Page 18 - Delaware Medical Journal - February 2016
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49%
48%
40%
Within 180 days
22%
14%
Within 30 days
FIGURE 3
Percentages of children in Delaware foster care receiving well visits within 30 and 180 days of entry into foster care, FY13- FY14
82%
Less than one year old
1-5 years old 6-19 years old
based on all Medicaid medical claims, excluding dental, vision, nursing homes, and other costs incurred within the juvenile justice system or the state’s child mental health system that are not billed to Medicaid. Also, as mentioned above, because most individuals who participate in Medicaid in Delaware are enrolled in managed care plans which pay for care using a capitated rate, the billed amount is consider the relative billed amounts (or claims) for different services provided to children in foster care, as this is an indication of health care needs, as well as an indication of the potential burden on the health care system.
We found that more than half of the total claims for children
in foster care were for outpatient behavioral health services. Additionally, while 87 percent of children in foster care had a physician visit in FY13-FY14, the relative cost of physician visits is low compared to other types of services, such as urgent or emergency care. Average billed amounts for children in foster
care were similar among different age groups with the exception average claims. When compared with other children in Medicaid, children in foster care in Delaware have approximately three
times higher average claims. This disparity is largely attributed
to differences in outpatient behavioral health claims which were roughly 14 times higher for children in foster care. The average prescription drug cost was also approximately three times as
high for children in foster care compared with other children in Medicaid in Delaware in FY13-FY14, and this difference is largely
attributable to higher costs associated with psychotropic drugs among the foster care population.
Patterns on Entry into Foster Care
To explore the relationship between foster care status and health care utilization, we also examined patterns of selected service utilization prior to entry into foster care compared with children’s utilization while in foster care. Among children who were new to foster care
in FY14 and had at least one claim during the prior year (n=127), utilization went up for every type of service. As seen in Figure 2, entry into foster care appears to be associated with better access to health care services. Further, the percent of children that received a well or preventive visit increased from 36 percent to 72 percent.
Preventive Screenings
In order to assess timeliness of preventive screenings and adherence to the AAP recommendation that children in foster
of entry into foster care, we analyzed a subsample of the cohort that entered foster care in FY13 or FY14 (n=542). Figure 3 shows the percentages of those children receiving well visits/preventive screenings within 30 and within 180 days of entry into foster care, according to age group. Our analysis revealed, only 31 percent of children new to foster care during our study time period met the AAP recommendation. Further, 41 percent still had not had a well visit within six months.
We furthered examined the data for those children without a well
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Del Med J | February 2016 | Vol. 88 | No. 2
