Page 17 - Delaware Medical Journal - February 2016

SCIENTIFIC ARTICLE
72%
36%
86%
52%
51%
20%
20%
32% 29%
41%
Well-child
Physician’s ED Office
Urgent Care
Behavioral Outpatient
FIGURE 2
Percent of children receiving selected services before and after entry into foster care in Delaware.
FY2013, Prior to Foster Care
FY2014, After Entering Foster Care
in the Medicaid claims data because the Delaware Division of Prevention and Behavioral Health Services (PBH) provides more intensive inpatient and outpatient services that are included in the State Medicaid Plan as a “carve out,” with PBH functioning as a Similarly, health care services provided to children while in detention centers are paid for outside of the traditional Medicaid program through the Delaware Division of Youth Rehabilitation Services. Children eligible for Medicaid due to their disability status (i.e. SSI eligible) were removed from the database in order to have a more comparable cohort. We present the results for the full two-year cohort unless otherwise indicated.
RESULTS
Characteristics of Children in Foster Care
Among the 1,458 total children in foster care in Delaware in FY13 and FY14, 320 were new to foster care in 2013 and 222 entered foster care in 2014. These numbers show slight decreases over previous years, mirroring regional and national trends. The majority (59 percent) of children in foster care reside in New Castle County where a similar percentage of the population is concentrated. Fifty-one percent are male, a majority (50-55 percent) is African American, and the median age of children in foster care is 9 years old. Table 1 shows the total population of children in foster care
included in our cohort for FY13 and FY14 according to age groups. The median length of time in foster care for children in Delaware is 1.6 years, while the mean is 2.3 years, suggesting that some children in Delaware are in foster care for particularly long periods of time which skews the average. In fact, 23 percent of children in this cohort have spent more than half of their lives in foster care.
Health Care Utilization and Cost
Figure 1 illustrates categories of service utilization among children in foster care compared with other children in Medicaid. Ninety-
one percent of children in foster care received at least one type of health care service during FY13 or FY14, and 87 percent had a physician visit during this period. Physician visits in our database can include well-child visits, preventive screenings, as well as nurse practitioner, or physician assistant. Compared with other children in Medicaid, children in foster care had relatively high
rates of behavioral health visits in an outpatient setting, which are that over three-quarters of children ages 6 and older in foster care had a behavioral health visit during the study period. Notably, visits to the emergency department were similar across the two cohorts.
The total amount billed for children in foster care exceeded $30 million across FY13 and FY14. Importantly, this billed amount is
Del Med J | February 2016 | Vol. 88 | No. 2
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