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Support for Children's Services Transformation
Foster Care and Adoption Assistance in Medicaid: Rising Enrollment & Use of Behavioral Health Services
Support for Children's Services Transformation

Budget Impact

In addition to targeted service enhancements that will help children in the children’s services system, the Ohio Department of Medicaid plans to invest $20 million (all state GRF dollars) for multi-system youth innovation over the biennium. Ohio Medicaid will also invest $28.1 million ($10.4 million state GRF) to fund new services for autism spectrum disorder in SFY 2021.


The number of children in custody is rising due to the opioid epidemic, and children in custody have increasingly complex health care needs. Further, six in ten children are placed in children’s services custody for reasons other than abuse and neglect; many are involved with the system because they cannot access the services they need. As the chart above shows, the number of children in foster care and receiving adoption assistance in the Medicaid program is rising, as is this population’s need for behavioral health services.

Ohio Medicaid plays a critical role in helping youth and families move beyond the children’s services system with supports and services to address their trauma, physical and mental health challenges, substance use disorders, and other critical health and behavioral health needs. Medicaid services and supports can also prevent children, youth and their families from reaching the point of requiring the intervention of children’s services agencies. These services can help children and their parents achieve health goals that contribute to maintaining a family unit.

Policy Proposal

The Department of Medicaid is supporting Ohio’s children’s services innovation efforts with a three-pronged

1. Preventing removals from families and placements in children’s services custody:

  •  Medicaid is partnering with the Department of Job and Family Services and its Office of Children’s Services Transformation, and with the Governor’s Office of Children’s Initiatives to implement the Family First Prevention Services Act, which aims to prevent children from entering child welfare custody. This will include service and coordination enhancements for the children’s services population.
  •  Ohio Medicaid is developing a new intensive behavioral health care coordination service for children with complex needs that will help prevent placements in out-of-home care and residential treatment. This type of service planning and organization of supports will help prevent voluntary custody relinquishment due to a family’s inability to access coordinated community-based care.
  •  The Department is working with the Medicaid managed care plans to develop new, targeted quality strategies specifically for children, including efforts to ensure appropriate use of psychotropic medications. The managed care plans will be implementing new assessments based on social determinants of health; assessing and addressing these needs can help families prevent children’s services involvement.

2. Improving care for complex children by maximizing Medicaid services and coordination for those served by multiple state and local systems:

  •  On any given day, over 130 children in children’s services custody are placed in out of state treatment facilities because they cannot find the care they need in Ohio. In many cases, considerable county resources are expended to access out-of-state services. Medicaid is exploring options to improve access to intensive services for multi-system youth within Ohio. Enhancing these services will help prevent additional children from being sent out of state while enabling us to bring children back home to be closer to their families and circles of support. These enhancements will also be helpful in preventing parental relinquishment of child custody when a family cannot access necessary services.
  •  Medicaid is providing additional hands-on technical assistance and coordination to assist county children’s services agencies with identifying and accessing appropriate treatment within Ohio and outside of the state. Dedicated staff at Medicaid are working to convene and assist county children’s services agencies, families, the Department of Job and Family Services, and managed care plans.
  •  The Department is creating a multi-system youth innovation fund targeted at existing programs’ non-billable services for children with complex needs to create pathways to coverage under Medicaid.
  •  Ohio Medicaid is adding new coverage for autism spectrum disorder services, which will help keep kids and their families together in their communities, preventing out-of-home residential treatment.

3. Helping children and families move beyond the children’s services system:

  •  The Department of Medicaid’s existing services and supports can help to address trauma, addiction, and other critical health and behavioral health needs. Medicaid’s ongoing service and care coordination enhancements will be beneficial for children when they leave foster care.
  •  Improving parents’ health helps children return to their families as quickly as possible. Medicaid’s new behavioral health care coordination services, existing behavioral health benefits, and managed care plan care management strategies will continue to provide access to and coordination of necessary services for parents, including services and more intensive care coordination support for parents who have the most pressing substance use disorders and mental illness needs