HEALTH CARE

news Critics cite health care failures for vulnerable adopted children

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One night last month, a 9-year-old boy with autism and who spoke out about suicide was among about 70 foster children and youth sleeping in a Georgia hotel under state supervision.

Amelie Group Community Care, Georgia’s designated Foster Care health insurer, is providing psychiatric residential treatment facilities, according to Audrey Brannen, complex care coordinator for Georgia’s Child Welfare Agency. She said he stayed at the hotel for over a month before being placed on temporary emergency placement at the Foster Home.

Brannen said the boys and other children staying at the hotel had no permanent placement and many were not receiving support for their complex mental and behavioral needs.

Dissatisfaction with the care gap has become so great that Georgia Department of Social Services Commissioner Candace Broads sent a scathing six-page letter to the state’s Medicaid agency in August. She argued that her Amerigroup, a division of Elevance Health, was not held accountable for the care failure and should not renew the foster care contract.

“Simply put, the state’s most vulnerable children are not getting the physical, mental, or behavioral health care they need.

Amerigroup declined to comment specifically on Broce’s remarks, saying it had not seen her letter. But Michael Perry, Amerigroup’s Georgia spokesman, said the insurer, in collaboration with state agencies, hosted monthly meetings to hear concerns and “help these vulnerable individuals find the appropriate resources they need.” We will continue to work to ensure access to medical and support services.” success. “

Such issues extend beyond Georgia, said Sandy Santana, executive director of the national advocacy group Children’s Rights. Foster care is primarily focused on cases of abuse, neglect, and even death, but the failure of states and insurance companies to provide adequate health care to these children is widespread, mostly It’s happening without public scrutiny.

“These kids are in and out of the ER and other kids aren’t accessing services,” Santana said. “This is a country-wide problem.”

Nearly all children in foster care are eligible for Medicaid, a state federal program for low-income individuals, but the state determines the childbirth mechanism. It is one of at least 10 states that have turned to managed care companies to provide specialized services for the rest of the world. I am teaching. But getting many of these vulnerable children into timely care, regardless of structure, is a problem, Santana said.

Of course, getting mental health care for children with private insurance can also be challenging, but the challenge is even greater for children under state care. Foster care, adoption , kinship care.

“This is a unique population,” she said. “They go through a lot of toxic stress before they go into foster care.”

In states using professionally managed care for these children, transparency and oversight remain spotty, and the quality of care remains a troubling unknown.

For example, since 2020, the state of Illinois has paid insurance giant Centene Corp. more than $350 million to administer health insurance for more than 35,000 current and former foster children. . But last year, a survey by the Illinois Answers Project newsroom found that Centene’s YouthCare division repeatedly failed to provide basic medical services like dental visits and immunizations to thousands of children. Federal authorities are currently investigating the contract allegations.

Centene said YouthCare has not been notified of the investigation. In a statement, the company said the Illinois Answers Project report was based on outdated information and described recent progress to “ensure families have access to the quality care and services they need.” Said he didn’t.

In some cases, child advocates say the care children receive is not adequate. Filed a lawsuit against the state for failing to properly oversee the prescription of psychotropic drugs to children in foster care. According to court documents, 34 percent of her adopted children in the state were put on psychotropic drugs, most of which had no recorded psychiatric diagnosis.

Georgia’s Lisa Rager said she and her husband, Wes, are well aware of the hurdles in accessing foster care services. I have taken care of more than one foster child, and have put 11 of them up for adoption from state custody.

She said one child waited over a year to see a specialist. Getting approved for speech and occupational therapy is “hard work”.

Mr Rager said he was paying out-of-pocket for his three children’s psychiatric medications because of insurance issues. “I’d rather pay cash than wait for Amerigroup,” she said.

Broce said in his letter that such problems occur frequently. Amerigroup’s “narrow definition of ‘medically necessary services’ is, at first glance, more restrictive than state and federal standards,” she wrote.

“All too often, case managers and foster parents are told the next available appointment is weeks or months away,” she told the joint state appropriations board on Jan. 17. Bross added that her agency formed a legal team to fight Ameliegroup’s treatment. Denial.

AmeriGroup’s Perry said the company’s clinical policy has been approved by the state and follows regulatory and care guidelines.

In the last 12 months, Amerigroup received $178.6 million in funding from the government for a specialized foster care program serving approximately 32,000 children in Georgia. The contract is currently being prepared for re-bid.

David Graves, a spokesperson for the Department of Community Health, which operates Medicaid in the state, said Broth’s letter was part of the contract renewal process and the agency would not comment. , which regularly monitors the quality of care children in state care receive. He pointed to state reports that showed that the Amerigroup did well on several indicators, such as asthma drug use.

But Melissa Havalen-DeWolfe, research and policy director for the nonprofit Voices for Georgia’s Children, said most children who cycle to state emergency departments because of mental illness are placed in foster care. He said he was.

“The caregivers we speak to desperately need help coordinating behavioral health care. It’s about sharing health information among healthcare providers,” she said.

To solve these problems, pediatrician Zetley wants to create a bigger benefit package for foster children, better coordinate care, and raise Medicaid reimbursement rates so that these managed care We encourage you to attract more providers to your network.

Contracts with managed care companies should also be merit-based, with financial penalties where appropriate, says Kim Lewis, managing attorney in the National Health Law Program’s Los Angeles office.

“Managed care is as good as the state’s ability to manage contracts and make sure what they’re getting is what they’re paying for,” she said. Just saying, ‘Here’s a check,’ expecting the result of a check doesn’t work.”

But in Georgia, the state has never imposed financial penalties for Amerigroup failing to meet contractually mandated quality standards, said Graves, a spokesperson for the Regional Health Department. He confirmed that the agency and Amerigroup are working to resolve the issues that have been brought to their attention.

Georgia has set up an oversight board that will hold public meetings to monitor the quality of Amerigroup’s performance. However, the state said last month that the commission has not met since August 2020. After KHN’s inquiry, Graves said the panel will begin meeting again this year.




This article is reprinted from khn.org with permission from the Henry J. Kaiser Family Foundation. An editorially independent news service, Kaiser Health News is a program of the Kaiser Family Foundation, a nonpartisan health policy research organization independent of Kaiser Permanente.

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