Transition of Foster Care Children to Medicaid Managed Care

Office of Health Insurance Programs
Division of Health Plan Contracting and Oversight
March 18, 2013

  • Presentation is also available in Portable Document Format (PDF, 262KB)

MRT 1458

Transition of Benefits and Populations into Managed Care

April 1, 2013

(Contingent on CMS approval):

  • Non per-diem foster care children placed directly in the community by LDSS
  • Affects counties outside NYC only
  • B2H and designated DD remain exempt

Population and Enrollment

Current Population:

  • Approximately 3650 children

Current Enrollment:

  • Approximately 1520 enrolled in managed care
  • Approximately 2130 children will be enrolled beginning 4/1/13
  • 24 counties exempting foster care children from enrollment or are actively disenrolling

County Enrollment Status:

  • 32 counties are voluntarily enrolling
    • 10 routine enrollment
    • 22 enrollment on case by case basis

Planning for Phase-In

Collaboration with OCFS and LDSS:

  • Understand needs of population;
  • Systems currently in place;
  • Best practices.

DOH review of FFS providers for network overlap analysis.

Evaluation of LDSS Current Policies

Conducted electronic survey to assess:

  • Foster Care enrollment policies
  • Access to services

Current system is working for each county

  • Maintain current structure
  • Utilize providers experienced in trauma

How Will this Population be Enrolled?

Enrollment begins 4/1/2013

(contingent upon CMS approval)

  • LDSS will enroll on a case by case basis;
  • LDSS will be responsible for plan selection;
  • Review each case at next evaluation;
  • No Auto-assignment of these children;
  • Upstate enrollment will be completed within 6 months.

Good cause for enrollees in foster care:

  • To change plans or disenroll;
  • Change in circumstances;
  • Entering, leaving, or changing foster care placement.

Coordination between the Local Districts and the Plan

LDSS will identify a foster care coordinator:

  • Point person identified at each district;
  • Communication between LDSS and plans;
  • Expedite access and enrollment.

MCO will identify a managed care coordinator:

  • Point person identified at each plan;
  • Communication between LDSS and plans;
  • Work with the county to expedite access to care as needed.

Local District Activities

As child enters foster care, LDSS will:

  • Arrange initial assessment at intake;
  • Arrange comprehensive diagnostic assessment within 30 days of intake;
  • Problems with coding annual and ongoing assessments as a well child visit, which is limited;
  • Identify current providers for child;
  • Determine current care child is receiving;
  • Determine if child is current managed care enrollee

For children entering foster care;

If child is a current managed care enrollee:

  • May remain in current plan, or
  • Select new plan if appropriate.

If child is not enrolled in managed care:

  • LDSS selects appropriate plan,
  • LDSS selects a primary care provider, and
  • LDSS begins enrollment process.

Choosing the Right Plan

Criteria for Plan Selection:

  • Location where child will be placed;
  • Plans serving the child´s new location;
  • Overlap between plan provider network and child´s current providers;
  • Length of time child will be in foster care.

Transition Issues and Opportunities for Improvement

Plans have critical role in integrating care for Children in Foster Care

  • Participating Providers
  • Continuity of care
  • Case management
  • Mandated assessments
  • Behavioral health

MCO Requirements

Provider Network:

  • Augment the provider network to include physicians and other providers currently seeing foster care children;
  • Network should include providers:
    • Experienced in trauma based care;
    • Currently providing mandated and specialty services to this population.
  • Allow flexibility when authorizing assessments or services for this population;

Continuity of Care:

  • If a provider treating a patient does not participate in the plan, transitional care must be provided for a 60 day period;
  • Plans must allow the current treatment plan to continue until a new assessment and care plan is established;
  • MCOs must cover mandated assessments and diagnostic exams;
  • Mandated assessments meet established guidelines.

Plans and LDSS Working Together

Facilitating Access to Care:

  • Current enrollees: Plan liaison issues replacement ID card or other plan identification to foster care coordinator by next business day if needed;
  • New enrollees: Plan liaison issues "Welcome Letter" and ID card within 15 days;
  • Plans must identify a process to allow the member to access services upon enrollment if ID card is not received;
  • No change in enrollment process: Use current address on file (LDSS) since child is in their custody;
  • Coordinator alerts plan in writing of new enrollment, disenrollment, change in status, change of PCP.

Case management:

  • Available to children in foster care;
  • Case manager works with plan liaison (if different) and foster care coordinator;
  • Foster care case management - determines permanency planning only; not involved in determining health care services

Discharge planning:

  • Coordination between foster care coordinator and plan liaison;
  • Treatment plan for child leaving foster care, transferring out of or disenrolling from the MCO, or discharged from inpatient setting;
  • Treatment plan is in place prior to discharge date.