A Longitudinal Examination of Timely Well Child Visits Among Michigan Older Foster Care Youth in Medicaid: Fee-For-Service Versus Health Maintenance Organizations

Background: Health insurance and utilization of preventive health care services are vital to the promotion of adolescent health, including the approximately 400,000 U.S. youth in foster care. Foster care youth are a medically vulnerable population for which 87-95% suffer from physical health conditions. To decrease unmet health needs of this vulnerable population, federal guidelines have been established that require states to conduct a comprehensive health assessment within 30-60 days of placement; however, the most effective method to provide this care remains unclear. While some evidence suggests fee-for-service (FFS) may serve foster care children, including older youth, better; studies on the general population have found that children obtain better access to more preventive health services when insured by health maintenance organization (HMOs). Despite the lack of unanimous agreement on the adoption of HMO Medicaid for this population, states are changing policy. We evaluated the timeliness of well-child visits for older foster care Michigan youth during the change from a FFS Medicaid program to HMO providers.

Methods: A three year retrospective study using linked administrative data collected by the Michigan Departments of Human Services and Community Health of 2,016 youth who were in foster care on or after their 14^th birthday during 2009-2012 was used to examine the odds of receiving a timely well-child visit within the recommended 30 day time frame (logistic regression) as well as days to the first visit (Cox Proportional Hazard Model, CPHM) controlling for race, age, and number of foster care visits.

Results: Youth entering foster care during the HMO period were more likely to receive a timely well-child visit than those in the FFS period (OR=2.4, 95% CI=1.86-3.14; P< .0001) and days to first visit decreased over time from a median of 61 days for those who entered foster care during the FFS period to 29 days for the HMO period.  Among the other factors examined, being non-Hispanic black compared to non-Hispanic white and having five or more placements compared to one were negatively associated with receipt of a timely well-visit.  

Conclusions:  Those youth who entered foster care during the HMO period had significantly greater odds of receiving a timely first well-child visit; however, disparities in access to preventive health care remain a concern for minority foster care youth and those who have experienced multiple placements.