Foster Parent Friday - How does medical care work?

I'm going to answer a series of individual, related questions related to medical and dental care for foster children.  I will remind you that foster care rules and processes can be highly state and/or county specific, so my answers are from my experience and may only be for where I live. 

Q: Who is responsible for foster children's medical care?

A: Generally speaking, children in foster care are in the temporary managing conservatorship of the state or local agency that has custody (CPS).  Therefore, ultimately that agency as given authority by the state is responsible for the care and protection of the child.  That being said, the foster parent is assigned many of those responsibilities when they formally accept a placement.  One such responsibility, generally, is medical care.  Generally, but not always, a foster parent is granted status as the primary medical consenter, which means he/she is allowed and responsible to make most medical decisions for the given child.  This status allows the foster parent to interact with the child's medical and dental provider to seek care on behalf of the child and to be the intermediary for insurance purposes.

Q: Speaking of insurance, who pays for the child's medical care?  Can they be on your personal insurance like a biological child? 

A: Children in foster care typically receive state provided medicaid.  I'm not sure if this is true everywhere, but here in Texas there are different medicaid plans - children in foster care have their own medicaid plan called STAR health/Superior medicaid.  It's nice that it's separated from need-based plans because the people who are assigned to work with our case are familiar with the foster care system and rules and the reason these children are on medicaid is much different than the reason other children are on medicaid - it just has different implications.  For example, with some government programs (WIC) there are required additional programs for parents to attend if their children receive assistance.  The presumption is that if we are going to be providing government support then the parents need could use additional education about nutrition, etc.  There are similar programs within medicaid.  I'm very grateful that I'm not required to attend additional educational programs or meetings about the importance of receiving medical and dental care or other classes like that - I just need the medicaid because that's the only way to insure my foster children. 

Medicaid is essential for foster parents with foster children. Children in foster care without a formalized adoption agreement are not eligible for a foster parent's private insurance - I can't add my foster children to the insurance I have through work. This has good and bad results, but the primary benefit is that I don't have to pay for medical care for foster children.

*Edited to add...I found out this week that through my insurance at work I CAN add my foster children...however that would be the primary insurance and medicaid secondary.  I tried calling 3 times to the medicaid info hotline number thing to find out how it works on the medicaid side and each time I was disconnected at various points in the conversation.  I gave up for the day, particularly because I was driving at the time and was tired of the hassle.*


Q: How much do you have to pay for their medical care?

A: Typically nothing.  Medicaid covers 100%, at least 100% of what medicaid covers.  I don't get a bill from the doctors (unless they coded something wrong, which they have done before).  I don't have to pay for prescriptions.  I don't have to pay for dental visits (though at the same dentist for Logan I have a $45 copay). 

Q: Really?  Free - no cost?

A: Yes, except of course that medicaid coverage is not widely accepted. It's a pain to find doctors who will accept it. If they do, they're typically not accepting new patients. There are places I can always take them ike foster care clinics and ER rooms, but aside from that it can be hard to find somewhere to take them. Then I've found some and usually they are stereotypical gov't provided facilities. Overcrowded, too-long waiting, not enough attention from the kiddos, quick to write unnecesary prescriptions, etc. The reality is that medicaid loses doctors money in many cases, so there are many doctors who won't take it at all or who will take it but limit it to one program or a few charitable patient cases. My son's doctor's office, which is great and full of wonderful doctors and staff, accepts one plan of medicaid but not the one for foster care. I try to encourage doctors to take the foster care plan if they are going to do it for anyone because it is neither the foster child's fault or the foster parent's fault that they are in the situation of using medicaid - there is nothing they can do about it AND it is likely that the foster parent has other children who will pay with cash or other more friendly insurance and it can be a win-win charitable deal.

There really is limited cost.  You do have to pay for OTC medications, though you could go to the ER and get them covered for free if you needed to.  I don't do that because really, it's minimal when they  need some Qtips or tylenol or band-aids and I'm not going to waste government dollars for stuff like that, especially when I receive money each month to care for the children.  There have been a few times where I've had to pay minimal $$ amounts for prescriptions.  Consider it like your own prescriptions - sometimes there's a generic and the doctor wrote the prescription for the name brand - you can call the doctor to change it to a more cost-friendly  medication or pay for the more expensive one.  In the cases I'm thinking of I could have called the doctor for a different medicine but it was easier to pay the cost than go through the exercise of changing the prescription - it was $4 or $10 or so here and there.  Very rare, but my choice rather than getting things changed. 

Q: So, you're responsible for their medical care.  How do appointments work for medical and counseling?  Do you have to figure out all of that and schedule it on your own or does the social worker do that?

A: Thank God the social worker doesn't do that!  I have to make all appointments for the kiddos as I would with a biological child.  The children require doctor visits with a certain degree of frequency, but it essentially is the same with your own biological child.  If you follow the rule "as doctor directs..." you'll be pretty safe.  Of course, many times the children come into care behind on vaccines (yes, you have to follow recommended vaccine schedule unless dr doesn't recommend) and therefore you may have more frequent appointments. 

Just like with any other insurance, sometimes there are things you need authorization for, whether it's tests or specialists.  I haven't had a problem with any of that and pretty much have been able to do whatever I needed to do without hassle.  There are a few other things that may need social worker approval first.  For an example, I recently requested a psychological evaluation for a child.  If a dr. would have recommended it, I probably would have been able to just go ahead and schedule it through medicaid and notify the SW that we were doing it per doctor recommendations.  BUT, since it was my recommendations and not the doctors, the SW had to get a special authorization not so much to get it done but for the funding.  There are certain rules about authorizing surgeries, general anesthesia, etc. where I would need to contact the case worker, but I do so for authorization/notificaiton of the procedure, not the scheduling. 

I do all the scheduling for appointments in my house and if I didn't, I just can't imagine how that would work out.  There have been a handful of times where the kids have come to me with existing appointments that I had to meet, but other than that, i'm the scheduling queen.

There was one remaining question from this series that I'm going to answer in another post.  It had to do with why there are so many appointments in the beginning of a placement.  It will take mie on a long tangent so I'll address it later, maybe next week.  Until then friends, have a good week!