Children in foster care may be underaccounted for in the Medicaid program


Study: Many foster children are not receiving needed health care

The currently accepted statistics for numbers of children who live in foster care and are eligible for Medicaid may seriously underestimate the actual figure, according to a new analysis by pediatric researchers at The Children's Hospital of Philadelphia. The study also reinforces previous findings that significant numbers of children in foster care are failing to receive needed health care services.

Medicaid, the federal health care program for low-income families and many children with disabilities, also insures most children living in foster care. As a result, "most prior studies that estimated health service use by children in foster care used Medicaid records as their source of information," said the study's lead author, David Rubin, M.D., M.S.C.E., director of Research and Policy for Safe Place: The Center for Child Protection and Health at The Children's Hospital of Philadelphia. "The problem we found is that Medicaid records fail to identify many foster care children, especially those who may not have been receiving medical services they needed."

The study appeared in the May-June issue of Ambulatory Pediatrics.

The research team studied Medicaid eligibility files for a sample of 5,683 children who entered foster care in Philadelphia during 1994 and 1995. They found that the Medicaid system failed to identify 28 percent of the children as residing in foster care. "We found a systematic sampling bias," said Dr. Rubin. "Children were more likely to be identified correctly as foster children if they had a greater number of foster care placements or used more services, such as hospital emergency departments or mental health programs."

"However, we found that nearly 40 percent of the children in our sample never visited an outpatient health care or mental health provider during the year after they were placed in foster care," added Dr. Rubin. "Many of these children were among those not identified by Medicaid as living in foster care. The concern is that these children may be falling through the cracks, because other studies have shown that the majority of children in foster care have chronic unmet medical or mental health needs."

Noting that the proposed new federal budget contains some $10 billion in cutbacks to Medicaid, Dr. Rubin believes his group's findings of sampling bias have particular relevance to the current debate about the level of public funding for Medicaid. He adds, "Although our findings were based on data from the mid-1990s, there's no reason to suspect those findings would be different today. As such, policymakers risk underestimating the burden of needs and service use among children in foster care. They may also underestimate potential implications for foster care children from large rollbacks in the Medicaid program."

Source: Eurekalert & others

Last reviewed: By John M. Grohol, Psy.D. on 21 Feb 2009
    Published on All rights reserved.