Medical Homes For Children in Foster Care: A Proposal for CCNC Consideration Proposal collaboratively developed by: NC Pediatric Society Foundation & Benchmarks August 2, 2012

Population Characteristics 14,266 children served in foster care during SFY ,700 entered; 3,400 exited; 9,000 on any given day Age Distribution (end of month for ) – 38% 0-5 years old – 30% 6-12 years old – 25% years old 60% leave within 1.5 years

Population Needs American Academy of Pediatrics: children in foster care have higher prevalence of physical, developmental, dental and behavioral health conditions than any other group of children Children in foster care cost Medicaid more than three times what non-disabled, Medicaid-eligible children cost due to their complex physical and behavioral health needs (2008, Center for Health Care Strategies)

Buncombe County 204 Children in DSS Custody (2/29/2012) Family Foster Care Therapeutic Foster Care Level I Group Care Level III/IV PRTF – 14 Children Age range: 7.5 yrs – 18 yrs Length of Time in PRTF Range: 3 mo – 12 mo. Median Length of Time in PRTF: 6.5 mo Median # of MH Placements: 8 (range: 2-13) Median # of Hospital: 2 (range: 0-8) 8 out of 14 (57%) entered DSS custody when they were 5-8 yrs old and have been in custody for a median of 8 yrs 6 out of 14 (42%) entered DSS custody when they were yrs old ESTIMATED COST FOR PRTF CARE: $1.475 million

Importance of Medical Home Linking children to Carolina Access II homes is first step – As of Dec 2011, 63% of 0-4 years enrolled and 52% for 0-20 (this includes adopted children) Enhancing capacity of medical homes to serve this high need population is the next step – Challenges include complex coordination needs; confidentiality issues; transience of the population; and the need for a “trauma lens” in assessment and service delivery

Proposed Medical Home Functions Collaboration with local Department of Social Services Coordination or provision of brief health screenings within 7 days of entering care Coordination or provision of more comprehensive health, behavioral health, developmental, and substance abuse screenings/assessments within 30 days Ongoing coordination of referrals to and communications with array of service providers Coordination with LME-MCO to ensure care coordination of behavioral health services Education of caregivers (e.g. foster and kinship parents) Provision/receipt of t.a. and consultation within CCNC network on serving this population (clinically, administratively)

Quality Improvement Initiative Provide support to pilot primary care practices in select CCNC networks: – Professional education on trauma and the unique health/behavioral health needs of children in foster care; – Clarification of confidentiality issues; – Training and support for appropriate billing; – T.A. and support in the development of screening, assessment, and service delivery strategies aligned with the requirements of the foster care system

Proposed Performance Indicators Comparison of cost PM/PM of CCNC enrolled foster children vs. other Medicaid child pop. Decreased use of high-end services including Emergency Department visits and hospitalizations Decreased use of psychotropic medications Increased compliance with Health Check well-child periodicity schedules Increased timely compliance with the ACIP immunization schedule Increased rate of annual dental visits Continued use of same health care providers/practice during foster care placement Levels of physician, patient and caregiver satisfaction Impact of provider education on Medicaid coding strategies for assessing and treating children in foster care to ensure financial sustainability