P0087 - A Statewide Approach to Increasing Early Access to Medical Care for Children Entering Foster Care

Background: In 2016, the Texas Pediatric Society’s (TPS) foster care committee completed an assessment comparing current state requirements for healthcare for children in foster care to national best practice standards. Early access to medical care for children in foster care emerged as an important disparity. Later that year, the Texas Department of Family Protective Services (DFPS) worked with providers in Dallas and Lubbock to pilot a 3-day medical exam upon foster care entry. TPS, the Children’s Hospital Association of Texas, Children’s Health Dallas, and other stakeholders advocated for a statewide requirement, and in 2017, the Texas legislature passed SB11 which included the requirement for a medical exam within three business days for children entering foster care. DFPS convened an implementation workgroup including representatives from the Health and Human Services Commission (HHSC), Superior Health Plan (the Medicaid managed care organization insuring children in foster care in Texas), and medical professionals. Implementation of the 3-day exam occurred in a regional manner from April 1 to October 1, 2018. DFPS, HHSC, and Superior collaborated to develop exam criteria, documentation, and education for staff, medical providers, residential providers, and caregivers. In December 2019, DFPS submitted a report regarding the implementation process and results to the Texas legislature.

Purpose: To describe the process and results of Texas’s implementation of a 3-day exam for children entering foster care.

Methods: Data collected from the IMPACT case management system was entered by DFPS caseworkers from October 2018 through August 2019, and Medicaid Encounter Data was based on claims submissions available for October 2018 through January 2019 due to claim lags. Data was reported for timely and not timely (late) exams at statewide and regional levels.

Results: Statewide results are found in Figure 1. For the 11 months of available data from IMPACT 74% of children entering foster care received timely 3-day exams with an additional 7.5% of children receiving exams after the 3-day timeframe. Medicaid Encounter Data for the first four months revealed similar numbers with 72.3% of children receiving timely exams. Regional trends showed significant variations with timely exam completion ranging from 45% to 93% in August of 2019.

Discussion: The addition of a medical exam within 3 business days of entering care marks a significant change in medical care for children in Texas foster care. Early access to care can identify additional concerns for abuse and neglect, ensure children have needed medications and medical equipment, and establish a medical home. Implementation required collaboration between DFPS, HHSC, Superior Health plan, medical providers, and stakeholders across the state and resulted in approximately ¾ of children entering Texas foster care receiving timely exams.