Department of Health and Human Services 
OFFICE OF 
INSPECTOR GENERAL 
C  U H
HILDREN S  SE OF  EALTH 
C S W
ARE  ERVICES  HILE IN 
F C :  I
OSTER  ARE LLINOIS 
-
Inspector General 
FEBRUARY 2004 
OEI-07-00-00642  Office of Inspector General

http://oig.hhs.gov 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as 
amended, by Public Law 100-504, is to protect the integrity of the Department of Health and 
Human Services (HHS) programs, as well as the health and welfare of beneficiaries served 
by those programs. This statutory mission is carried out through a nationwide network of 
audits, investigations, and inspections conducted by the following operating components: 
Office of Audit Services 
The OIG's Office of Audit Services (OAS) provides all auditing services for HHS, either by 
conducting audits with its own audit resources or by overseeing audit work done by others. 
Audits examine the performance of HHS programs and/or its grantees and contractors in 
carrying out their respective responsibilities and are intended to provide independent 
assessments of HHS programs and operations in order to reduce waste, abuse, and 
mismanagement and to promote economy and efficiency throughout the department. 
Office of Evaluation and Inspections 
The OIG's Office of Evaluation and Inspections (OEI) conducts short-term management and 
program evaluations (called inspections) that focus on issues of concern to the department, 
the Congress, and the public. The findings and recommendations contained in the 
inspections reports generate rapid, accurate, and up-to-date information on the efficiency, 
vulnerability, and effectiveness of departmental programs. 
Office of Investigations 
The OIG's Office of Investigations (OI) conducts criminal, civil, and administrative 
investigations of allegations of wrongdoing in HHS programs or to HHS beneficiaries and of 
unjust enrichment by providers. The investigative efforts of OI lead to criminal convictions, 
administrative sanctions, or civil monetary penalties. The OI also oversees State Medicaid 
fraud control units, which investigate and prosecute fraud and patient abuse in the Medicaid 
program. 
Office of Counsel to the Inspector General 
The Office of Counsel to the Inspector General (OCIG) provides general legal services to OIG, 
rendering advice and opinions on HHS programs and operations and providing all legal 
support in OIG's internal operations. The OCIG imposes program exclusions and civil 
monetary penalties on health care providers and litigates those actions within the 
department. The OCIG also represents OIG in the global settlement of cases arising under 
the Civil False Claims Act, develops and monitors corporate integrity agreements, develops 
model compliance plans, renders advisory opinions on OIG sanctions to the health care 
community, and issues fraud alerts and other industry guidance.  A B S T R A C T

Our study determined that all 50 sampled children in the Illinois 
foster care program received Medicaid services, and nearly all 
received their most recent required Early and Periodic Screening, 
Diagnosis, and Treatment (EPSDT) medical and dental 
examinations and initial health examination upon entry into foster 
care. In contrast, less than half of the sampled children received a 
comprehensive health care evaluation and mental health screen. 
Less than half of case files contained a copy of the medical history, 
which is required by State and Federal regulations and designed to 
ensure that children are provided with needed health care services. 
As a result, several children received duplicate services. The Office 
of Inspector General (OIG) recommended that the Administration 
for Children and Families (ACF) work with the Illinois Department 
of Children and Family Services (DCFS) to increase the number of 
comprehensive health evaluations and mental health screenings 
conducted within required time frames; and that health 
information for children in foster care is updated on an ongoing 
basis, provided to foster care providers, and maintained in the case 
file. OIG also recommends that the Centers for Medicare & 
Medicaid Services (CMS) work with the Illinois Department of 
Public Aid to prevent potentially unnecessary costs to the Medicaid 
program resulting from duplicate services. ACF responded that it 
is working with DCFS to improve the provision of health and 
mental health services to children in foster care and that the 
provision of these services will be addressed in Illinois Program 
Improvement Plan in response to a Child and Family Services 
review. CMS agrees in part with our recommendation, recognizing 
the concern about the potential for Federal and State funds being 
unnecessarily expended for duplicate Medicaid services; however, 
CMS believes DCFS should work to better inform foster care 
parents and providers of the availability of services and the State 
requirements under the Healthworks and Passport program. 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  i  E X E C U T I V E   S U M M A R Y

OBJECTIVE 
To determine whether sampled children in the Illinois foster care 
program receive health care services. 
BACKGROUND 
Currently, there are an estimated 565,000 children in foster care 

nationwide, many of whom are reportedly in poor health. 

