Unmet needs: Critics cite failings in health care for vulnerable foster children

One night last month, a 9-year-old boy who had autism and talked about killing himself was one of about 70 foster care children and youth sleeping under state supervision in hotels across Georgia.

Audrey Brannan, coordinator of complex care for Georgia’s child welfare agency, said Amerigroup Community Care, Georgia’s designated health insurer for foster care, had refused to place the boy in a psychiatric residential treatment facility. She said he stayed in a hotel for more than a month before receiving a temporary emergency placement in a foster home.

The boy and other children living in the hotel lacked permanent placement, Brannan said, and many were not getting help for their complex mental and behavioral needs.

The frustration over the gap in care had become so bad that Candice Brosse, commissioner of the Georgia Department of Human Services, sent a scathing six-page letter to the state Medicaid agency in August—signalling an unusual interagency conflict. She argued that Amerigroup, a unit of Eleven’s Health, was not being held accountable for failures in care, and that its foster care contract should not be renewed.

“Simply put, the state’s most vulnerable children cannot access physical, mental or behavioral health treatment — and deserve it,” Brose wrote.

Amerigroup declined to comment specifically on Brose’s comment, saying it had not seen his letter. But Michael Perry, a spokesman for Amerigroup Georgia, said the insurer hosts collaborative monthly meetings with state agencies to listen to any concerns and “will continue to work on behalf of these vulnerable individuals to ensure that they have Have access to appropriate healthcare and support services.” be successful.”

Such problems extend beyond Georgia, according to Sandy Santana, executive director of the national advocacy group Children’s Rights. While foster care primarily grabs headlines for cases of abuse or neglect – even deaths – the failures of states and insurance companies to provide adequate health care for these children are widespread and have come under massive public scrutiny. occur without

“These kids cycle in and out of the ER, and are not accessing other services,” said Santana, whose group has filed lawsuits in more than 20 states over foster care problems. “It’s an issue across the country.”

Nearly all children in foster care are eligible for Medicaid, the state-federal program for low-income people, but states decide on the delivery mechanism. Georgia is one of at least 10 states that have turned to managed-care companies specifically to provide specialized services for foster children and others under state supervision. At least three more — North Carolina, New Mexico and Oklahoma — are taking similar steps. But regardless of structure, getting timely access to care for many of these vulnerable children is a problem, Santana said.

Getting mental health care for privately insured children can certainly be a struggle, but the challenge is even greater for children in state custody, says Dr. Lisa, a Milwaukee pediatrician and president of the American Academy of Pediatrics Council. Jaitley said foster care, adoption and kinship care.

“This is a unique population,” she said. “They have experienced considerable toxic stress prior to entering foster care.”

Andy Schneider, a research professor at Georgetown University’s Center for Children and Families, said that for those states that use specialized care for these children, transparency and monitoring remain spotty and the quality of care remains unknown.

For example, Illinois has paid more than $350 million through 2020 to insurance giant Centene Corp. to manage health coverage for more than 35,000 current and former foster care children. But last year, an investigation by the Illinois Answers Project newsroom found that Santen’s youthcare unit repeatedly failed to provide basic medical services like dental care and immunizations to thousands of these children. Federal authorities are now investigating allegations about the contract.

Centene said Youthcare had not been informed of any investigation. In a statement, the company said the Illinois Answers Project’s reporting was based on out-of-date information and did not account for its recent progress as it “works to ensure that families have access to high-quality care and services.” Is.”

In some cases, child advocates say the care the children receive is not appropriate. In Maryland, the American Civil Liberties Union, Disability Rights Maryland, and the local branch of Children’s Rights filed a lawsuit against the state this month, alleging that it conducts inadequate oversight of psychotropic medication for children in its foster care system. failed to do. Court documents state that at least 34% of the state’s foster children are prescribed psychotropic drugs, although most of them do not have a documented psychiatric diagnosis.

In Georgia, Lisa Rager said she and her husband, Wes, know all too well the barriers to getting services for foster children. The suburban Atlanta couple has taken in more than 100 foster children and adopted 11 of them out of state custody.

One child waited more than a year to see a specialist, she said. Getting approval for speech or occupational therapy is “a lot of trouble”.

Rager said she pays out-of-pocket for psychiatric drugs for her three children because of insurance constraints. “It’s better for me to pay cash than wait on Amerigroup,” she said.

Problems like this happen frequently, Brose said in his letter. Amerigroup’s “narrow definition for ‘medically necessary services’ is — on its face — more restrictive than state and federal standards,” she wrote.

“Too often, case managers and foster families are told that the next available placement is weeks or months later,” she told the state’s Joint Appropriations Committee on January 17. Brose said his agency has formed a legal team to fight the Amerigroup treatment.

Amerigroup’s Perry said its clinical policies are state-approved, and follow regulatory and care guidelines.

In the most recent 12-month period, AmeriGroup received $178.6 million in government funds for its Special Foster Care plan, which serves Georgia’s nearly 32,000 children, most of whom are foster children and children removed from state custody. has been adopted. The contract is currently up for re-bidding.

David Graves, a spokesman for the Department of Community Health, which runs Medicaid in the state, said the agency would not comment on Brose’s letter because it is part of the contract renewal process. Graves said the agency regularly monitors the quality of care that children in state custody receive. He pointed to a state report that showed Amerigroup did well on several metrics, such as asthma drug use.

But Melissa Haberlein DeWolff, research and policy director for the nonprofit Voices for Children of Georgia, said the vast majority of children who cycle through state emergency departments for mental illness are in foster care.

“Most caregivers we talk to are desperate for practical health care coordination help – finding providers and getting appointments, how to manage behavior and medication, and how to prevent crises, and health information between providers. Sharing,” she said.

To fix these problems, Zeitley calls for increasing Medicaid reimbursement rates to create a larger benefits package for foster children, better coordination of care, and attracting more providers to these managed-care networks. recommend.

Contracts with managed-care companies should also be performance-based, with financial penalties if necessary, said Kim Lewis, managing attorney for the Los Angeles offices of the National Health Law Program.

“Managed care is only as good as the state’s ability to manage the contract and make sure what they’re getting is what they’re paying for,” she said. “It just, you know, hoping for the best and ‘here’s the check’ doesn’t work.”

But in Georgia, the state has never financially penalized Amerigroup for failing to meet contractually mandated quality standards, confirmed Graves, a spokeswoman for the Department of Community Health. He said the agency and Amerigroup work to resolve any issues brought to their attention.

Georgia has established an Oversight Committee with public meetings to monitor the quality of AmeriGroup’s performance. But the committee has not met since August 2020, the state said last month. Following questions from KHN, Graves said the panel would begin meeting again this year.

Related topics

Contact Us Submit a story tip

Leave a Comment