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68% 62%
61% 63% 61%
23%
41% 37%
15%
Well-child
Urgent
Behavioral ED Outpatient
Inpatient
8%
FIGURE 1
Percentages of children in Delaware foster care who received selected services compared with other children in Medicaid, FY13-FY14
Children in foster care
METHODS
Medicaid claims data supplied by the Delaware Division of Medicaid and Medical Assistance (DMMA) provide the basis for this analysis. The claims database includes billing information for every encounter that a Medicaid participant has with a covered health care professional. In addition, the database includes claims for prescription drugs covered under Medicaid. We extracted
data on diagnoses, types of services and professionals, types of 2014 (i.e. covering the time period from July 1, 2012 through June 30, 2014). Importantly, due to the nature of the claims database, most of the cost data in our analyses are based on the “billed amount” for services. The billed amount can vary substantially from the actual cost of services because most individuals who participate in Medicaid in Delaware are enrolled in managed care plans which pay for care using a capitated rate. This means that but is still useful for making comparisons, examining trends,
and understanding the relative distribution of costs. Because prescription drugs are paid separately, the data for prescription costs are for the actual amount.
Data to support our analyses were also provided by the Delaware Department of Services for Children, Youth and Their Families
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Other Medicaid eligible children
(DSCYF). Variables include demographic information on children in foster care, such as age, race/ethnicity, and zip code, as well as characteristics associated with children’s tenure in the foster care system, such as number and type of foster placements. The DSCYF
each child, such that we are able to identify children in foster care within the Medicaid database and link the health-related data with characteristics of foster care. After linking the Medicaid records with the DSCYF records, the resulting database used in our analyses includes 1,458 children in foster care during the time period FY13 and FY14.
We calculated descriptive statistics for selected diagnoses, prescription drug utilization, and health care services billed for this cohort, broken down by age group and characteristics of foster care where appropriate. In order to better understand the health and health care utilization of children in foster care in context, we compared diagnoses, patterns of utilization, and costs among children in foster care with a comparable cohort
of 124,667 non-foster care children participating in Medicaid in Delaware during this time period.
Services provided to children in foster care who are placed within certain institutions, such as a youth detention center or an inpatient mental health facility were excluded from our analyses unless
