Not All Children in Foster Care Who Were Enrolled in Medicaid Received Required Health Screenings

WHY WE DID THIS STUDY

Children in foster care often experience chronic medical, developmental, and mental health issues. States' ability to ensure that foster children receive needed health services is critical to these children's well-being. The Social Security Act requires each State to develop a plan for ongoing oversight and coordination of health services for children in foster care, which includes establishing a schedule for initial and periodic health screenings. Screenings may include medical, dental, hearing, vision, mental health, and other (e.g., developmental) assessments. Furthermore, ACF is responsible for monitoring States' foster care programs, including States' oversight and coordination of health services for children. One method by which ACF monitors States is periodic reviews of States' child welfare systems, known as Child and Family Services Reviews. This report describes whether children in foster care receive required initial and periodic health screenings according to their States' schedules.

HOW WE DID THIS STUDY

We selected four States with large foster care populations (California, Illinois, New York, and Texas) to determine whether children in foster care received initial and periodic health screenings as established in each State's plan. Nearly all children in foster care are eligible for Medicaid; therefore, Medicaid pays for many of the health care services that these children receive. Therefore, from each of the 4 States we selected a simple random sample of 100 children who were in foster care and were enrolled in Medicaid between July 1, 2011, and June 30, 2012. We also conducted a structured interview with staff from ACF to determine whether ACF ensures that children in foster care receive the required screenings.

WHAT WE FOUND

Nearly a third of children in foster care who were enrolled in Medicaid did not receive at least one required health screening. Furthermore, just over a quarter of children in foster care who were enrolled in Medicaid received at least one required screening late. Moreover, ACF's reviews do not ensure that children in foster care receive the required screenings according to State schedules.

WHAT WE RECOMMEND

We recommend that ACF expand the scope of its Child and Family Services Reviews to determine whether children in foster care receive required health screenings according to the timeframes specified in States' plans. ACF stated that it would consider this recommendation. We also recommend that ACF identify and disseminate State strategies to ensure that all children in foster care receive required health screenings. We encourage ACF to work with States to (1) identify the barriers that prevent children in foster care from receiving required screenings and (2) identify, disseminate, and implement strategies for overcoming those barriers. Such strategies might include developing educational materials for foster parents that discuss the benefits of health screenings and providing incentives to families and children in foster care to encourage participation in required screenings. ACF concurred with this recommendation.