Healthcare utilization among children in foster care in the greater Houston area

Children in foster care have greater physical and mental health conditions than children not in foster care. However, little is known about their actual healthcare utilization. This study describes healthcare utilization from July 1, 2014 to June 30, 2016 among children in foster care in the greater Houston, Texas area who receive Medicaid coverage through a single Medicaid managed care organization for children in foster care. Enrollment and claims data were used to describe demographic characteristics; outpatient utilization, location and type of encounters; inpatient utilization; and timeliness of first visit. Overall, 11,073 children were enrolled for any portion of the study period and 88% utilized healthcare services. Children who accessed healthcare services were significantly younger (p < 0.001) and enrolled in the study period longer (p < 0.001) than those who did not access care. Overall, the mean number of outpatient encounters per person-year was 16.5 (SD 42.0) with a median of 6 encounters. The majority (58.8%) of outpatient services were provided in the home, but these were only accessed by 21.6% of the children. Among the 1,412 (12.8%) children who utilized inpatient services, the number of inpatient days per person-year ranged from 0.5 to 365.3 with a median of 2.9 inpatient days per person-year. With respect to timeliness of the first visit, 61% of children received healthcare services in their first 30 days in care, indicating 40% did not receive this initial encounter as recommended by the American Academy of Pediatrics and required by the Texas Department of Family and Protective Services. The high volume of home-based services for skilled nursing; occupational, physical, and speech therapy indicate a high level of need for a subset of this already vulnerable population.