title: Timely Health Service Utilization of Older Foster Youth by Insurance Type.
abstract: OBJECTIVE
  To evaluate the impact of a policy change for older foster care youth from a fee-for-service (FFS) Medicaid program to health maintenance organization (HMO) providers on the timeliness of first well-child visits (health care physicals).
  
  
  METHODS
  A three-year retrospective study using linked administrative data collected by the Michigan Departments of Human Services and Community Health of 1,657 youth, ages 10-20 years, who were in foster care during the 2009-2012 study period was used to examine the odds of receiving a timely well-child visit within the recommended 30-day time frame controlling for race, age, days from foster care entry to Medicaid enrollment, and number of foster care placements.
  
  
  RESULTS
  Youth entering foster care during the HMO period were more likely to receive a timely well-child visit than those in the FFS period (odds ratio, 2.46; 95% confidence interval, 1.84-3.29; p < .0001) and days to the first visit decreased from a median of 62 days for those who entered foster care during the FFS period to 29 days for the HMO period. Among the other factors examined, more than 14 days to Medicaid enrollment, being non-Hispanic black and having five or more placements were negatively associated with receipt of a timely first well-child visit.
  
  
  CONCLUSIONS
  Those youth who entered foster care during the HMO period had significantly greater odds of receiving a timely first well-child visit; however, disparities in access to preventive health care remain a concern for minority foster care youth, those who experience delayed Medicaid enrollment and those who experienced multiple placements.
authors.affiliation: School of Social Work, Wayne State University, Detroit, Michigan. Electronic address: ew6080@wayne.edu.
authors.forename: Angelique
authors.initials: A
authors.lastname: Day
authors.affiliation: Interdisciplinary Health Sciences PhD Program, Western Michigan University, Kalamazoo, Michigan.
authors.forename: Amy
authors.initials: A
authors.lastname: Curtis
authors.affiliation: Department of Statistics, Western Michigan University, Kalamazoo, Michigan.
authors.forename: Rajib
authors.initials: R
authors.lastname: Paul
authors.affiliation: Department of Statistics, Western Michigan University, Kalamazoo, Michigan.
authors.forename: Prince Addo
authors.initials: PA
authors.lastname: Allotey
authors.affiliation: School of Social Work, Wayne State University, Detroit, Michigan.
authors.forename: Shantel
authors.initials: S
authors.lastname: Crosby
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000706:statistics & numerical data*; D018588:Fee-for-Service Plans / Q000191:economics*; D005260:Female; D005581:Foster Home Care / Q000706:statistics & numerical data*; D006279:Health Maintenance Organizations / Q000191:economics*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics; D008824:Michigan; D012189:Retrospective Studies; D014481:United States; D055815:Young Adult
keywords: Aging out; Foster care; Preventive health care; Primary care; Well-child visits