Health and Child Welfare

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For additional related resources, please see the following Hot Topics webpages:


  • Checklist of Needed Services for Children in Foster Care
    This checklist from the Child Welfare League of America identifies necessary services for children in foster care.

  • Working Together: Health Services for Children in Foster Care
    The New York State Office of Children and Family Services developed this manual with the assistance and advice of voluntary agencies and county departments of social services. The primary audiences are foster care caseworkers, supervisors, and persons responsible for the coordination of health services. It is not specifically designed for distribution to foster parents, child care workers, or health care practitioners. The policies, protocols, and legal footnotes are specific to New York State's locally administered, state supervised foster care system. However, it contains some more general information and serves as an excellent model. (Updated 2008)

  • When You’re 18 – A Health Care Transition Guide for Young Adults
    Published by, this guide contains information to help young adults understand what it means to be legally in charge of their health care and how to stay healthy as they grow into adulthood. Includes quizzes on being an adult with special needs, life as an adult, and talking with doctors, plus additional web resources on college and work. (2009)


  • New Developments in Maternal, Infant, and Early Childhood Home Visiting
    This issue of Pediatrics, the monthly journal published by the American Academy of Pediatrics, helps to highlight opportunities that home visiting provides to create partnerships with the pediatric community in supporting the nation’s children.  The articles appearing in the supplement demonstrate the need for close collaboration and close coordination across systems to address early childhood health and development, as well as to optimize communication, collaboration, and child health outcomes.  The articles also show the importance of home visiting as a public health strategy to strengthen vulnerable young families and their communities to promote and assure the health, development, and well-being of children and families.  This publication was sponsored by the Health Resources and Services Administration and the Administration for Children and Families, U.S. Department of Health and Human Services.  (November 2013)

  • A Teen-Friendly Reproductive Health Visit
    This resource from the Centers for Disease Control and Prevention (CDC) outlines elements that are important in delivering youth-friendly contraceptive and reproductive health services, including: confidentiality, privacy, consent, accessibility, cultural and linguistic appropriateness, comprehensive services, and parent/guardian involvement. (Last updated September 2013)

  • Medicaid and Children in Foster Care
    The health care needs of children in foster care are vast and often compounded by their circumstances. These children face myriad challenges – from placement instability, to emotional, behavioral, and educational difficulties, to juvenile justice involvement – that threaten their health and well-being. Because they are often at the intersection of multiple public systems including behavioral health, child welfare, education, juvenile justice, and primary care, it is critical for these systems to work collaboratively to meet their health needs. This brief from the Center for Health Care Strategies details the health care needs of children in foster care and the role of Medicaid in providing health coverage for this population. It also highlights existing policy levers that may help to address some of the ongoing health and well-being issues faced by children in foster care. (2013)

  • Special Health Care Needs Among Children in Child Welfare
    This research brief from the Administration for Children and Families, Office of Planning, Research and Evaluation examines the presence of special health care needs among children in the child welfare system. It specifically examines the presence of chronic health conditions (e.g., asthma, diabetes) and special needs (e.g., emotional disturbance, speech impairment, developmental delay).

  • Health Care of Young Children in Foster Care
    This policy statement from the American Academy of Pediatrics gives specific suggestions for pediatricians and other health care professionals and child welfare agencies concerning the delivery of health services to young children in foster care. (March 2002)

  • Healthy Ties: Ensuring Health Coverage for Children Raised by Grandparents and Other Relatives
    The Children's Defense Fund published this 50-state survey of Medicaid and Children's Health Insurance Program (CHIP) enrollment policies for children being raised by kinship caregivers. (2001)
  • Foster Children with Special Needs: The Children's Aid Society Experience
    Children in foster care have many health needs. This article in the Mount Sinai Journal of Medicine presents the model of the Children's Aid Society (CAS) of New York City in addressing these needs. (May 2004)
  • Children Discharged from Foster Care: Strategies to Prevent the Loss of Health Coverage at a Critical Transition
    This report discusses the importance of maintaining health coverage for children who are discharged from foster care and presents strategies that state child welfare and Medicaid agencies can employ to reach this goal. In addition, the report also addresses the needs of children who "age out" of the foster care system at age 18, and discusses state options to expand health coverage to this group. (January 2003)
  • Children in Foster Care: Challenges in Meeting Their Health Care Needs Through Medicaid
    Summarizing the results of a study conducted for the Office of the Assistant Secretary for Planning and Evaluation in the U.S. Department of Health and Human Services, this brief discusses Medicaid health care issues for children in foster care. (March 2001)
  • The Foster Care Independence Act of 1999: Enhancing Youth Access to Health Care
    This article from the July-August 2000 Journal of Poverty Law and Policy discusses the option for states to extend Medicaid eligibility for young people who are under 21 and who on their 18th birthdays were in foster care under the custody of the state. In addition to implementing this option, states can take many steps through their child welfare agencies and Medicaid agencies to ensure that young people leaving foster care enroll in Medicaid and receive the services to which they are entitled.
  • Quality Health Care Services for Children in Out-of-Home Care
    This 2001 report from the Task Force on Health Care for Children in Out-of-Home Care to the Wisconsin Legislature resulted from a legislative charge to develop a model to improve the access and quality of health care for children in foster care. This report summarizes the data, findings and recommendations made by the Task Force. (September 2001)

