North Carolina reports early progress in Medicaid plan for foster children

By Jaymie Baxley 

North Carolina’s new Medicaid plan for children in the foster care system has enrolled more than 32,000 young people, and state and health plan officials told lawmakers Tuesday they’ve cut the average time to arrange a child’s placement from 45 days to 16.

The update came during a meeting of the General Assembly’s Joint Legislative Oversight Committee on Medicaid, where officials from the N.C. Department of Health and Human Services and Healthy Blue Care Together — the Blue Cross and Blue Shield of North Carolina subsidiary administering the plan — gave their early progress report on the Children and Families Specialty Plan launched in December.

The plan is designed to provide integrated physical and behavioral health coverage to children and young adults who are in foster care or have previously received child welfare services. It is intended to replace a patchwork regional system in which children were served by local managed care organizations whose coverage didn’t automatically follow a child when they moved across county lines.

“There was no one source of health care for these children,” said Melanie Bush, interim director of NC Medicaid. “Now that we have a statewide plan, Healthy Blue Care Together is able to manage their care across the entire state.”

A ‘digital backpack’ for medical records

Within 24 hours of their enrollment, state officials said, every child covered by the plan is assigned a care manager whose role is to help families and social workers find and coordinate services.

“As soon as the child enrolls in the plan, the care manager will reach out to the member and a complete risk assessment, which will include a medication review, is done, and coordination directly with their primary care provider occurs,” said Angela Boykin, CEO of Healthy Blue.  “Additionally, the care manager will continually evaluate the member’s reunification and permanency goals.”

Boykin described the system as giving every child a kind of “digital backpack” — a continuously updated record of their health history, medications and care needs that travels with them regardless of where they’re placed.

She offered an example of what that means in practice: a child moving into foster care who needs an asthma inhaler. 

Under the old regional system, that medication information might not have transferred with the child if he or she moved from their parents’ care in one county to the home of a relative in another. Under the new plan, Boykin said, the care manager ensures the prescription is ready at the child’s new location before they arrive.

“It’s not a start-over for the child,” she said. “It’s not additional trauma or confusion for the family that’s involved. [Everything] stays consistent because the record and information stays together.”

Michael Leighs, NC DHHS’ deputy secretary for opportunity and well-being, framed the plan in the context of a broader push to reform child welfare in the state, which also includes the PATH NC child welfare information system, now live in 89 counties, and the Fostering Care Act passed last spring. 

He noted that kinship placements have expanded to nearly one in three foster care arrangements — a figure he attributed in part to financial supports for unlicensed kinship providers.

Leighs used a hypothetical case to illustrate what the plan can mean for families: a grandmother who might otherwise have said no to taking in a grandchild with complex medical needs can now say yes because a care manager is supposed to handle coordination.

“For John, this difference is life changing,” Leighs said, using a fictional name. 

“The system is working better,” he contended. 

Smoothing ‘bumps in the road’

The plan is intended not only to help families, but also to ease pressure on county child welfare agencies, whose social workers must already juggle court appearances, placement monitoring and reunification planning alongside health-related tasks.

Nearly 80 percent of the state’s 100 counties have accepted an offer to have a Healthy Blue care manager co-located inside their Department of Social Services office, Boykin said. The plan also employs regional DSS liaisons who are supposed to build relationships with local offices.

“Establishing those local relationships is very important,” said Bush, who took over as interim head of NC Medicaid after former director Jay Ludlam’s departure at the beginning of March.

Still, officials acknowledged that the plan’s implementation has not been without challenges. 

Early provider payment problems required the plan to issue hardship payments totaling roughly $1.7 million across December, January and February, though Bush said no new hardship payment requests had come in during February or March, suggesting the billing issues may be resolving.

Care management quality was also cited as an area of continued monitoring. Bush said Healthy Blue had responded to early complaints by providing additional training and reassigning staff. 

“With every managed care launch, there are bumps in the road that we try to smooth,” she said.

Boykin listed care manager training and skill development as one of her top three challenges going forward, alongside building local county relationships and helping new providers navigate the plan’s billing requirements.

“The challenges we are trying to solve are not going to be solved overnight,” Boykin said. “It is going to take each of us in this room and many others across the state working together to achieve the child welfare reform we need to see happen.”

For Bush, the ultimate goal of the plan is to ensure that “children are getting the screenings and health care services they need the minute they come into child welfare custody.”

The greatest indicator of the plan’s success, she added, will be “improved health outcomes for those children.”

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