Funder: The Annie E. Casey Foundation

Author: Sheila Pires, Human Service Collaborative, and Beth Stroul, Management and Training Innovations

June 2013 | Report


Children involved in the nation’s child welfare system often have significant health care needs, including physical, dental, and especially, behavioral health needs, with accompanying high expenditures. As the primary source of funding for physical and behavioral health care for this population, Medicaid programs must be able to meet their unique health and social needs while operating within the constraints of their budgets.

In some states, child welfare, Medicaid, and behavioral health systems have collaborated to “make Medicaid work” more effectively for this population. Their experiences can inform other states about effective Medicaid strategies and how to approach the necessary delivery system changes.

This report, authored by Sheila Pires and Beth Stroul, and funded by the Annie E. Casey Foundation, explores the strategies used in four leading states — Arizona, Massachusetts, Michigan, and New Jersey — to boost the effectiveness of their Medicaid programs and improve care for children and families involved with child welfare. Representatives from each state’s Medicaid, behavioral health, and child welfare agencies were interviewed about their cross-agency partnerships; successes and challenges in collaborating; and lessons for other states.

The report includes case studies for each state and outlines best practices within eight focus areas: (1) financing; (2) eligibility, enrollment, and access; (3) screening and early intervention; (4) covered services; (5) individualized service planning and intensive care coordination; (6) psychotropic medication; (7) providers; and (8) performance and outcome measurement.

The experiences of the profiled states can inform additional state efforts in developing more coordinated delivery system approaches, and ultimately making Medicaid work better, for this population of children with complex needs.