New medical exam requirements for Medicaid members in foster care

The Michigan Department of Health and Human Services (MDHHS) released new medical exam requirements for Medicaid health plans and providers serving children in foster care.

These new requirements go into effect in March. With roughly 10,000 children in foster care at any given time, PCPs could see an increase in scheduling demand.

Requirement 1

Medicaid beneficiaries in foster care must complete a medical exam within 30 days of entering foster care.

This exam is required and will be covered at no cost to the member, regardless of the date of their last medical exam. Additionally, children in foster care require the following services:

  • Ages 0-20 years: All appropriate medical exams (EPSDT or Well-Child Exam) for their age
  • Ages 3 years and older: Dental exam within 90 days of entering foster care unless the child had a dental exam within six months prior to the date

Our care management team is actively involved in reaching out to foster parents or caregivers to schedule needed exams within the MDHHS timelines.

Requirement 2

Health plans must allow Medicaid members in foster care to maintain their current PCP.

This applies to PCPs within a reasonable distance of the member’s foster care living arrangement, for both in and out-of-network providers.

2024 PIP reports to show Medicaid members’ foster care start dates

To support compliance with these new guidelines, we added Medicaid members’ foster care eligibility (start) dates to the following PCP Incentive Program (PIP) reports:

  • HEDIS Gaps in Care (PIP_11C)
  • Membership Eligibility (PIP_075)

You’ll see this information at the end of each report in a column titled “Medicaid Foster Eligibility Date” when the 2024 PIP reports are released in April.