Study Finds Foster Children More Likely to Have Behavioral Health Problems Than Others in Medicaid

Foster children are more likely to have mental health or substance abuse conditions than other Medicaid-enrolled children, according to a new publication from Mathematica Policy Research, Inc. The policy brief, titled "Children in Foster Care: Challenges in Meeting Their Health Care Needs Through Medicaid," found that foster children are also less likely to have continuous, year-round health insurance coverage, which previous research has noted as an important factor in access to care. Using Medicaid claims records from California, Florida, and Pennsylvania, Mathematica researchers compared health-related considerations for foster children to those children receiving adoption assistance, Aid to Families with Dependent Children or Supplemental Security Income over a two-year period in the mid-1990s. The report's main findings include:

• Children in foster care represent 1%-3% of Medicaid-enrolled children but account for 4%-8% of Medicaid expenditures.
• The majority of children studied were enrolled in Medicaid before they entered foster care, but between one-third and one-half lost their Medicaid coverage upon leaving foster care. Moreover, these children had less continuous Medicaid coverage than children receiving adoption assistance or SSI.
• Children in foster care were more likely than other groups of Medicaid children to have a mental health or substance abuse condition -- either alone or in combination with a physical condition.
• Foster care children were more likely than other groups of Medicaid children to receive preventive or dental care, but the numbers remained low. For example, 28%-41% of foster care children received a preventive care visit during the year, depending on the state, and 36%-54% received dental care. Only 23%-38% received mental health or substance abuse services.
• Health care utilization and expenditures varied considerably across the three states studied. Monthly expenditures for a foster child ranged from $154 in California to $293 in Pennsylvania and $375 in Florida. Medicaid spending for foster care children was two or more times higher than the average for all Medicaid children.