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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 15: Continuous and Adequate Insurance

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Strategy. Foster Care

Approach. Implement programs within Medicaid agencies to support children in the foster care system in establishing health insurance.

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Overview. Children and youth in foster care are an often overlooked subpopulation of CYSHCN with unmet health care needs. State Title V/CYSHCN programs can play a significant role in improving the system of coverage and care for this group of vulnerable children. State Title V and Medicaid agencies have programs that support the needs of children in foster care to ensure they receive timely health care services, have a comprehensive health care record, are not overmedicated (with special attention to mental and behavioral health), and have the supports they need to transition to adult systems of care.1

Evidence. Expert Opinion/Field Generated. The Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs (CYSHCN) has identified this strategy as an innovative strategy. Read more in their practice report.

Target Audience. Systems.

Outcome. Percent of children, ages 0 through 17, who are continuously and adequately insured. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Using the approach “Implement programs within Medicaid agencies to support children in the foster care system in establishing health insurance,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies):

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

  • Number of programs within Medicaid agencies that Title V works with related to foster care.
  • Number of foster families who have been outreached about insuring children in their care.

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

  • Percent of programs within Medicaid agencies that Title V works with related to foster care that focus on establishing health insurance.
  • Percent of foster families who report satisfaction in working with Title V to insure children in their care.

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

  • Number of children within foster care who are covered by health insurance as a result of collaboration between Title V and Medicaid.

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

  • Percent of children within foster care who are covered by health insurance as a result of collaboration between Title V and Medicaid.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4):

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

Reference:

1 Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs. Foster Care Financing Strategy.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.