Mental health care utilization and expenditures by children in foster care

Objective: To determine the percentage of children with mental health diagn oses and utilization and expenditures of mental health services among child ren in foster care compared with other children receiving Medicaid, includi ng those with disabilities. Design: Analysis of Medicaid claim and eligibility records in southwestern Pennsylvania for fiscal year 1995. Population: A total of 39 500 children between ages 5 and 17 years continuo usly eligible for Medicaid in southwestern Pennsylvania were included in th e analysis. Main Outcome Measures: Percentage of children with mental health diagnoses and mental and general. health care utilization and expenditures classified by participation in foster care and Medicaid eligibility. Results: Children in foster care were 3 to 10 times more likely to receive a mental health diagnosis, had 6.5 times more mental health claims, were 7. 5 times more likely to be hospitalized for a mental health condition, and h ad mental health expenditures that were 11.5 times greater ($2082 vs $181) than children in the Aid to Families With Dependent Children (AFDC) program . Overall, utilization rates, expenditures, and prevalence of psychiatric c onditions for children in foster care were comparable with those of childre n with disabilities. Conclusions Children in foster care are significantly more likely to suffer from mental health conditions and use more mental health and general healt h services than AFDC children. Service use and expenditures are comparable with those of disabled children, suggesting that reimbursement rates and ca re management for children in foster care need to be reexamined.