Foster officials blame ‘hoteling’ problem on health-care shortfalls
“make one thing that we have accomplished today is to raise awareness and to
sure that everybody understands this is a front-burner issue.” Sen. Kay Kirkpatrick, who chairs the Children and Families Committee
A legislative hearing about the “hoteling” of foster children in Georgia zeroed in the problems children in state custody face in getting health care.
So far this fiscal year, more than 400 children have spent the night in hotels or state offices because appropriate placements could not be found for them, Audrey Brannen, a complex care coordinator at the Georgia Division of Family and Children Services told lawmakers this week.
The reasons behind the hoteling problem are complex, but one major contributor is lack of access to appropriate health care, Brannen said during the joint hearing convened by the state Senate’s newly created Children and Families Committee and the Senate Health and Human Services Committee.
“We are here to protect children from their caregivers who may be maltreating them,” she said. “We cannot do that when so many of our resources, both staff and financial, are trying to plug the holes in our health-care system. It’s like using your index finger to stop the leak on the Titanic.”
Care coordination services for foster children are often lacking, Statesboro pediatrician Dr. Michelle Zeanah told lawmakers. She said she has a hard time getting information about a child’s needs and treatment history from Amerigroup, the state’s contracted insurance plan for children in foster care.
Another problem is that many children who end up in hotels have autism, but there aren’t enough clinicians to diagnose and treat autism in Georgia and reimbursement rates for autism evaluation are too low. This leads to long waits for diagnoses and care, Zeanah said.
“If we reimbursed providers that are serving children who are in foster care at a higher rate, then providers would be highly motivated to serve those children,” she said.
Zeanah also questioned whether contracting with a private insurance company really helps Georgia children and youth in foster care. Amerigroup is owned by Elevance, formerly known as Anthem, a large, for-profit company.
“The goal of managed care is cost savings,” Zeanah said. “Why can’t foster children be started with the goal of creating access instead of the goal of reducing cost?”
Mike Dudgeon, a fostercare parent and a former policy director in the lieutenant governor’s office, echoed that call. He suggested returning health care of foster children to the older “feefor-service” model, where the state pays directly for medical services, or putting foster children on the State Health Benefit Plan, which insures teachers and other state employees.
“If it’s good enough for our employees, it should be good enough for our foster kids,” said Dudgeon, also a former state representative from Forsyth County.
Dudgeon noted that he and his wife sometimes paid for health-care services for children they were fostering out of their own pockets because they could not find a provider that accepted the Amerigroup plan.
He said he had trouble getting data about the insurer’s financials and performance when he worked in state government.
“We were stonewalled for months and months and months … and this is with the weight of the lieutenant governor’s office and the weight of the Senate Budget Office behind it,” Dudgeon said. “All I can tell you, there’s a lot of smoke there that this money is not being appropriately spent. … We need rabid transparency.”
The problems around accessing health care for foster children have spurred DFCS to establish a special legal team dedicated to appealing insurance denials.
“Every day, my office will review all medical treatment denials, and we will file appeals if we determine that such treatment is medically necessary for the child or the youth,” said Brian Pettersson, the lawyer who leads the new team.
“Not only is the current system detrimental to the health-care needs of the foster children, but the current system does not benefit the citizens of the state of Georgia. … It increases (the Georgia Department of Human Services’) overall expenses that are used to expand and fill the gaps in coverages that taxpayers already paid for.”
Representatives from Amerigroup, the insurance plan under fire, also testified.
“We’ve been doing this since 2014,” Amerigroup President
Mel Lindsey said. “I’ve never made a decision about how to treat anyone, particularly a foster-care kid, that was related to cost. And I never will.”
Lindsey and other officials from Amerigroup said they want to improve the care they deliver, but there are some factors they cannot control, such as shortages of treatment facilities in Georgia.
“We know there are opportunities for improvement in the system of care and certainly what we do as well,” Lindsey said. “We are deeply committed to working … to improve the way we serve.”
“One thing that we have accomplished today is to raise awareness and to make sure that everybody understands this is a front-burner issue,” added Sen. Kay Kirkpatrick, R-east Cobb, who chairs the Children and Families Committee. “These kids didn’t ask for this and they should be going to the front of the line, however we can get them there.”