1. MCO Contracting Strategies for Children in the Child Welfare System
NAMD Fall 2018 Conference
Heather Howard
November 13, 2018
A grantee of the Robert Wood Johnson Foundation

2. Today’s Session Goal of Session Agenda
Discuss how Rhode Island, Texas and Washington are working with managed care organizations to serve children in the child welfare system
Agenda
Level setting
Overview of each state’s Medicaid managed care model for children in child welfare system
Discussion
Questions from audience

3. Children Served By the Child Welfare System
687,000 children (just under 1% of child population) spent time in foster care in FFY 2016
On average, children spent 20 months in care
Children enrolled in Medicaid through foster care comprised 2.6% of the Medicaid child population in 2011

4. Opioid Crisis: Driving up Foster Care Caseload
Children are entering system at a younger age and staying longer as a result of potential of relapse
Percent change in Number of Children in Foster Care By State, 2014 to 2018

5. Children in Foster Care Have Complex Needs
Children in foster care are high utilizers of behavioral health services and have highest rate of service use across all categories
Source: Center for Health Care Strategies, “Faces of Medicaid Data Series: Examining Children’s Behavioral Health Use and Expenditures, ”

6. Medicaid Expenditures on BH for Children in Foster Care are High
Expenditures on behavioral health services for children in foster care are higher than for other children enrolled in Medicaid
More likely to use restrictive and expensive behavioral health services
Mean Expenditures for Children Receiving BHS
Source: Center for Health Care Strategies, “Faces of Medicaid Data Series: Examining Children’s Behavioral Health Use and Expenditures, ”

7. Children in Foster Care are Prescribed Psychotropic Medications at High Rate
24% of children in foster care received psychotropic medication in 2011
Children in foster care comprised 2.6% of Medicaid child population in 2011, but they represented 9.5% of children prescribed psychotropic medication
47% of children in foster care prescribed psychotropic medications were prescribed two or more medications
Expenditures on psychotropic medications for children in foster care represented 15.6% of total child psychotropic medication expenditures in Medicaid

8. Medicaid Managed Care & Children in Child Welfare System
States vary in whether enrollment in managed care is voluntary or mandatory LA
WA* OR CA NV ID MT WY UT CO AZ NM TX OK ND KS NE SD AR
MO* IA
MN*
GA* TN MS AL MI OH IN IL WI FL PA VA ME NY WV NC KY SC AK NH VT NJ DE MD HI CT MA RI
Mandatory
Voluntary
Exempt/No Info
Source: National Academy for State Health Policy, “State Medicaid Managed Care Program Design for Children and Youth with Special Health Care Needs”
* Mandatory for foster care, voluntary for adoption

9. Medicaid Managed Care & Children in Child Welfare System
Eight states have specialized plans or preferred plans for children in child welfare system LA WA OR CA NV ID MT WY UT CO AZ NM TX OK ND KS NE SD AR MO IA MN GA TN MS AL MI OH IN IL WI FL PA VA ME NY WV NC KY SC AK NH VT NJ DE MD HI CT MA RI

10. Thank You Heather Howard Director, State Health and Value Strategies
Phone: