Foster children and young people transitioning out of the child welfare system frequently encounter obstacles to adequate housing, which some healthcare providers and health insurance companies are trying to address with novel programs.
This interest in foster youths stems from the increased focus on social determinants of health, including housing, over the past decade. In addition to the potential societal good, these organizations see opportunities to keep children connected to the healthcare system, which could lead to adverse health outcomes and higher spending.
"When you're looking at health, it's not just healthcare," said Angela Boykin, vice president of government operations for Blue Cross and Blue Shield of North Carolina. "Health is so much more than that. It's your mental well being, your physical well being, stability, access to food and employment."
Blue Cross and Blue Shield of North Carolina has partnered with SaySo, a North Carolina-based youth advocacy organization, to help young people moving out of the foster care system obtain affordable housing.
By tackling housing problems head on and helping youths leaving the foster care system to stay healthy, healthcare companies can also save money.
Better access to affordable housing led to a 12% reduction in healthcare spending among Medicaid recipients in 2016, according to a study by the Center for Outcomes Research and Education. The same housing efforts resulted in 18% fewer emergency department visits, the study found.
Foster children make up a small portion of any insurance company's membership, but carriers such as Blue Cross and Blue Shield of North Carolina, Centene and CVS Health's Aetna have deployed programs targeting this segment of the population.
"If they can put a couple million dollars into something that is good for people, fits in with healthcare and also is applauded by multiple other parties, then that is a win-win for them," said Dr. Kelly Doran, an emergency medicine and population health professor at the New York University Grossman School of Medicine.
Health systems and state Medicaid programs are seeking ways to control costs and promote better outcomes for these vulnerable children and young adults. The federal government also has stepped up its efforts. The departments of Health and Human Services and Housing and Urban Development launched the Housing and Services Resource Center in December, which aims to facilitate partnerships between health systems and housing programs.
Housing support has been an immense relief to those transitioning out of foster care and dealing with chronic health issues, the COVID-19 pandemic and making rent, SaySo Executive Director Carmelita Coleman said.
In collaboration with SaySo, Blue Cross and Blue Shield of North Carolina's Medicaid managed care plan, Healthy Blue, launched a housing flex fund in March to support individuals leaving the state's child welfare system.
Former foster care youth can apply for help with deposits, short-term or partial rent assistance, overdue rent and utility bills, and furniture purchases. Applicants are connected to additional programming and resources through SaySo, which has 29 chapters and 750 members across North Carolina, so they can focus on areas such as work, school and becoming independent adults, Coleman said.
The fund aligns with Blue Cross and Blue Shield's mission and its commitment to improving health outcomes, Boykin said. The Healthy Blue-SaySo partnership has provided assistance to about 30 young people in its early weeks, she said.
The need is especially urgent this year because the state government ran out of money for programs that assist young people with housing needs, Coleman said. Keeping it going is vital to these youths' health, she said.
"We can either invest in our young people, or we'll have to pay for it on another end," Coleman said.
More than 424,000 children are living in foster care nationwide, according to data from HHS's Adoption and Foster Care Analysis and Reporting System. About one-fifth of children who age out of the system are expected to experience homelessness, the National Foster Youth Institute reports.
Nearly half of children in foster care have special healthcare needs and chronic conditions such as asthma, anemia, visual loss, hearing loss and neurological disorders, according to a JAMA Network survey published in 2020.
These children also have higher rates of anxiety, behavioral disorders, developmental delays and speech disorders than children who live with their parents.
Those disparities have biological bases. Trauma and chronic stress during early childhood can affect brain development and have effects on physiology that lead to mental and behavioral health disorders, said Dr. Kelly Hodges, medical director at Children's Community Health Plan, a Wisconsin-based Medicaid carrier.
The American Academy of Pediatrics has instituted primary and preventative care standards for foster children that call for frequent wellness checks as well as developmental, mental and behavioral health screenings at regular intervals, Hodges said.
But the often itinerant lives of foster children make applying guidelines like those difficult. As children move from home to home, their medical records and health histories don't always follow them, so these kids would benefit from care coordinators, Hodges said.
The University of Rochester Medical Center in New York created a centralized medical home model to address that problem, allowing foster children to access holistic care without switching between health systems, said Dr. Moira Szilagyi, president of the American Academy of Pediatrics.
The hospital also offers to guide and care for these patients even after they exit the foster care system, Szilagyi said. Children and young adults who have been in foster care are eligible for Medicaid until they turn 26, and the coverage is transportable across state lines.
As soon as individuals age out of the foster care system, however, they often lose access to care because they don't receive notifications at their new addresses and don't understand what information needs to be verified to retain their benefits, said Mary Christine Reed, an attorney with Texas RioGrande Legal Aid and director of Texas Foster Youth Justice Project.
Reed has encountered significant barriers assisting these young people with their Medicaid coverage, she said. Insurance company employees often provide inaccurate information because they're unfamiliar with special Medicaid coverage benefits for current and former foster children, she said. These insurers also require applicants to complete complicated forms that ask for information the children may not know.
Housing, childcare and financial instability are the biggest reasons why kids wind up in the child welfare system, said Marlo Nash, managing director of the Children's Home Society of America network. Whatever benefits housing programs from healthcare organizations have, more investment is needed to prevent the underlying problems, she said.
"Housing dollars often come into play after something terrible has happened, instead of saying, 'How do we recognize when families are on the brink of homelessness and stabilize them before they become homeless and they end up in the child welfare system?'" Nash said.