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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. 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/CSHCN programs can play a significant role in improving the system of coverage and care for this group of children who have additional health needs. 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. Strategies with this rating are recommended by credible, impartial experts, guidelines, or committee statements; these strategies are consistent with accepted theoretical frameworks and have good potential to work. Often there is literature-based evidence supporting these strategies in related topic areas that indicate this approach would prove effective for this issue. Further research is needed to confirm effects in this topic area.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Boston University's Catalyst Center Financing Strategies Database

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Cost. This strategy helps to decrease the financial expenditure incurred by individuals, healthcare systems, and society in general for healthcare services.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Social Determinants of Health. This strategy advances economic, social, and environmental factors that affect health outcomes. SDOH include the conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

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. Here are sample ESMs to use as models 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?")

PROCESS MEASURES:

  • Number of outreach events for campaigns conducted to educate families about CHIP eligibility and benefits. (Measures efforts to raise awareness and promote enrollment)
  • Number of partnerships established with schools, community organizations, and healthcare providers to identify and refer eligible children to CHIP. (Shows the breadth of community partner engagement in outreach)

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

PROCESS MEASURES:

  • Percent of children in foster care who are enrolled in Medicaid for another public health insurance program. (Assesses the coverage rate among the focus population)
  • Percent of healthcare providers serving children in foster care who receive training on trauma-informed care practices. (Reflects the adoption of care approaches tailored to the unique needs of this population)

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

PROCESS MEASURES:

  • Number of Medicaid policies for protocols developed to streamline enrollment and ensure continuity of coverage for children in foster care. (Reflects efforts to reduce administrative barriers)
  • Number of partnerships established between Medicaid, child welfare, and community-based organizations to support the holistic needs of children in foster care. (Measures cross-sector collaboration)

OUTCOME MEASURES:

  • Number of emergency department visits for hospitalizations prevented among children in foster care due to proactive care management and support. (Reflects the potential for improved health outcomes and cost savings)
  • Number of youth in foster care who receive transition planning and support to maintain health insurance and access adult care systems. (Demonstrates the impact on long-term health and well-being)

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

PROCESS MEASURES:

  • Percent of children entering foster care who are screened for Medicaid eligibility and enrolled within a specified timeframe. (Measures the efficiency and effectiveness of the enrollment process)
  • Percent of children in foster care whose health needs and service utilization are regularly monitored and reported by the Medicaid agency. (Shows the use of data for quality improvement and accountability)

OUTCOME MEASURES:

  • Percent reduction in the gap between children in foster care and the general pediatric population on key health indicators (e.g., developmental screenings, immunization rates). (Demonstrates progress toward health outcomes)
  • Percent increase in the number of children in foster care who achieve permanency and have a stable source of health insurance. (Shows the ultimate goal of supporting long-term health and well-being for this population experiencing barriers to care)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

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

References

1 Catalyst Center/National Center for Health Insurance and Financing for Children and Youth with Special Health Care Needs. Foster Care Financing Strategy.
https://ciswh.org/project/the-catalyst-center/financing-strategy/foster-care/

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.