Background:

Medicaid and Foster Youth.

The Health Care Authority (HCA) administers the Medicaid program, which is a state-federal program that pays for health care for low-income state residents who meet certain eligibility criteria. Persons under 19 years old who are in foster care and are under the legal responsibility of the state or a tribe located within the state are eligible for Medicaid. Persons under 21 years old who are either in foster care or eligible for continued foster care services may also enroll in Medicaid. In addition, persons between 19 and 26 years old may receive Medicaid if they either were in foster care and enrolled in Medicaid on their eighteenth birthday or were older than 18 when their foster care assistance ended.

Integration of Health Care and Behavioral Health Services for Foster Youth.

In 2014 the HCA and the Department of Social and Health Services were directed to develop a plan to provide integrated managed health and mental health care for foster children on Medicaid. The plan had to address the development of a service delivery system, benefit design, reimbursement mechanisms, and standards for contracting with health plans. The plan had to include a timeline and funding estimate for full integration. In addition, the plan had to be designed so that the requirement for providing mental health services to children under the T.R. v. Dreyfus and Porter settlement (T.R. settlement) is met.

The report submitted to the Legislature identifies a timeline for integration of services with January 2018 as the date for executing an integrated contract. The report noted that the primary challenge of full integration would be moving foster children affected by the T.R. settlement to a managed care organization while maintaining continuity and quality of care.

Antipsychotic Medications.

Antipsychotic medications were intended to help people with severe mental illnesses such as schizophrenia or bipolar disorder, but are now used for many other conditions. Early antipsychotics, commonly referred to as first generation antipsychotics, carried several side effects such as movement disorders and sedation. More recently developed antipsychotic medications, commonly referred to as second generation antipsychotics, have fewer side effects related to motor skills, although they have been associated with weight gain, type 2 diabetes, and other side effects. A 2012 report by the federal Agency for Healthcare Research and Quality noted the increased use of antipsychotic medications for children and youth despite the general lack of high-quality and longitudinal studies.

The HCA must review the psychotropic medications of all children under 5 years old and establish methods to evaluate the appropriateness of the medication for the children, including the use of second opinions from experts in child psychiatry. "Psychotropic medications" include the following drug classes: antipsychotic, antimania, antidepressant, antianxiety, and Attention Deficit Hyperactivity Disorder.

Summary:

Integrated Medicaid Managed Care for Foster Youth.

The Health Care Authority (HCA) must seek proposals to provide integrated managed health care and behavioral health care to foster children enrolled in Medicaid. Behavioral health services must be integrated into managed health care plans for foster youth by October 1, 2018. The request for proposals must address the development of a service delivery system, benefit design, reimbursement mechanisms, and standards for contracting with health plans. In addition, the plan must meet the requirements for mental health services as established under the T.R. v. Dreyfus and Porter settlement. The integrated managed care plan must begin providing services on December 1, 2016.

Antipsychotic Medication Reviews for Foster Youth.

The HCA must require that an expert in psychiatry provide a second opinion review for all prescriptions of one or more antipsychotic medications for any child under 18 years old who is in the foster care system and is enrolled in Medicaid. A 30-day supply of medications may be dispensed pending the second opinion review. The second opinion must address psychosocial interventions that have been or will be offered to the child and the caretaker to address the behavioral issues.

The HCA must promote the appropriate use of behavioral therapies in place of or in addition to prescription medications where appropriate and available, rather than merely encouraging their use.

Votes on Final Passage:

House	92	6
Senate	44	3	(Senate amended)
House	96	2	(House concurred)