Compared with children from the same socioeconomic backgrounds, 

children in foster care experience much higher rates of serious 

physical and psychological problems. Illinois is the focus of this 

inspection and is one of a series of eight States chosen to represent 

a diverse cross-section of foster care nationwide. 

All Title IV-E children in the Illinois foster care program are 

eligible for Medicaid. Federal Early and Periodic Screening, 

Diagnosis, and Treatment (EPSDT) guidelines require each State to 

make preventive health care services available to Medicaid-eligible 

individuals under the age of 21, at intervals which meet reasonable 

standards of medical and dental practice, as outlined in 

Sections 1902(a)(43) and 1905(r) of the Social Security Act (the Act). 

In addition, Sections 472(h) and 1902(a)(10)(A)(i)(I) of the Act 

require States to provide Medicaid, or equivalent health insurance 

coverage, to children eligible to receive Title IV-E funds. 

This inspection is based on information gathered from multiple 

sources: reviews of Federal and State policies; analysis of child-

specific Medicaid claims data and case file documentation for 

50 randomly-sampled children in foster care; interviews with foster 

care providers (e.g. foster parents and residential facility staff) and 

caseworkers for the children in our sample; and interviews with the 

Illinois Department of Children and Family Services (DCFS), 

Illinois Department of Public Aid, and other State agency officials. 

Our analysis focused on a 3-year Medicaid claims period for 

children in foster care ending on December 31, 2002.

OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  ii  EE XX EE CC UU TT II VV EE    SS UU MM MM AA RR YY  
FINDINGS 
All sampled children had Medicaid coverage and claims for 
health care services 
In accordance with Federal and State regulations, all of the 
sampled children had Medicaid coverage. All 50 children had at 
least one Medicaid claim for health care services. 
All sampled children received their most recent EPSDT 
medical examinations, and 76 percent received their most 
recent EPSDT dental examinations, in accordance with State 
guidelines 
Almost all of the sampled children who received their most recent 
dental examination within required timeframes had a foster care 
provider who was aware of the availability of Medicaid services, 
whereas half of the children who did not receive their most recent 
dental examination within required timeframes had a foster care 
provider who was unaware of the Medicaid services available. 
Ninety-seven percent of sampled children received their 
Initial Health Screening within required timeframes 
Illinois requires that each child entering State custody receive an 
Initial Health Screening within 24 hours to identify and document 
acute medical problems and/or abuse, and to provide the 
caseworker with appropriate medical information to place the child. 
The Initial Health Screening is scheduled by the caseworker and 
can be performed at a hospital, clinic, or physicians office which 
makes access available 24 hours a day, 7 days a week. 
Only 42 percent of sampled children received 
Comprehensive Health Evaluations within required 
timeframes 
Illinois requires that children entering State custody receive a 
Comprehensive Health Evaluation within 21 days that includes an 
in-depth physical examination and comprehensive medical and 
psychosocial history. These examinations are usually performed by 
a primary care physician during regular business hours and 
scheduled by the childs foster care provider. 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  iii  EEE XXX EEE CCC UUU TTT III VVV EEE     SSS UUU MMM MMM AAA RRR YYY  
Only 1 of 14 sampled children required to receive a Mental 
Health Screen had one completed within required timeframes 
Illinois requires a Mental Health Screen to be performed within 
21 days of entering State custody for all children aged 5 or older. 
Mental health screens are performed in conjunction with 
Comprehensive Health Evaluations, and are usually performed by 
a primary care physician limiting access to regular business hours. 
Forty-eight percent of case files had a Health Passport 
Federal law requires that a childs health records be provided to the 
foster care provider at the time of the childs placement. This 
information is important so that appropriate health care services 
may be provided to children in foster care. Foster care providers 
and caseworkers indicated that a childs medical history (i.e. Health 
Passport) is provided at the time of placement in a majority of 
cases. However, only 48 percent (24/50) of the case files contained 
copies of the Health Passport, and only 8 of these Health Passports 
contained complete, accurate, and up-to-date medical information. 
Because of missing or incomplete Health Passports, which would 
have indicated the immunizations that had been received, some 
children received duplicate immunizations. 
RECOMMENDATIONS 
We recommend that the: 
Administration for Children and Families (ACF) work with the 
Illinois DCFS to increase the number of: 
o	 Comprehensive Health Evaluations and Mental Health Screens 
conducted within required timeframes 
o	 Health Passports that are (1) updated on an ongoing basis, 
(2) reviewed for accuracy and completeness during the 
Administrative Case Review, and (3) copied each time the 
health information is updated, so that a copy of the most recent 
Health Passport is maintained in the case file and provided to 
the foster care provider 
Centers for Medicare & Medicaid Services (CMS) work with ACF 
and the Illinois Department of Public Aid to: 
o	 Prevent potentially unnecessary costs to the Medicaid program 
resulting from duplicate services 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  iv  E X E C U T I V E   S U M M A R Y  
AGENCY COMMENTS 
ACF indicated the background provided a useful perspective of the 
problem and the addition of the case file documentation and 
analysis of claims data were also informative. ACF noted that it is 
working with DCFS to improve the provision of health and mental 
health services to children in foster care and that the provision of 
these services will be addressed in Illinois Program Improvement 
Plan in response to a Child and Family Services Review. Child and 
Family Services Reviews measure individual States performance 
related to the health and well-being of children in the child welfare 
system. 
CMS agrees in part with our recommendation, recognizing the 
concern about the potential for Federal and State funds being 
unnecessarily expended for duplicate Medicaid services; however, 
CMS believes State foster care agency should work to better inform 
foster care parents and providers of the availability of services and 
the State requirements under the EPSDT program. 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  v  T A B L E   O F   C O N T E N T S

