After Rebecca and Bruce Austin gave birth to their daughter, they struggled to get pregnant again. So they signed up to become foster parents.
“I wouldn’t change it for anything,” says Rebecca, reflecting on the past nine years.
Of the nine children the Austins have fostered, they adopted four and are still caring for a fifth. Their children range in age from 22 to 4.
And the five still living at home see 14 doctors.
Three children see psychiatrists. One has regular visits with specialists for epilepsy and other health conditions. Another has therapy four times a week for movement and speech delays.
“So, a typical day is pretty crazy,” Rebecca says. “I say I’m a stay-at-home mom, but with all the doctor’s appointments and therapies and appointments and stuff, I’m on the go all the time.”
The Austins live in Windsor, a rural town in central Illinois. Being 25 miles from the nearest hospital is challenging enough.
But now, the state is moving all current and former foster children covered by Medicaid into health plans provided by private insurers that contract with the state.
The change to what’s known as Medicaid Managed Care has many families like the Austins concerned.
More states move to managed care
In the U.S., 40 states, including the entire Midwest, rely on insurance companies to provide healthcare to people on Medicaid, according to the Kaiser Family Foundation.
Proponents of the managed care model say it can lower costs while increasing access to care.
States that switch to managed care often find they have more predictability with their budgets, because they’re no longer paying providers for each service. Instead, they pay insurers a set amount per enrollee for all health care needs.
But evidence that managed care lowers costs and increases access to care is both limited and mixed.
In recent years, Illinois switched most of the state’s Medicaid enrollees into managed care. Former foster children moved onto those plans on Feb. 1, and current foster children are scheduled to join them on April 1.
Now, some question whether the move is in the childrens’ best interests.
Critics point out that many foster children have complex physical and mental health needs, and the switch can disrupt long-standing relationships with therapists and other providers.
For thousands of families like the Austins, this means figuring out if their children’s providers will still be in-network or whether they’ll have to find new doctors, who might be farther from home.
Rebecca says they found a managed care plan that allowed them to keep most of their children’s providers.
But when the switch was finalized in February, the Austin children were among the 2,500 former foster kids whose health coverage was interrupted. State officials blamed a “glitch” in the system.
John Hoffman, a spokesperson for the Illinois Department of Healthcare and Family Services, said in a statement that the agency worked with managed care organizations to “immediately to correct the error, resolving it within days.”
For the Austins, the error meant they had to cancel appointments and had problems getting prescriptions filled.
“My daughter who has epilepsy, her medicine was… a little over $1,000,” Rebecca says. “I didn’t have $1,045 to pay her for the medicine and so, we were in a panic as to what to do because she had to have the medicine.”
Phone calls to pharmacies and insurers were onerous, she says, but ultimately resolved medication issues.
Still, the Austins’ youngest, 4-year-old Camdyn, missed two weeks of therapy sessions, while they waited for the new insurer to approve them.
Rebecca worries these delays will slow his progress toward being ready for kindergarten.
How to improve Medicaid managed care
Attorney Heidi Dalenberg of the ACLU of Illinois, which sued the state to force reforms in the child welfare system, says managed care can be beneficial. It can ensure all kids get regular well-checks and prevent doctors from overtreating or overmedicating children.
But those benefits will only be realized if the state has prepared for the transition and holds insurance companies to their contract requirements, she says. That includes ensuring they have appropriate provider networks so children have access to doctors close to home.
“We are not opposed to managed care itself,” Dalenberg says. “We are opposed to managed care that is not appropriately planned. That’s what we have to guard against.”
She says thanks to a settlement agreement with the state, a retired federal judge is monitoring Illinois’ progress toward fixing the system.
Hoffman says the switch to managed care, provided by the insurer YouthCare Illinois, will help improve healthcare for current and former foster children by coordinating and providing services.
“Right now, when a family needs a provider for their child, they’re left to navigate a complex system alone,” Hoffman said in a statement. “With YouthCare, families have a personal care coordinator, who helps manage their overall care, researches providers, and schedules appointments.”
He says the problems caused by last month’s glitch have been resolved and will not resurface when the 17,000 current foster children get switched into managed care plans on April 1.
The Austins’ foster daughter will be among them.
Right now, Rebecca Austin says their main concern is whether their daughter will be forced to switch to a therapist an hour’s drive away, since the one she sees nearby isn’t in the managed care network.
“She has established a relationship with that counselor, she’s been going there for almost two years and now we have to start all over again,” Rebecca says. “And that’s trauma. That’s a huge trauma.”
The state says even providers that are not in-network by April can be paid for services during a six-month “continuity of care” period, during which insurers will try to expand their networks.
The Austins are trying to be optimistic and are actively working to address this concern. But the state’s track record doesn’t give them much assurance.
This story was produced by Side Effects Public Media, a news collaborative covering public health.
Follow Christine on Twitter: @CTHerman