“If a provider has not stepped back and looked at the larger history of abuse, multiple families, needs being neglected, they may put children on medication that may or may not benefit the child,” Szilagyi said. “They may not see it’s the impact of childhood trauma.”
“(Foster children) can be a fluid population in terms of providing adequate services to them,” said David A. Rogers, assistant deputy secretary for Medicaid. “There’s a uniqueness there that makes them a good target population” for managed care.
Szilagyi said she’s had patients who come in with five or six different diagnoses. Once doctors understand the children’s backgrounds better, they’re often able to get them the right mental health services.
She emphasized the importance of preventive care. “If you’re not getting preventive care, then you’re not getting your other needs met.”
Sara Rosenbaum, a health law and policy professor at George Washington University, said many states are interested in doing more managed care programs for at-risk populations.
“In some ways, insurers who specialize or have an expertise in care of high-needs populations may have less risk (caring for them)...it’s not to say there aren’t any risks, but with the general population, you don’t know whether there’s going to be unanticipated risks.” Specialists are more likely to know what to expect, she said.
Florida is not alone in taking this approach. Tennessee and Texas have already moved foster children into managed care, and Georgia plans to do so later this year.
Carolyn Ingram, senior vice president at the nonprofit Center for Health Care Strategies, and a former director of Medicaid in New Mexico, said states need to pay higher rates to insurers managing the care of high-needs populations, including foster kids, because they cost more, but those costs will pay off in better health.
“If you don’t do managed care for the high-needs population, then you’re not going to change the health of those people.”
Chris Johnson, a senior pastor at Liberty Baptist Church, and his wife Alicia, said they decided to become foster parents in 2009 after praying on the need for more good homes. Their most recent foster kids will be eligible for Florida’s new managed care plan. And Johnson said he can use the help in getting them the care they need. “It’s challenging,” he said.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communications organization not affiliated with Kaiser Permanente.
Tue, Feb 11 2014