  • Foster Care: State Practices for Assessing Health Needs, Facilitating Service Delivery, and Monitoring Children's Care (GAO Report)
    Providing health care services for foster children, who often have significant health care needs, can be challenging. The Administration for Children and Families (ACF) oversees foster care, but state child welfare agencies are responsible for ensuring that these children receive health care services, which are often financed by Medicaid. In light of concerns about the health care needs of foster children, the United States Government Accountability Office (GAO) was asked to study states’ efforts to improve foster children’s receipt of health services. This report has four objectives. It describes specific actions that some states have taken to: (1) identify health care needs, (2) ensure delivery of appropriate health services, and (3) document and monitor the health care of children in foster care. It also describes the related technical assistance ACF offers to states. To address these objectives, GAO selected 10 states and interviewed state officials and reviewed related documentation regarding the nature and results of the states’ practices. To describe ACF’s technical assistance, GAO interviewed officials and reviewed documents from ACF, states, and relevant technical assistance centers. (February 2009)
    Full Report:

  • Risking Their Future: Understanding the Health Behaviors of Foster Care Youth
    This report by the Schuyler Center for Analysis and Advocacy (SCAA) looks at the reproductive health behav­iors of adolescents and young adults in the foster care system. It grew out of two previous publications from SCAA: the 2006 document Growing Up in New York: Charting the Next Generation of Workers, Citizens and Leaders, and the 2008 report, Teenage Births: Outcomes for Young Parents and Their Children. Both documents (accessible here) showed that many youth in foster care face major challenges at the time they become sexually active. (2009)

  • Adolescents’ Experiences and Views on Health Care
    This report from The National Alliance presents findings from focus groups of over 200 low-income adolescents in four cities – Chicago, Los Angeles, Miami, and Washington, DC. These youth want health care services that are accessible and inviting, and provide a wide range of primary care services that are teen-specific. They also want youth to play a significant role in their own health care. (March 2010)

  • Fiscal Year (FY) 2011 Federal Medical Assistance Percentage (FMAP) Rates Affecting Programs under Title IV-E of the Social Security Act
    The Program Instruction (ACYF-CB-PI-10-12) is to provide State, Territorial and Tribal title IV-E agencies with information regarding changes to the FY 2011 FMAP rates made by P.L. 111-226.

    Action Required/Financial Reporting: Each title IV-E State agency should confirm that the State’s Chief Executive Officer has submitted, or will be submitting by September 24, 2010, the required letter requesting the application of the higher FMAP rate for that State as authorized through Public Law 111-226. States must use the applicable FMAP rate in submitting estimates and claims for each quarter in FY 2011.  This rate will be different, in accordance with current law, for each of these four quarters. When reporting prior quarter adjustments for title IV-E assistance payments, States should be careful to apply the proper FMAP rate applicable to the FY and quarter in which the cost was paid by or allocated to the IV-E agency.

    Inquiries to:
    Children's Bureau Regional Program Managers or ACF Regional Grants Officers.
  • Meeting the Health Care Needs of Children in the Foster Care System
    In September of 2002, the Georgetown University Child Development Center completed a three-year study to identify and describe promising approaches for meeting the health care needs of children in the foster care system. In this study, the term health care encompassed physical, mental, emotional, developmental and dental health. The study was funded by the federal Maternal and Child Health Bureau, and supported in part by the Children's Bureau, Administration for Children and Families. In response to a national search for promising approaches, the study collected information on over 100 different approaches.

  • Protecting Confidential Health Services for Adolescents & Young Adults: Strategies & Considerations for Health Plans
    This issue brief from the National Institute for Health Care Management (NIHCM) Foundation reviews the legal protections in place to ensure confidential care delivery for adolescents and young adults, the effect of privacy and confidentiality concerns on the use of health services, and health insurance system barriers and other challenges to delivering confidential care to this population. The brief also presents several strategies for health insurers to assure that their billing processes are protecting adolescents’ access to confidential care. (May 2011)

Resources from the States

  • New Jersey:
    Coordinated Health Care Plan for Children in Out-of-Home Placement

    In 2006-2007 the Department of Children and Families assessed the provision of health care services for children in placement to construct a statewide plan for better meeting the health care needs of children in custody. This report details the assessment and DCF’s plans for implementing improvements in its health care delivery system for children in out-of-home placement.

