Health Differs by Foster Care Eligibility: A Nine-Year Retrospective Observational Study Among Medicaid-Enrolled Children

Abstract

ObjectiveThis study sought to determine the prevalence and rates of physical, behavioral and chronic health conditions among Medicaid-enrolled Colorado children by foster care eligibility codes over nine years. MethodsThis retrospective, population-based study used Colorado’s Medicaid administrative data for all enrolled children, aged <19 years old, from July 2011 - August 2020 to determine the period prevalence and rates of physical, behavioral and chronic health conditions. We identified children in foster care by Medicaid eligibility codes and used the Pediatric Medical Complexity Algorithm version 3.0 (PMCA) to describe health condition outcomes. We report frequencies and percentages by foster care eligibility status, birth year cohort and sex. ResultsAmong 1,084,026 children, we identified 34,971 children in the foster cohort. Rates of physical (1,105.0 per 100,000 person-months, PMs) and behavioral health conditions (583.6 per 100,000 PMs) were two to three-fold higher among the foster cohort than peers (physical 685.1 per 100,000 PMs; behavioral 212.2 per 100,000 PMs). By birth cohort, rates of behavioral health conditions among children in foster care were up to eight times greater than peers. The foster cohort had greater prevalence of chronic conditions with (55.2%) and without (38.6%) behavioral health inclusion. ConclusionThis study provides a broader health assessment among Medicaid-enrolled children and finds condition disparities concentrated among youth in foster care. A more complete understanding of health problems among children in foster care is critical for health, child welfare and Medicaid systems to improve health outcomes through coordinated and evidence-based interventions, programs, and policies. What’s NewThis retrospective study among Medicaid-enrolled children who differ by foster care eligibility expands the assessment of physical, behavioral and chronic health conditions and disaggregates PMCA-identified mental health conditions into ICD-10 F-code categories. Condition disparities concentrated among youth in foster care.