Objective: To determine and compare health care utilization and expenditures of children in foster care with those of other children and to identify and describe high-cost children in foster care.
Design: Analysis of the Medicaid program claims data in the state of Washington.
Population: A total of 1631 children in foster care and 5316 children in the Aid to Families With Dependent Children (AFDC) program in 1990. The children were ages 0 through 7 years and eligible for Medicaid continuously during the study year.
Main outcome measures: Health care utilization and expenditures classified by types of health service and health care provider; proportion of children with 1990 expenditures exceeding $10,000 and most prominent diagnoses associated with their health care utilization.
Results: Mental health services were used by 25% of children in foster care compared with 3% of AFDC children (P < .001), and supportive services of visiting nurses and physical therapists were used by 13% of children in foster care and 1% of AFDC children (P < .001). Twice as many children in foster care than AFDC children used medical equipment or specialist services or were hospitalized (P < .001). Mean health care expenditures in 1990 were $3075 for children in foster care and $543 for AFDC children (P < .001). High-cost children included 8% of children in foster care and 0.4% of AFDC children. Among the high-cost children in foster care (n = 106), 59% had mental disorders and 31% had congenital conditions.
Conclusions: Results suggest a higher prevalence and greater complexity of illnesses, particularly mental disorders, among children in foster care. Despite the high utilization and cost of mental health services, previous research suggests there may be underutilization of these services compared with need. Appropriate allocation of resources is essential if foster care agencies are to adequately meet the diverse and compelling needs of children in foster care.