and extensive care coordination. As the nation’s health insurer for children and youth whose foster care families receive assistance under Title IV-E of the Social Security Act, Medicaid has a particularly important role to play in protecting the health of individual children and youth as well as improving the well-being of the foster care population generally.

In 40 states and the District of Columbia, state Medicaid programs contract with managed care organizations (MCOs) to furnish covered services to Medicaid beneficiaries. In some of these states, children and youth in foster care are not enrolled in MCOs but continue to receive services through fee-for-service (FFS) Medicaid. In other states, children and youth in foster care are enrolled in MCOs along with other Medicaid-eligible children and adults. And in some states, the Medicaid agencies currently contract with a single MCO to furnish services to all foster care children in the state. Because these MCOs focus on the foster care population, rather than enrolling a range of beneficiary groups, we refer to them as MCO/FCs. Six states—Arizona, Florida, Georgia, Tennessee, Texas, and Washington—contracted with MCO/FCs to furnish services to children and youth in foster care in calendar year 2018. To assess how MCO/FCs performed for their enrollees in that year, we searched the websites of the Medicaid agencies, child welfare agencies, and MCO/FCs in each of these states. We conducted our scan between December 2020 and May 2021; this paper presents the results. A companion paper presents the results of a scan of the websites of 56 MCOs in 13 states for information on their performance for enrolled children and pregnant women during calendar year 2018.¹

In this scan, we were able to locate enrollment data for each of the MCO/FCs, but those data were not disaggregated by race or ethnicity. We were unable to find any measures of performance with respect to Medicaid’s comprehensive pediatric health benefit—Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services—which is of particular importance to a high-need population like those in the child welfare system. Finally, we searched for evidence of performance on quality measures during 2018 and found substantial results for only four of the six MCO/FCs that were operational that year. None of the quality measures we were able to find were disaggregated by race or ethnicity.

In short, much of the information one would need to assess how well each of the six MCO/FCs performed for foster care youth in FY 2018 was not publicly available. We are not able to draw any conclusions about the performance of these MCO/FCs, and we cannot make any meaningful comparisons between their performance and that of their MCO/FC peers in other states.

[View list of data elements searched.]

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Medicaid Managed Care for Foster Care Children and Youth: A Natural Experiment with Little Transparency

1. Corcoran, A., et al., “ Transparency in Medicaid Managed Care: Findings from a 13-State Scan” (Washington, D.C.: Georgetown Center for Children and Families, September 2021), available at https://ccf. georgetown.edu/2021/09/09/transparency-in-medicaid-managed-carefindings-from-a-13-state-scan/.