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Single statewide health plan for foster children aims to end chaotic status quo

en. Jim Burgin and Sen. Lisa Barnes, R-Johnston in committee meeting.
ncleg.gov livestream

RALEIGH — Currently, members of both parties and both chambers at the General Assembly seem in agreement that the status quo on health care for N.C. foster children is unacceptable. The children are moved frequently, and when they arrive at their new placement, they are frequently dropped from their health providers and have to start over. 

Now it seems there is momentum to finally get something done to fix the issue. Members of both parties told Carolina Journal that there will likely be legislation on it during this 2022 short session. The plan appears to be to create one statewide health plan for children in foster care.

“I think this is very bipartisan,” Sen. Jim Burgin, R-Harnett, a chairman of both the Senate Health Committee and the Senate Health Appropriations Committee, told Carolina Journal. “There should be no politics at all in this. We’ve just got to do our best for the kids that will one day be making the decisions.”

Burgin said that at the moment, foster children are too frequently being transferred from one location to another. He said that not only is this traumatic for them, but their medical care is then thrown into chaos each time. 

“Listen to these numbers: the average foster child in North Carolina has been in seven different living environments, like homes or facilities, and is on six prescriptions,” Burgin said. “That’s a recipe for disaster to me.”

Sen. Sydney Batch, D-Wake, works in child-welfare law in addition to being involved in legislative discussions on the issue, giving her more than one angle on the chaos in health care for foster children. 

“One of the kids on my caseload has moved five times,” Batch told Carolina Journal in a phone interview. “And if you move from one LME-MCO [a local management entity or managed care organization that oversees an individual’s government-funded health care] catchment area to another, services don’t get continued. So you have to switch over and start [new] providers. So this kid has had four therapists and five placements in the matter of two-and-a-half or three years.”

She said this is a problem because there is often a time gap before they are able to find new providers, get the providers up to speed, and start up services again. Often, by the time this whole process is complete, the child’s new foster placement may have fallen through, and they need to move again, creating a longer gap in their health services. 

Batch said this is especially a problem with foster kids with higher needs, because there may not be the specific services they need in one area. This means they will often be moved from one specialized group home or therapeutic environment to another, and these will not likely be within the same LME-MCO catchment area. These highly troubled children, after being repeatedly moved and not having psychiatric services for weeks on end, often have difficulty adjusting to the new placements, so they are then moved again.

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“And the cycle continues and continues,” Batch said. “And every additional move for a child is an additional trauma.”

In 2017, members of both parties and many in the child services and health care fields realized the system was failing, and the N.C. Department of Health and Human Services began to develop solutions. Batch said the changes were delayed due to the Medicaid-reform transition in North Carolina and then because of the COVID pandemic. But this past year, DHHS released a “white paper” on the topic, and there is a bipartisan group in the state House and Senate motivated to move quickly on the issue, possibly even in the current short session. 

“So what we’re working on is I want to get it where we do a fantastic assessment of a child, we put them where they need to be, and they stay there,” Burgin said. “We’re looking at a statewide system, and there’s going to be some requests-for-proposal [RFPs] put out later this year. The LME-MCOs and the different health plans will be able to submit a proposal to take over foster care and run a statewide program.”

Batch said many of the LME-MCOs and other entities that are interested in bidding to be that sole statewide provider are concerned that they will not have enough time to get their RFPs together. For this reason, she said there is talk of passing a bill authorizing the new foster-care health system during the summer 2022 short session, but including a one-year delay to allow more bids. 

“There is probably going to be a bill, not by me, probably on the House side, to just delay the RFP process,” Batch said.

She just hopes that the delay doesn’t lead to an extension of the current system. Batch said, in addition to the LME-MCOs, insurance companies like Blue Cross Blue Shield are also likely to make bids. 

“There needs to be enacting legislation in order to have a statewide foster-care plan,” Batch said. “So if nothing happens, then the LME-MCOs will continue to provide the services and we’ll continue to have mental health services provided in all these different areas.” 

Burgin said there are currently 41,000 children under 18 who are connected to the foster-care system, with 11,000 active at the moment in a placement. 

“We’ve got to do better for these kids,” Burgin said.

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