State Practices for Assessing Health Needs, Facilitating Service Delivery and Monitoring Children’s Care

Government Accountability Office (GAO)

An estimated 80 percent of the nearly 500,000 youths in foster care nationally have “significant health care needs,” ranging from chronic physical conditions to developmental and mental health disorders, according to federal estimates. Recent government surveys found that about 30 percent of foster youth did not receive adequate treatment or did not have their health  assessed at all.

In response, the GAO conducted this analysis of health care procedures for foster youth in 10 states, which were selected for their geographic diversity and differences in foster care caseloads.

The GAO found that every state mandates physical exams for children upon entering foster care, and most conduct screening for developmental and mental health irregularities at that time. Several states also evaluate incoming foster children for substance abuse problems. Once inside the foster care system, children receive routine exams at regular intervals, as required by state Medicaid guidelines.

States have implemented various procedures aimed at improving health care for foster youth, who are covered primarily by Medicaid. These measures include using specialized staff to quickly register foster children for Medicaid and increasing payment rates for doctors who treat foster youths.

To monitor the quality of foster care, most states rely on a combination of paper and electronic records, the GAO found. Texas, however, has developed a fully electronic health record for each foster youth and the records can be viewed on a secure website by those involved in the child’s care.

Finally, the report noted that the U.S. Administration for Children and Families has established 25 technical assistance centers designed to help child welfare officials coordinate their efforts with existing health care programs. Although the report makes no recommendations, its findings suggest that increased collaboration between foster care and health officials is necessary to ensure quality treatment for foster children. Free, 58 pages. (202) 512-6000,


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