All patients in foster care are now enrolled in Medicaid Managed Care

Since 2013, children and youth in direct placement foster care in New York State counties outside of New York City have been mandatorily enrolled in MMC. Effective July 1, 2021 — children and youth placed in foster care in the care of VFCAs are now also mandatorily enrolled in MMC, unless otherwise exempt or excluded. The enrollment mandate was also expanded to include those in direct placement foster care in the counties of New York City.

As part of the 2021 transition, VFCAs may choose to become licensed health care providers through New York State Public Health Law Article 29-I. This allows VFCAs to provide certain physical and mental health services, as well as enter into agreements with managed-care companies that provide these services.

Additional requirements

The pharmacy benefit requirements for children and youth placed in foster care include rapid replacement of medically necessary prescriptions, transitional fills for those newly placed in foster care, and out-of-network access to pharmacies when a child or youth is placed in foster care outside the MMC plan’s service area.

In addition, 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 or qualified practitioner in the MMC plan’s network for the purposes of this assessment.

Important considerations*

• 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.

With these disparities in mind, CDPHP reminds providers that access to comprehensive, high-quality health care is especially critical for foster children and youth.

If you have a patient in foster care and have questions or concerns, 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.