  • New York:
    A Medical Guide for Youth in Foster Care
    New York State’s Office of Children and Family Services has released a 28-page booklet to guide youth in care through the health care system. The booklet covers informed consent, rights to privacy and to refuse medication, and information about how to get and pay for medical care. (2011)

Managed Care

  • Medicaid Managed Care for Children in Child Welfare
    Children in the child welfare system have an extremely high prevalence of physical and behavioral health problems. This issue brief from the Center for Health Care Strategies examines the complex physical and behavioral health care needs and associated costs for children in child welfare and outlines critical opportunities and challenges within Medicaid to better manage care for this high-risk, high-cost population. (April 2008)

  • The Implementation of Managed Care in Child Welfare: The Legal Perspective
    An overview of the legal issues raised by the implementation of managed care principles in child welfare during the early and mid-1990's. By Denise Winterberger McHugh for the NRCPFC (Spring 2000)
PowerPoint Presentations
  • Foster Care Evaluation Services (FaCES) Clinic and Evaluation
    This presentation describes a clinic which evaluates the health care needs of young children entering foster care in Massachusetts. Presented 10/24/2005 at the Annual National Association of State Foster Care Managers meeting by Audrey Smolkin, Director of Research and Policy Analysis at the Center for Adoption Research, University of Massachusetts.

  • Healthcare Services for Children in Foster Care
    This presentation was given by Vince Champagne, Health Services Manager for Cook County, Illinois Department of Children and Family Services, and Dr. Paul Kienberger Jaudes, Medical Director for IDCFS, at the 2007 meeting of the National Association of State Foster Care Managers. It describes the Illinois model of health care for children in foster care.

  • Meeting the Health Care Needs of Children in Foster Care
    This presentation focuses on some of the key components in developing strategies to address improving performance in meeting the health care needs of children in foster care. Presented 10/24/2005 at the Annual National Association of State Foster Care Managers meeting by Jan McCarthy, Director of Child Welfare Policy, National TA Center for Children's Mental Health at Georgetown University.
NRCPFC Information Packet Websites
  • Medical Home for Children and Adolescents Exposed to Violence
    This website from the American Academy of Pediatrics provides pediatricians and all medical home teams with the resources they need to modify practice operations to more effectively identify, treat, and refer children and youth who have been exposed to or victimized by violence.

  • UCLA Center for Healthier Children, Families & Communities
    The UCLA Center for Healthier Children, Families and Communities has produced a number of materials, including several policy briefs, on health and mental health services for children in foster care.

  • Center for Health Care Strategies, Inc.
    CHCS is working with states, health plans, and community organizations to improve the physical and behavioral health outcomes for these children by increasing coordination of care, implementing electronic medical records, and identifying best practices in behavioral health pharmacy management.

  • Caring Communities for Children in Foster Care
    This project is directed through the Parent Educational Advocacy Training Center (PEATC) of Virginia, funded by the Maternal Child Health Bureau Integrated Services Initiative with the American Academy of Pediatrics. In collaboration with Fairfax County, VA, Child Welfare Agencies, the Caring Communities project has been developing strategies and identifying "best practices" to increase comprehensive health care services for children in foster care. Visit their website for a look at their health profile and online materials for folks interested in improving the lives of children in foster care.

  • National Center for Children in Poverty
    Operating out of Columbia University in New York City, the NCCP has as its mission to identify and promote strategies that prevent child poverty in the United States and that improve the lives of low-income children and their families. One of its many useful tools is a Policy Database that provides state-by-state information on Medicaid and the State Children's Health Insurance Program.
  • Healthy Foster Care America
    This website from the American Academy of Pediatrics (AAP) was developed as a place where professionals, partner organizations, and families can find the latest tools, resources, facts, and figures on the health and well-being of children and teens in foster care. The site includes expert information on health issues, customizable forms for health care professionals, and a wide variety of advocacy and health care fact sheets. 

  • Health of Infants, Toddlers & Preschoolers in the Court System
    Resources from the American Bar Association.
  • Centre of Knowledge on Health Child Development
    This Canadian web site is dedicated to providing the latest and best information on child mental health problems and the influences that shape the developmental health and well-being of children and youth


Last updated 1/30/14