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Not All Children in Foster Care Who Were Enrolled in Medicaid Received Required Health Screenings

Rae Hutchison, a senior program analyst for the Office of Evaluation and Inspections in Kansas City, is interviewed by Brian Whitley, Regional Inspector General for the Office of Evaluation and Inspections.

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[Brian Whitley] I'm Brian Whitley, Regional Inspector General for the Office of Evaluation and Inspections in Kansas City. I'm speaking with Rae Hutchison, a senior program analyst, about a report entitled "Not All Children in Foster Care Who Were Enrolled in Medicaid Received Required Health Screenings." Rae, this sounds like an important issue. Would you start by telling us what you found?

[Rae Hutchison] Sure Brian. We found that a significant number of children in foster care who were enrolled in Medicaid did not receive their required health screenings. For example, 29 percent of these children did not receive at least one required health screening.

[Brian Whitley] So Rae, what kinds of services are included in a health screening?

[Rae Hutchison] Typically, a child would receive a range of general medical checkups, dental exams, hearing, vision and mental health assessments.

[Brian Whitley] These are important services for all children, so why did you focus specifically on children in foster care?

[Rae Hutchison] These children often experience chronic medical, developmental, and mental health issues. Early intervention and treatment of health issues found during these screenings can be key to a healthy future for these children.

[Brian Whitley] You already said that not all children received their required screenings. What about timeliness - did these children get their screenings on time?

[Rae Hutchison] Although many of the screenings were delivered on time, we discovered that 28 percent of children received at least one of their required health screenings late.

[Brian Whitley] Tell us more about schedules for these required health screenings.

[Rae Hutchison] State foster care programs are required to develop a plan for initial and periodic health screenings for children.

[Brian Whitley] Do all States' foster care programs use the same schedule?

[Rae Hutchison] No. States may determine the frequency at which children in foster care should receive required health screenings so they often vary. Some States have adopted the same schedule as a Medicaid benefit that provides comprehensive and preventative health care services for children under the age of 21. It is called EPSDT, which stands for Early and Periodic Screening, Diagnostic and Treatment. Other States have schedules that require more frequent screenings for children in foster care when compared to their State's EPSDT screening schedule.

[Brian Whitley] So, how did you look into whether children received required health screenings according to that schedule?

[Rae Hutchison] We focused on whether children in foster care, who have Medicaid coverage, received their required initial and periodic health screenings from mid-2011 to mid 2012 in four states, included California, Illinois, New York, and Texas. We chose those states because they make up 31 percent of the national population of children in foster care. Then, we selected a sample of 400 children and looked at data to see if they were actually getting required health care services on time.

[Brian Whitley] Did your study focus on anything else?

[Rae Hutchison] Yes. We also wanted to know whether the federal Administration for Children and Families, or ACF, was making sure that these children received their required health screenings.

[Brian Whitley] So how does ACF monitor State's child welfare systems?

[Rae Hutchison] ACF conducts Child and Family Services Reviews that look at several areas of a State's child welfare system, including whether children receive required health screenings.

[Brian Whitley] Are these reviews an effective way to make sure children are receiving these services?

[Rae Hutchison] Not really. These reviews don't check to make sure screenings adhere to the State's schedule. ACF reviews only assess whether each State provides initial and periodic health screenings while children are in foster care.

[Brian Whitley] Interesting. So, what action are we recommending ACF take to address these concerns?

[Rae Hutchison] Well, we are recommending that ACF expand its Child and Family Services Reviews to more accurately determine whether children get the required screenings when they need them. We also recommend that ACF work with States on ways to improve compliance with screening guidelines.

[Brian Whitley] Did ACF agree with OIG's recommendations?

[Rae Hutchison] Yes. ACF said that it would consider our first recommendation to expand future reviews. They also agreed with our second recommendation to provide better guidance to states.

[Brian Whitley] Rae, thank you for sharing this important work.

[Rae Hutchison] Thank you, Brian.