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Portland CCO focuses on foster kids

Health Share, which serves 3,500 foster children on Medicaid, seeks to identify best approaches to meeting this population’s needs
February 9, 2015

Portland-based coordinated care organization Health Share of Oregon is targeting what Bobby Martin calls an “extremely vulnerable, distinctly disadvantaged population” – foster children.

Martin, Health Share’s new foster care navigator, shared the CCO’s goals with its advisory council on Friday, Feb. 6. Health Share’s board recently approved a strategy that puts a particular focus on foster children, he said.

Of the 8,500 children in foster care in Oregon, 3,500 receive Medicaid benefits through Heath Share, Martin said, adding the average stay in foster care is 21 months, with one in 10 children in foster care for five years.

About 60 percent are reunited with a parent, 21 percent are adopted, 10 percent age out and are emancipated at age 18, with another 8 percent going on to live with relatives other than parents.

Martin listed dire long-term outcomes from foster care.

One in five of these children are homeless by age 18. In Portland, 30 percent of the homeless population was in foster care at some point. About a quarter of them are involved in some way with the justice system within two years of leaving foster care. Some 71 percent of the girls and women who have been in foster care are pregnant by age. 21.

Martin said foster kids often have complex medical needs. More than half of these children show signs of two or more chronic conditions, including malnutrition. More than a third have dental problems. Some 70 percent reported at least two complex traumas, often involving a caregiver, a situation that puts these children at greatest risk of more trauma. Foster care kids are on psychotropic medication such as those used to treat attention-deficit disorder at four times the rate of that of other children on Medicaid, Martin said.

“One specific statistic that is telling is that adults who have been in foster care suffer PTSD rates at twice the rate of U.S. combat veterans,” Martin said.

Medicaid and Oregon’s Department of Human Services are the only two systems all kids in foster care interface with, Martin said. So what is Health Share’s role?

Oregon Health Authority sends Heath Share a list of foster care kids in the tri-county area who are supposed to get physical, mental and dental assessments within 60 days. Currently Health Share and OHA reports show between 57-58 percent of the foster care children on Health Share’s roles are assessed in that two-month timeframe.

“We’re missing a pretty big opportunity to determine outcomes if only about half get assessed,” Martin said.

Health Share aims to get 90 percent of the foster care children it serves assessed within 60 days and hopes to broaden its maternal health and kindergarten readiness strategy to prevent children from needing to enter the foster care system at all.

At Friday’s meeting, the Health Share advisory council also heard how Ride2Care, the nonemergency medical transportation company that took over rides to dialysis, chemotherapy and other medical trips in January for both the Portland metropolitan area CCOs, is addressing complaints.

An eight-hour crash of the Ride2Care phone system prompted the most complaints. Broadway Cab, which provided 13 percent of the transports in January, had 91 complaints. “We know the issues and we’re taking ownership,” said Ride2Care’s Richard Eberle. “We’ve moved some trips from one provider.”

With a goal of 99.6 percent of transport without complaint, he said Ride2Care finished January with 99.8 percent out of 4,400 trips per day without complaint.

Health Share CEO Janet Meyer also told the council that the Oregon Health Authority has again moved the deadline for screening the eligibility of 12,000 Health Share members, this time to the end of February. In January 2014, people who received supplemental nutrition were automatically added to Medicaid rolls in Oregon without a full confirmation of their Medicaid eligibility. Now the health authority is scrambling to catch up on screenings and paperwork.

“They are not automatically re- enrolled,” Meyer said, referring to changes in income and other factors. “Every 12 months [OHA] will re-determine eligibility.”