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Wayne State social work study finds HMOs hold promise for ensuring foster youth access to preventive care

January 8, 2016

The State of Michigan’s decision to convert most foster youth health care administration from a Medicaid fee-for-service (FFS) model to a Medicaid managed care system has led to more timely receipt of well-child visits for many youth entering foster care, researchers from the Wayne State School of Social Work have found.

In a study published in the January issue of the Journal of Adolescent Health, Assistant Social Work Professor Angelique Day, social work doctoral student Shantel Crosby, and their colleagues from Western Michigan University (WMU) examined well visits received by more than 1,650 foster youth during the three-year period (2009-12) coinciding with the state’s change in Medicaid policy from FFS to health maintenance organization (HMO) providers. The percent receiving a well visit within 30 days of entering foster care – the policy goal established by the state – rose from 27.6% in the FFS period to 52.2% in the managed care period. Moreover, the percent meeting the state’s requirement that foster youth be enrolled in Medicaid within 14 days of entering the system rose from 85.1% in the FFS period to 96.8% in the HMO period.

“The Affordable Care Act is raising the stakes for states to make sure that foster youth are getting timely preventive health care, so policymakers nationwide are looking for ways to help them determine how best to deliver these services,” said lead author Day, a national expert on foster youth well-being and consultant to the federal government. “While our findings may not directly apply to other states, our study demonstrates the use of an effective and efficient cross-system research methodology states can use to study their own foster youth population and service models.”

Day was referring to the first-of-its-kind study she designed and implemented with coauthors Amy Curtis, a WMU epidemiologist and professor, and Rajib Paul, WMU associate professor of statistics, to analyze both Michigan Medicaid and child welfare casework data in order to track county-by-county utilization. With help from Crosby and WMU graduate statistics student Prince Addo Allotey, the authors are attempting to determine whether Michigan’s foster youth are receiving adequate preventive, dental and prenatal health care services. The interdisciplinary research team’s work is being funded with a $75,000 grant from Blue Cross Blue Shield of Michigan Foundation (http://socialwork.wayne.edu/news.php?id=17136).

Day, who is director of Wayne State’s Transition to Independence Program for foster youth success and retention, cautions that Michigan’s Medicaid HMO system must be further refined to benefit all foster youth. The JAH article reveals that minority foster youth, most notably non-Hispanic blacks, had lower odds of a timely well-child visit even under an HMO system, as did foster youth who had lived in five or more placements and those who were not enrolled in Medicaid within 14 days. The authors make several policy and practice recommendations to address these disparities, urging greater clarification of roles played by those responsible for foster youth (e.g., foster parents, caseworkers, attorneys, judges and health care providers); improved communication between child welfare and community health agencies; improved Medicaid reimbursement for physicians who treat foster youth; and specialized medical homes to coordinate foster youth care.

“Foster youth are a medically vulnerable population among whom multiple health conditions are common as a result of abuse and neglect,” Day said. “If not addressed early, these conditions can worsen and compound one another to create lifelong physical and behavioral problems. Our study yields important insights to help make sure none of Michigan’s foster youth fall through the cracks of the health care system.”

Day’s article, “Timely health service utilization of older foster youth by insurance type,” was published on Dec. 17.

 
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