Medical Assistance Foster Care Policy Updated
In April 2013, Michigan Medicaid amended its policy to highlight clinical needs and guide clinical care for children and youth in foster care. Its key points are:
1. Children must have a comprehensive examination within 30 days of entering foster care, regardless of when the most recent exam was done.
2. That examination and each scheduled periodic examination thereafter must include screening for emotional/behavioral problems using a standardized, normed instrument.
3. The evaluations must include all the elements included in the Early and Periodic Screening Diagnosis and Treatment (EPSDT) guidelines.
4. Documentation of the initial and subsequent examinations must reflect these required elements, though they no longer need to be done on the forms that the Michigan Department of Human Services (DHS) provides.
5. When psychotropic medications are recommended, the informed consent process must be documented on the appropriate DHS form (DHS-1643), and the consent form signed by the legally-empowered guardian before that psychotropic medication can begin.
What does this policy mean for primary care practices?
1. Offices will need to evaluate their clinical documentation to ensure that all of the EPSDT elements are included, amend if needed or continue using DHS forms.
2. Offices will need to score and interpret whatever standardized, normed emotional/behavioral screener they use.
3. Offices will need to work with DHS when prescribing psychotropic medications, to get help contacting the birth parents (consenters for temporary court wards), or to speak with the foster care worker (consenters for most permanent wards).
DHS is taking steps to improve partnerships with primary care by doing the following:
1. Caseworkers are being trained to work with families to complete one of two emotional/behavioral screening tools: Ages and Stages Questionnaire-Social Emotional (ASQ-SE) ages 3 months-5 ½ years or Pediatric Symptom Checklist (PSC) ages 6 and up. These completed questionnaires will come with kids to each exam.
2. DHS is working to get better at informing primary care providers about the legal status of kids.
3. DHS is working to maintain children's medical homes.
4. DHS is working to connect more successfully to primary care practices.
5. DHS is working to help foster parents communicate with providers up front so that appointments are scheduled according to need.
The following resources may be helpful for Health Centers:
Michigan Medicaid Policy
Health Access Guide for Foster Families (DHS PUB 268)
DHS Policy: Psychotropic Medication in Foster Care (FOM 802-1)
Psychotropic Medication Informed Consent Form (DHS-1643)
DHS Well Child Exam Forms
American Academy of Pediatrics "Healthy Foster Care America” Web Pages
National Child Traumatic Stress Network