Ensuring coverage for the most vulnerable

Study finds that children in the welfare system have stable health insurance; emphasizes need to protect Medicaid availability

A majority of children in the child welfare system maintain stable health coverage, finds a first-of-its-kind study published in the current issue of the American Journal of Public Health. Ramesh Raghavan, M.D., Ph.D., assistant professor of social work and psychiatry at Washington University in St. Louis and lead author of the study, says that these findings are “a testament to the success of policies directed at securing stable insurance coverage for children.

“Given this vulnerable population’s dependence on Medicaid, protection of existing entitlements to Medicaid is essential to preserve their stable insurance coverage,” he says.

Raghavan says that this type of study is important because it helps measure the effectiveness of current Medicaid policy.

He notes that although the stability of health insurance coverage over time was encouraging, “this dependence on Medicaid may be perilous for children in the welfare system.”

Raghavan cites a number of challenges in maintaining Medicaid coverage for child welfare populations:

• In fiscal year 2007, child health insurance programs faced a cumulative shortfall of $800 million across 17 states

• Medicaid’s new premium and cost sharing requirements
“Children receiving child welfare services may need to pay for non-preferred drugs and emergency department use,” Raghavan says. “It’s also unclear who will pay for health care when kids are removed from homes and placed into foster care.”

• Potential changes to Medicaid-reimbursable case management
“These changes, if enacted, may reduce the flexibility and array of services needed to comprehensively serve these kids,” he says.

Raghavan and colleagues conducted this study using data from four waves of the National Survey of Child and Adolescent Well-Being to examine coverage among 2,501 youths in the child welfare system.

He led a team of researchers from Rady Children’s Hospital, San Diego; University of California at San Diego; San Diego State University; and Tufts University-New England Medical Center, Boston, MA. The HHS/Administration for Children and Families funded their study.