A medical home for children in foster care reduces expenditures

ABSTRACT Children in foster care are at risk from fragmented care, delayed access, medical complexity, and increased mental health needs. We studied health care expenditures for children in foster care managed by a Patient-Centered Medical Home foster care specialty clinic (Fresh Start). We used Alabama Medicaid claims data from 2016 to 2018 to compare the costs incurred by 75 pediatric patients managed by Fresh Start with 75 matched children in foster care. Compared to their matched controls, the average total expenditures of Fresh Start children were lower by $536 (p = .02, 95% CI [−1008, −63]), primary care expenditures were lower by $171 (p = .09, 95% CI [−371, 28]), and pharmacy expenditures were lower by $63 (p = .02, IQR = 598). Reduced expenditures identified among children managed by the Fresh Start PCMH may represent more access to care coordination, behavioral health services, and trauma-informed care, with more pronounced effects on primary care and pharmacy costs.