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Making Managed Health Care Work for Kids in Foster Care
January 1998
Tasks for Managed Care Organizations
- Recognize children in foster care as a special and high risk population
- Understand the complex needs of children in foster care and the state's responsibilities for their care
- Train physicians and other health care providers on the unique needs and circumstances of children in foster care, including their needs for mental health and developmental services
- Establish practice procedures that allow for the special needs of children in foster care including immediate eligibility for services, longer and more frequent appointments, availability of health care professionals to appear in court proceedings and communicate with caseworkers and foster parents
- Establish appropriate fee structures
- Provide case management services
- Coordinate medical and psychosocial recordkeeping
Tasks for State Medicaid Offices
- Recognize children in foster care as a special and high risk population
- Understand the complex needs of children in foster care and the state's responsibilities for their care
- Involve the child welfare agency in the design, negotiations and implementation of the state's Medicaid managed care plan
- Ensure that MCO (managed care organization) contracts include access to the necessary physical, mental health and developmental services that children in foster care require
- Hold MCOs accountable for the services they are paid to deliver
- Require that health professionals within the MCO network understand the unique needs and circumstances of children in foster care
- Ensure continuous coverage for children in foster care should a change in MCOs be required
Tasks for Public Child Welfare Agencies
- Understand how managed health care works
- Educate Medicaid office and MCOs to the complex needs of children in foster care and the state's responsibility for their care
- Participate in the design, negotiations and implementation of state Medicaid managed health care plans
- Ensure that MCO contracts include the full range of benefits for children in foster care
- Hold MCOs accountable for the services they are paid to deliver
- Establish clear and streamlined process to authorize health care services
- Train foster parents, biological parents and caseworkers to understand and utilize managed care
- Provide an ombudsperson to help with enrollment and advocacy for children in foster care
- Clearly delineate services covered in the managed care contract and services that remain the responsibility of the child welfare agency
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