ABSTRACT .....................................................................................................i

EXECUTIVE SUMMARY ................................................................................ii

INTRODUCTION ............................................................................................1

FINDINGS ....................................................................................................10

All sampled children had Medicaid coverage and claims for health 

care services .............................................................................................. 10

All sampled children received their most recent EPSDT medical 

examinations, and 76 percent received their most recent EPSDT 

dental examinations, in accordance with State guidelines ...................... 11

Ninety-seven percent of sampled children received Initial 

Health Screenings within required timeframes ....................................... 13

Only 42 percent of sampled children received Comprehensive 

Health Evaluations within required timeframes ..................................... 13

Only 1 of 14 sampled children received a Mental Health Screen 

within required timeframes ...................................................................... 14

Health Passports are in only 48 percent of case files and are not 

updated at the Administrative Case Review ............................................ 16

RECOMMENDATIONS .................................................................................18

APPENDICES ..............................................................................................20

Appendix A: Sampled Children....................................................... 20

Appendix B: Medicaid Claims for Sampled Children ..................... 22

Appendix C: Agency Comments - ACF ........................................... 25

Appendix D: Agency Comments - CMS........................................... 28

ACKNOWLEDGMENTS................................................................................29

OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  I N T R O D U C T I O N

OBJECTIVE 
To determine whether sampled children in the Illinois foster care 
program receive health care services. 
BACKGROUND 
Currently, there are an estimated 565,000 children in foster care 
nationwide,1 many of whom are reportedly in poor health. To 
determine if children in foster care are receiving mandated health 
care services, we selected eight States for review. 2  The States were 
chosen to represent a diverse cross-section of foster care 
nationwide. Illinois was selected because of its large size, 
geographic location, and fee-for-service provision of Medicaid 
services. Illinois had 33,125 children in foster care at the end of the 
Federal fiscal year 2000, based on the most recent Federal data 
available. 3  The Administration for Children and Families (ACF) 
has regulatory oversight of the Title IV-E foster care program, 
including approval of State plans to ensure that State foster care 
programs are operating within Federal guidelines. 
Compared with children from the same socioeconomic backgrounds, 
children in foster care experience much higher rates of serious 
physical and psychological problems.4  Dental problems are 
prevalent in the foster care population and physical health 
problems (e.g. delayed growth and development, malnutrition, and 
1Retrieved November 1, 2002 from 
http://www.acf.dhhs.gov/programs/cb/dis/afcars/cwstats.html. 
2Other States selected for review are: Georgia, Texas, Kansas, New Jersey, 
New York, North Dakota, and Oregon. 
3FY 2000 Foster Care Entries, Exits, and In Care on the Last Day. Retrieved 
December 12, 2003 from 
http://www.acf.hhs.gov/programs/cb/dis/tables/entryexit.htm. 
4Health Care Issues for Children in Foster Care, March 25, 2002. Retrieved 
December 12, 2003 from 
http://www.casey.org/cnc/documents/health_care_issues.pdf. 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  1  II NN TT RR OO DD UU CC TT II OO NN  
asthma) affect 30 to 40 percent of children in the child welfare 
system.5 
Children in foster care have greater health care needs, yet many 
foster care providers (e.g. foster parents and residential care facility 
staff) report having difficulty finding health care professionals who 
are willing to care for these children. 6  The health care available for 
children in foster care is often characterized by lack of access; lack 
of information sharing among health care providers, child welfare 
workers, and foster care providers; and long delays in obtaining 
services.7  Furthermore, studies have shown that low percentages 
of children in foster care are actually receiving health care services. 
Therefore, concern exists that children with the greatest health 
