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TexProtects testifies on Medicaid managed care for foster youths

TexProtects testifies on Medicaid managed care for foster youths

On Wednesday, June 27, a joint hearing of the House General Investigating & Ethics Committee and a subcommittee of House Appropriations accepted testimony on oversight of the Texas Health & Human Services Commission's management of Medicaid managed care. TexProtects' Vice President of Public Affairs Pamela McPeters was there, testifying on recommendations to improve healthcare delivery for our children in the foster care system. She also provided detailed written information on Medicaid managed care for foster youth.

Here is her testimony:

In 2008, STAR Health was created to address challenges for children and youth in the foster care system that existed under the fee for service model. Challenges included fragmented care, lack of coordination, a lack of metrics to effectively measure health outcomes, and overmedicating children with psychotropic drugs. The program has made improvements resulting in: 1) an electronic health record to better coordinate care, 2) Foster Care Centers of Excellence that provide integrated healthcare and support services, 3) significant reduction in inappropriate use of medications, and 4) reduction in hospital admissions for some of the most common conditions (such as diabetes and asthma).

Over the past decade we’ve made great strides as a state with the progress of STAR Health, but there’s still room for improvement and our foster children are counting on us to deliver. Foster care children suffer from serious physical, mental, developmental, and psychosocial problems rooted in childhood adversity and trauma. A 2014 HHSC caregiver study (External Quality Review Organization) suggests there are limitations to access and there is an unmet need for care coordination for children in STAR Health. The STAR Health Plan reports enrolling 16 to 18 percent of STAR Health children as active participants in service management, although more than half of the children enrolled in STAR Health have special healthcare needs. Despite screening and outreach requirements, data showed that only 35 percent of caregivers said they received a call to assess their care coordination needs. Of the children and youth whose caregivers received a phone call, 55 percent were identified as needing more intense support and planning through service management. The most common types of special healthcare needs among children and adolescents were problems that require counseling (36 percent). The Hogg Foundation for Mental Health reported in 2015 that 185 out of the 254 Texas counties, or 73% of Texas counties, did not have a single psychiatrist and 40 counties did not have a single Licensed Clinical Social Worker.

To improve healthcare delivery for our foster care children, we suggest HHSC, DFPS and the legislature take the following three steps: 1. Strengthen and expand the DFPS Medical Director’s office to include additional medical professionals who can serve as a resource, respond to inquiries, offer comprehensive review, act as an ombudsman, and effectively represent the healthcare needs of foster children. 2. Streamline and incorporate strong accountability measures in the complaint and appeals process. Priorities should be timeliness, enhancing notifications, and making available information to additional stakeholders within the system for complaints, appeals, and State Fair Hearings. 3. Ensure children have access to the care they need and address the chronic shortage of behavioral health and specialty care providers. To do so, the state should invest more in current Foster Care Centers of Excellence and create additional centers, and partner with stakeholders to develop innovative solutions that eliminate barriers, provide essential investment, and expand best practices and prevention and support services.

Partners, including the state, have a critical role in ensuring high-quality health services for children in out-of-home care. Through provisions like a medical home, healthcare integration and coordination, and advocacy on behalf of children, together we can ensure the state’s most vulnerable children receive the best care. Child welfare professionals and associates, such as the health plan, medical providers, caseworkers and case managers, attorneys, judges, foster families and others, are part of a large and complex system. Without their biological parents, foster children are wholly dependent on this system. Stakeholders all share the goal to heal and promote the well-being of foster children by providing for their health, safety, stability, and permanency. To be successful, stakeholders need the best tools and structures in place.

Posted on June 29, 2018.

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