By Taylor Hendricks, Communications Associate, Center for Health Care Strategies

“They are our kids and we must take steps together to make sure they’re being served.”

Children involved with the child welfare system, including many covered by Medicaid, have significant physical and especially, behavioral health care needs. Given the complexity of their circumstances and the fragmentation of child-serving systems, it is often difficult for these children to get the health care they need.

Several states – Arizona, Massachusetts, Michigan, and New Jersey – have developed innovative strategies to work across their child welfare, behavioral health, and Medicaid agencies to maximize Medicaid’s effectiveness for this hard-to-serve population. The experiences of these states are explored in a new Center for Health Care Strategies report, Making Medicaid Work for Children in Child Welfare: Examples from the Field, made possible by the Annie E. Casey Foundation.

Authors Sheila Pires and Beth Stroul interviewed representatives from each state’s child welfare, behavioral health and Medicaid agencies, and synthesized state strategies into eight key areas that include creative approaches to financing; eligibility and enrollment systems; screening and early intervention processes; and individualized service planning, among others.

“Ours is not a child welfare, mental health, Medicaid, or juvenile justice initiative, but one that crosses systems.”

Each of the profiled states has honed in on what it means to create real partnerships between their child-serving systems and how to achieve the critical linkages, for example, through a memorandum of understanding or universal protocols for serving the child welfare population. They have learned to work within the guidelines and regulations of the current Medicaid system, while capitalizing on opportunities to make it work better—for instance through waiver programs, or the expansion of home- and community-based services.

Their experiences coalesce into several broad lessons. At the child level, providers must understand the unique needs of children in child welfare (which may include histories of trauma and abuse), and should adopt an individualized approach to service planning (such as the wraparound model). At the systems level, stakeholders should work together to develop comprehensive financing mechanisms that maximize impact, a robust Medicaid benefit, and a cross-systems strategy for measuring outcomes and sustaining system changes post-implementation.

As states move forward with health reform, they should consider ways to make their Medicaid programs work better for current and expansion populations – including children in child welfare. Looking to the experiences of other states in doing so can provide valuable insights into this process.