care needs may not be receiving needed services. 
The Early and Periodic Screening, Diagnosis, and Treatment 
(EPSDT) program is designed to screen for, diagnose, and treat 
medical conditions in Medicaid-eligible individuals under age 21 
that might otherwise go undetected or untreated. However, a 
General Accounting Office report released in July 2001 states that 
available data from short-range studies show that the percentage of 
children in the general population receiving EPSDT services is very 
low. 8 
Preventive dental care is also included as part of EPSDT. A journal 
article reports that adherence to the American Dental Association 
recommendations for preventive dental care leads to improved oral 
health and practicing preventive behaviors over the long term 
yields greater benefits than doing so over the short term.9 
5Fact sheet: The He alth of Children in Out-of-Home Care. Child Welfare League of 
America. Retrieved December 12, 2003 from 
http://www.cwla.org/programs/health/healthcarecwfact.htm. 
6Chernoff, R. et. al., Assessing the Health Status of Children Entering Foster Care, 
Pediatrics, 93:2, 1994. 
7Health Care of Young Children in Foster Care. Pediatrics, 109:3, 2002. Retrieved 
December 12, 2003 from http://www.aap.org/policy/re0054.html. 
8Medicaid: Stronger Efforts Needed to Ensure Childrens Access to Health Screening 
Services. General Accounting Office, GAO-01-749, July 2001. 
9Journal of Dental Research, March 2003; 82 (3): 223-7. 
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Medicaid for Children in Foster Care 
Illinois provides Medicaid coverage to all children in the 
Title IV-E foster care program, as well as other eligible children. 
Sections 472(h) and 1902(a)(10)(A)(i)(I) of the Social Security Act 
(the Act) require States to provide Medicaid, or equivalent health 
insurance coverage, to children eligible to receive Title IV-E foster 
care program maintenance funds. Federal EPSDT guidelines 
require each State to make comprehensive and preventive child 
health services available to Medicaid-eligible individuals under the 
age of 21, at intervals which meet reasonable standards of medical 
and dental practice, as outlined in Sections 1902(a)(43) and 1905(r) 
of the Act. Within broad national guidelines, each State establishes 
its own eligibility standards for the Medicaid program; determines 
the type, amount, duration, and scope of Medicaid services; sets the 
rate of payment for services to Medicaid patients; and administers 
its own Medicaid program.10  In fiscal year (FY) 2000, Medicaid 
payments for children in foster care nationwide totalled over 
$3.3 billion.11  Illinois Medicaid expenditures to provide health care 
services to children in foster care totalled approximately $281 
million in FY 2000. 12  The Centers for Medicare & Medicaid 
Services (CMS) is responsible for Federal oversight of individual 
State Medicaid programs. 
Illinois 
The Illinois foster care program is State-administered and divided 
into regional networks. The Illinois Department of Children and 
Family Services (DCFS) manages foster care in Illinois. DCFS may 
place children with public or private agencies. The Illinois 
Department of Public Aid manages the State Medicaid program. 
The management of the Illinois foster care program changed 
substantially in 1993 due to implemented changes brought about by 
the B.H. Consent Decree. One significant change was the 
introduction of the Healthworks program. 
10Retrieved May 20, 2003 from http://cms.hhs.gov/medicaid/eligibility/criteria.asp. 
11Medicaid Statistical Information System (MSIS) Report Fiscal 2000. Retrieved 
December 12, 2003 from http://www.cms.hhs.gov/medicaid/msis/00total.pdf. 
12Medicaid Statistical Information System (MSIS) Report Fiscal 2000: Illinois. 
Retrieved December 12, 2003 from http://www.cms.gov/medicaid/msis/00il.pdf. 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  3  I N T R O D U C T I O N  
B.H. Consent Decree 
The B.H. Consent Decree13 was the result of a class action lawsuit 
brought by the American Civil Liberties Union (ACLU) on behalf of 
children in the custody of the Illinois DCFS in 1988. ACLU alleged 
violations of the Fourteenth Amendment to the United States 
Constitution and the Adoption Assistance and Child Welfare Act of 
1980, 42 U.S.C.  620-68, 670-79(a), which requires States to make 
reasonable efforts to prevent the unnecessary removal of children 
from their homes and the unnecessary placement of children in 
foster care. Specifically, child welfare caseloads approached 
100 cases-per-worker, work was being duplicated, cases were 
scattered to such a degree that monitoring was difficult, there was 
a general lack of emphasis on prevention and primary care, and 
