Commissions a study regarding the quality of health care services received by foster children in New York state

Summary of specific provisions

Section one would require the office of children and family services to contract with an external organization to conduct an evaluation of the implementation and effectiveness of New York state's health care delivery system for children in the custody or guardianship of the state.

Section two would authorize the organization selected to conduct the evaluation, access to nonidentifiable information from the office of children and family services, department of health and local social services district and voluntary agencies for the purpose of the study. Allow for the collection of supplemental information as needed for the purpose of the study.

Section three would require the office of children and family service by June 30, 2010 to submit a report to the Governor, temporary president of the senate, speaker of the assembly, chairperson of the senate committee on social services and children and families and chairperson of the assembly committee on children and families, and the chairperson of the senate and assembly committees on health.

Justification

Studies have shown that in the United States, children entering foster care have significantly higher rates of chronic and acute medical problems, developmental delays, and psychological and behavioral disorders than children within the general population, including children from low income families. In New York State all children in foster care who are citizens or permanent residents of the United States, are eligible for healthcare services including mental health treatment and behavioral therapies, under Medicaid. New York State has a three tiered system for providing health care services to foster children under Medicaid: a per-diem, fee-for-services and managed care system. Approximately 75 percent of voluntary agencies use the per-diem system for children place under their care. Within the per-diem system a set amount of money is provided to the voluntary foster care agency to cover the cost of a foster child's medical care, based upon the number of days that foster child is placed with the agency. The per-diem rate also allows agencies .to offer health and mental health services on site or use the rate to hire other medical professionals to work part-time on the agency's premises. The remaining 25 percent of foster care agencies opt to use the traditional fee-for services in lieu of the Medicaid per-diem. The fee for-services Medicaid system allows beneficiaries to

go to any doctor who accepts their Medicaid card. The doctor then bills Medicaid directly for the service provided. Some agencies choose to use both the per-diem and fee-for-services to access health care services which are either not allowed or cannot be afforded under the agency's per-diem rate. An alternative to the per-diem/fee-for-service option for Medicaid services is Medicaid managed Care which is not available to all foster children. Managed care provides a consistent network of medical providers that treat both health and mental health care issues. Only foster children that are in the direct care of the local social services districts are able to enroll into Medicaid Managed Care, however, not those placed in volunteer agencies. With the state placing more children in the care of volunteer agencies, there are a large number of children in care that are ineligible for Medicaid Managed Care under current state law, and instead, receive healthcare services through the per-diem system.

Evidence suggests that when foster care agencies use both the Medicaid per-diem and fee-for-service billing mechanisms children in care receive inconsistent health and mental health care services. Whether this is due to an inadequately low per-diem rate or merely a gradual evolution of the foster care medical financing construct, this scattered usage of medical providers and billing arrangements means that it is unknown whether foster children are receiving all necessary medical services required by law and regulation. Exploring whether the Medicaid per-diem/Fee-for-Service system for foster children are effective in meeting the healthcare needs of New York State's foster children is an essential first step in identifying a solution. Although it has been proven that adequate health care for foster children is vital in ensuring that they become healthy and productive adults. Currently, many of the children's medical needs are going untreated and unaccounted for. Gathering more information from State agencies, foster care agencies, local districts and advocates to better understand how the Per-Diem, Fee-For-Service and Managed Care financing constructs affect the health outcomes of these children in need, will allow policy makers to make better decisions that will improve the health of children in foster care.

Prior legislative history

2009-10: S.5924/A.5497

Fiscal implications for state and local governments

Undetermined.

Effective date

This act shall take effect immediately.