Systematic Review of Managed Care Medicaid Outcomes Versus Fee-for-Service Medicaid Outcomes for Youth in Foster Care

Transitioning foster care children from fee-for-service (FFS) Medicaid to Medicaid managed care (MMC) plans is increasingly common, yet research on the impact of such transitions is limited. This systematic review addresses this gap by synthesizing evidence on the effects of transitioning foster care children from FFS to MMC on healthcare utilization and costs. Eligibility criteria included peer-reviewed articles on youth in foster care in the United States, aged 0-18 years, comparing selected outcomes under FFS vs. MMC. The outcomes of interest included behavioral, dental, vision, and well-child care. The databases searched were MEDLINE (PubMed), Cochrane Library (Wiley), APA PsycINFO (Ebsco), Social Services Abstracts (ProQuest), and Web of Science (Clarivate). A qualitative synthesis of articles meeting the inclusion criteria was performed. Five articles met the inclusion criteria. Three articles yielded mixed findings regarding behavioral healthcare, which was evaluated as having low certainty of evidence. Two articles on well-child visits indicate significant changes when transitioning youth from FFS to MMC coverage, with varied impacts based on how well-child visits were defined and rated moderate certainty of evidence. No articles examined dental or vision outcomes. Results suggest a shortage of empirical evidence on the effects of transitioning from FFS to MMC for children in foster care. Future research should describe insurance benefits packages in greater detail, as not all FFS or MMC programs are the same and continue to study the impacts of such transitions on healthcare utilization and outcomes for this vulnerable group.