Social, Health, and Demographic Predictors of High Healthcare Cost for Children in Foster Care

Background: Children in foster care have high health needs, and many of those needs are unmet at foster care entry. In southeastern Wisconsin care coordination services are available to children in foster care through a specialized Medicaid program. Currently all children within the program receive the same care coordination services despite different levels of medical or social needs. Objective: Our aim was to examine social, health, and demographic factors of children who have been in foster care for 60 days and determine which factors might be predictive of high healthcare cost for the subsequent 6 months. Design/Methods: A retrospective review was conducted of 300 children who entered foster care from October 2015 through February 2016. Social, health, and demographic information was reviewed from the child welfare database and medical record at the time the child had been in foster care for 60 days (Table 1). Medicaid health, care coordination, and pharmacy claims data were summed to calculate total healthcare cost for the subsequent 6 months. Univariate and multivariate analyses were performed to determine which factors and combination of factors at 60 days predicted high total healthcare cost in the subsequent 6 months. Results: The median per member per month (PMPM) total healthcare cost for the cohort was $151; 75th and 90th percentile $307 and $601 respectively. In univariate analysis, social, health, and demographic factors identified at 60 days after foster care entry that were associated with high total healthcare cost included age ≥15 years, placement in a group home, a Child and Adolescent Needs and Strengths (CANS) score ≥30, taking ≥1 medication and/or psychotropic medication, having an abnormal developmental or mental health screen, having ≥6 problems identified in the medical record, and being followed by a subspecialist or therapist (Figure 1). Multivariate analysis showed that the combination of CANS score ≥30, taking ≥1 medication, and placement in non-kinship foster care could identify children with PMPM median total healthcare cost >75th percentile. Decision tree analysis further identified combinations of factors that could predict children with PMPM median total costs >75th percentile with a sensitivity of 86% and specificity of 79%. Conclusions: Social, health, and demographic factors present at 60 days after foster care entry are predictive of high total healthcare cost over the subsequent 6 months and combining predictive facto