How providers and CDPHP work together for patients in foster care

High-quality care is critical

CDPHP® reminds providers that access to comprehensive, high-quality health care is especially critical for foster children and youth.

• Compared to children from similar socioeconomic backgrounds outside of the foster care system, children in foster care have higher rates of birth defects, developmental delays, mental and behavioral health needs, and physical disabilities.*

• Children and youth in foster care utilize mental health services (inpatient and outpatient) at a rate 15 to 20 times higher than the general pediatric Medicaid population.*

Your role and responsibility

As a CDPHP network provider, you may find yourself in a position to provide trauma-informed care to Medicaid Managed Care (MMC) children or youth in direct placement foster care or in the care of voluntary foster care agencies (VFCAs).

Provision and coordination of services for children and youth in foster care must be done in compliance with the New York Medicaid Program 29-I Health Facility Billing Manual and the Transition of Children Placed in Foster Care and NYS Public Health Law Article 29-I Health Facility Services into Medicaid Managed Care guidance documents located on the NYS Department of Health website.

Upon placement into foster care, a child or youth is required to have an initial medical assessment within the first 30 days of placement. The child or youth may utilize any primary care physician (PCP) or qualified practitioner in the MMC plan’s network for the purposes of this initial medical assessment.

Pharmacy benefit requirements

The pharmacy benefit requirements for children and youth placed in foster care include, but are not limited to, rapid replacement of medically necessary prescriptions and transitional fills for children and youth newly placed in foster care. 

Effective April 1, 2023, MMC members – including children and youth placed in foster care – had their pharmacy benefits transitioned to NYRx, the Medicaid Pharmacy program. However, physician administered drugs, durable medical equipment, prosthetics, orthotics, and supplies are still covered by CDPHP when billed as a medical or institutional claim. Refer to the NYS Pharmacy Procedure Code Manual for details.

CDPHP is here to help

If you have a patient in foster care and have questions or concerns – or if there’s a discrepancy with the assigned PCP on the MMC member’s ID card – the child or youth should not be turned away.

Please contact CDPHP foster care liaison Brianne Sullivan via email Briane.Sullivan@cdphp.com or phone (518) 641-3479.

*American Academy of Pediatrics Task Force on Health Care for Children in Foster Care, Fostering Health: Health Care for Children and Adolescents in Foster Care. (New York: American Academy of Pediatrics, 2005).; and Mark D. Simms, Howard Dubowitz and Moira A. Szilagyi, “Health Care Needs of Children in the Foster Care System,” Pediatrics 2000;106(4 Suppl):909- 918.; and Dutton M Fiori T, Karl A, Sobelson M. Medicaid managed care for children in foster care. In: Fund Medicaid Institute at United Hospital, editor: UHF; 2013.