A Longitudinal Examination of Timely Well Child Visits Among Michigan Older Foster Care Youth in Medicaid: Fee-For-Service Versus Health Maintenance Organizations
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 14th 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.
Provision of health care to the public
Public health or related public policy
Public health or related research
Compare the timeliness of well-child visits for older foster care youth when one state changed Medicaid coverage for these youth from fee-for-service to health maintenance organization. Assess statewide preventive service utilization of older foster care youth during a change in policy from fee-for-service to health maintenance organizations.
Keyword(s): Medicaid, Youth
Qualified on the content I am responsible for because: I am an epidemiologist with more than 20 years of analyzing large data sets, including as a senior epidemiologist with TB and HIV surveillance branches and the Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.