documentation of medical information was sporadic.14  In 1991, 
DCFS reached an agreement in the B.H. Consent Decree on 9 areas 
to improve the responsiveness of the Illinois foster care program to 
meet the needs of children in custody and improve accountability 
within the child welfare system.  One of those nine areas was 
related to the comprehensive health care of children in DCFS 
custody. Illinoiss solution was the implementation of the 
Healthworks program. 
Program Variation 
Each State establishes eligibility standards, determines services, 
sets payment rates, and administers its own foster care and 
Medicaid programs in accordance with general Federal guidelines. 
The resulting diversity produces variations in when and what types 
of services children receive in foster care. As such, the experiences 
reported in this State-specific report will be unique to the sampled 
childrens experiences in Illinois. 
Illinois Healthworks 
The Healthworks program is a comprehensive program 
coordinating the activities of foster care providers, caseworkers, 
State program administrators, community-based agencies, 
physicians, and medical case managers in providing health services 
to children in foster care. 
13B.H. stands for the initials of the first child named in the lawsuit. 
14Illinois DCFS Promotion of Quality and Accountability. Retrieved on 
May 20, 2003 from http://www.State.il.us/dcfs/budproqual.htm. 
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Section 471(a)(22) of the Act requires States to develop a State plan 
that includes standards to ensure that children in foster care 
placements in public and private agencies are provided quality 
services that protect their safety and health. Sections 
422(b)(10)(B)(ii) and 475(5)(D) of the Act require procedures to 
ensure that a foster childs health records be reviewed, updated, 
and supplied to the foster care provider at the time of placement. 
According to Section 475(1)(C) of the Act, health records should 
include, to the extent available and accessible, the names and 
addresses of the childs health providers, a record of the childs 
immunizations, the childs known medical problems, the childs 
medications, and any other relevant health information concerning 
the child determined to be appropriate by the State agency. 
The aspects of the Illinois Healthworks that we addressed include 
the following: 
(1) Initial Health Screenings: The DCFS investigator or caseworker 
is responsible for ensuring that Initial Health Screenings are 
conducted within 24 hours of a childs entry into State custody to 
treat acute medical needs, document possible medical problems and 
abuse, and provide the caseworker with appropriate medical 
information necessary for placement. 
(2) Comprehensive Health Evaluations: Foster care providers are 
generally responsible for ensuring that all children receive a 
Comprehensive Health Evaluation within 21 days of entering foster 
care, which includes an in-depth physical examination, 
comprehensive medical history, and, for children 5 years of age and 
older, a Mental Health Screen. These thorough evaluations are 
important to identify problems early on, especially for children who 
may not have received medical care prior to DCFS custody. 
(3) Health Passports: A Health Passport is initiated during the 
Comprehensive Health Evaluation. Physicians receive an incentive 
of $15 to initiate Health Passports as part of the Comprehensive 
Health Evaluation. The Health Passport is a manila booklet 
containing pertinent medical information relating to 
immunizations, family health history, child health visits, child 
health information, and a list of previous and current health care 
providers. The Health Passport is provided to and kept by the 
childs current foster care provider and is to follow the child 
through subsequent placements and providers to ensure continuity 
of care. A copy is required to be kept in the childs case file. 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  5  I N T R O D U C T I O N  
A previous study revealed that foster care providers and 
caseworkers are inconsistent in updating the Health Passports for 
the children in their care, 15 although the semiannual 
Administrative Case Review16 requires it. 
EPSDT Guildelines 
States establish EPSDT guidelines in accordance with Federal 
requirements to provide coverage for preventive child health 
services to all Medicaid-eligible individuals under the age of 21. 17 
State EPSDT programs must provide medical, dental, hearing, and 
vision screenings, and other necessary health care and treatment at 
intervals established by the State that meet reasonable standards 
of practice published by recognized health care organizations. 
In addition to the Initial Health Screening and Comprehensive 

