O3005: The Use and Impact of Home Health Care Services for Children in Foster Care

Background: Home health care (HHC) has the potential to promote quality of care for children with chronic health problems by allowing them to receive care in the home as opposed to more costly and less family-centered sites of care (i.e. hospital). Children in foster care have high rates of health problems and healthcare utilization, yet little is known about their use of HHC. As health systems and policymakers work to address the unmet health needs of these children and avoid costly ED visits and hospitalizations, it is important to understand the role that HHC plays in achieving these goals.

Methods: This ongoing study is a secondary analysis of longitudinal Medicaid claims data from 18 states over a 12-year time period (2000-2012). Data include a 40% random sample of all children under 19 years old enrolled in Medicaid during this time period; including children in foster care, who account for up to 8% of states’ Medicaid enrollees. We will conduct aggregate level analysis to 1) describe the use of HHC for children in foster care compared to children never in foster care; and 2) examine the impact of HHC use on other types of healthcare use for children in foster care compared to children never in foster care. We will report descriptive summary statistics of HHC service use over time and by Medicaid eligibility group (i.e. foster care vs low income), adjusted for age, gender, race/ethnicity, zipcode. We will also conduct multivariate regression analysis to identify the impact of HHC use on utilization of other healthcare services, such as ED visits, hospitalizations, office visits, and prescription drugs. Data findings will be interpreted and translated into practice and policy recommendations in collaboration with our advisory team of racially/ethnically/geographically diverse foster parents who care for children with complex medical and/or behavioral conditions.

Results: Preliminary analysis shows that by 2012 psychiatric home health services were among the most common HHC service types used, followed by durable medical equipment. In our claims data, 15% of all children on Medicaid have a mental health condition, compared to 53% of children in foster care. About 16% of low-income children (never in foster care) and 33% of children in foster care with mental health diagnoses use HHC services but there are wide variations by state. The most common mental health diagnoses and CPT codes associated with HHC services for children in foster care also vary by state, but ADHD and adjustment disorders were top diagnoses across majority of states. Data analysis ongoing.

Conclusion: As informed by our data and the lived experience of our foster parent advisory team, we will present practice and policy implications for the use of Medicaid-funded HHC services to improve health outcomes for children in foster care.