Valuing Collaboration: An Innovative Model to Improve Health Care Services in a Child Welfare Agency

Published in Children’s Voice, Volume 29, Number 2

by Audrey Smolkin, Linda Sagor, and Jessica Coolidge 

It has been a common practice for decades for state governments to establish partnerships with their university systems for training and workforce development, support to public education, and information technology. Yet only recently have states begun exploring partnerships to support state public health and health coverage initiatives more broadly (University of Massachusetts Medical School, 2012). Massachusetts has been a pioneer in creating such programs, and the partnership and work described here is part of a larger set of child welfare reforms spearheaded by the Commissioner, the Secretary of Health and Human Services, and the Governor. While some university partnerships have been limited to the Medicaid program, Massachusetts has established a robust partnership to expand health care options for children in the child welfare system. This article explores the history of these public health collaborations, the health care challenges faced by children in the foster care system, and how other states might learn from the efforts of Massachusetts to address these challenges.

Medicaid and University Partnerships
In the late 1980s, Medicaid program budgets grew tremendously and became the largest budget category for many states. The combined cost of program services and administration raised questions of how the program could be modified to increase the health of state citizens at the most efficient cost. The number of program beneficiaries and program expenditures has continued to grow over the past decade as the Affordable Care Act has greatly expanded the reach and influence of the Medicaid program, making it the key driver in the effort to increase health insurance coverage. In fiscal year 2019, Medicaid spending totaled over $616 billion. This has presented a significant challenge to state budgets and has increased the incentive for states to look to their universities for clinical expertise and efficiency. Federal Medicaid law requires that a state must have a single state agency to administer the program (Electronic Code of Federal Regulations, 2016a). However, multiple state agencies—such as departments of public health, social services, mental health, youth services, aging, and developmental disabilities services—may contribute to the administration of Medicaid in accordance with their expertise and purview, and federal Medicaid administrative dollars can be claimed to offset the cost of these efforts. Under Medicaid, the federal government matches state appropriations dollar for dollar or more for both services and administration. This federal match, known as Federal Financial Participation (FFP), has become a crucial source of funding for state health and human services agencies, and federal regulations allow FFP to be claimed for a sister state agency’s Medicaid-related work under a written agreement. In Massachusetts, that agreement is called an interagency service agreement (ISA) (Electronic Code of Federal Regulations, 2016b). Similarly, an ISA allows costs to be claimed and FFP to be received by a state’s public universities for their contribution of time or expertise in support of a state’s administration of the Medicaid program. More than 12 different states have established partnerships between universities and state Medicaid programs; these partnerships include agreements to provide research, program evaluation, clinical and policy guidance, information technology, service delivery, and data collection and analytics.

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Audrey Smolkin, MPP, is responsible for identifying, developing, and overseeing management of new programs, research and evidence-based policy initiatives related to children and families. This work includes partnering with the Massachusetts Department of Children and Families on medical care for children in care of the department as well as management related to a statewide network of Family Resource Centers. Her expertise is in trauma, racial equity, and child resilience. Her undergraduate degree is from the University of Pennsylvania and her graduate work was completed at the University of Chicago.

Jessica Coolidge is a licensed social worker and has worked with children and families who are at risk in Massachusetts for 19+ years. She is currently a medical social worker with the Health and Medical Services Team at the Massachusetts Department of Children and Families. Her current work involves statewide consultation within a multidisciplinary healthcare team, working on interagency public sector projects and healthcare coordination for youth in foster care. Jessica holds a BS from Lesley University and a MSW from Bridgewater State University.

Linda D. Sagor was appointed as the first medical director of the Massachusetts Department of Children and Families in 2015. She had previously served as a pediatric consultant for the department. She advises social workers, oversees the departmentʼs nurses, and reviews cases of children with complex medical or behavioral issues. She also is responsible for developing a policy to monitor children in state custody who are taking psychotropic medication and assembling a panel of doctors to oversee difficult cases. She received her medical degree from the College of Human Medicine at Michigan State University, and her masterʼs in public health from the School of Public Health at the University of Michigan.