Health Evaluation, Illinois DCFS also requires that children 

receive EPSDT medical screenings consistent with Federal EPSDT 

criteria. 

The current EPSDT frequency schedule for the Healthworks 

program requires that medical screenings occur at: 

birth; 1, 2, 4, 6, 9, 12, 15, and 18 months of age; and annually 

between the ages of 2 and 21. Dental examinations are required 

every year beginning at 2 years of age.18  Dental examinations are 

conducted separately from medical examinations. 

15Georgetown University, Child Development Center. (2000). Meeting the Health 
Care Needs of Children in the Foster Care System, Site Visit Report: Healthworks 
of Illinois. Retrieved December 12, 2003 from 
http://gucdc.georgetown.edu/foster.html. 
16Administrative Case Reviews are reviews conducted every 6 months with the 
caseworker, foster care provider, and other pertinent staff, to incorporate the 
childs health information into the service plan, to review and update the Health 
Passport, assess the status of the childs health care, and develop plans for unmet 
health issues. DCFS Foundation Training for New Caseworkers. 
17Section 1905(r) of the Social Security Act. 
18Handbook for Providers of Medical Services, Chapter 100 General Policy and 
Procedures, Illinois Department of Public Aid. 
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METHODOLOGY 
This inspection focused on the receipt of medical and dental health 
care services within EPSDT guidelines; requirements for initial and 
comprehensive health screenings and mental health assessments 
upon entry into foster care; and the provision of medical 
information to foster care providers. This study did not address 
follow-up care or the appropriateness of ongoing health care in 
meeting the needs of children in foster care. 
The inspection is based on information gathered from multiple 
sources: reviews of Federal and State policies; child-specific 
Medicaid claims data and case file documentation for 50 randomly-
sampled children in foster care; interviews with caseworkers for 
each of the 50 children in our sample; interviews with foster care 
providers for 46 children in our sample; and interviews with Illinois 
State agency officials. 
Reasons for State Selection 
Illinois was selected due to its large size, geographic location, and 
fee-for-service payment of Medicaid health care services. The 
Illinois DCFS is responsible for the welfare of children in State 
custody. 
Sample 
Children who met the following criteria were included in the study 

population: (1) were in foster care on December 1, 2002; (2) resided 

in Illinois; (3) were Title IV-E eligible, and (4) had been in 

continuous out-of-home foster care placements for at least 

6 months. DCFS provided us with a list of the 17,153 children who 

met these criteria. We selected a simple random sample of 

50 children in Illinois from the list of children who met the specified 

criteria. Appendices A and B provide information on the children 

included in our sample, and the services they received. 

Review of State Policy, Medicaid Data, and Case File Documentation

Policy Review -We reviewed Federal and Illinois State foster care 

and Medicaid policies. All Illinois children eligible for the 

Title IV-E foster care program are eligible for Medicaid services. 

Federal law relating to EPSDT requires that States meet 

reasonable standards of medical and dental practices as determined 

by the State after consultation with recognized medical and dental 

organizations. The Healthworks program satisfies the Federal 

EPSDT requirement. Therefore, we used Healthworks guidelines 

OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  7  I N T R O D U C T I O N  
to determine whether children in foster care had received their 

most recent EPSDT examination within required frequency 

guidelines.

Medicaid Claims Data Review -The Illinois Department of Public 

Aid and Illinois DCFS provided us with up to 3 years of Medicaid 

claims histories for each of the children in our sample. The data 

included claims for physician, dental, pharmaceutical, and mental 

health services paid between January 1, 2000 and 

December 31, 2002. We paid particular attention to the types of 

health and mental health services provided, dates of service, where 

the services were provided, and diagnoses, where available. Our 

review included only Medicaid claims for services provided on or 

after the date of the foster childs most recent entry into foster care. 

We defined examinations as current based on whether the most 

recent examination was within State frequency guidelines.

Case File Documentation Review -We requested and reviewed case 

file documentation from local DCFS offices for all the children in 

our sample. Information requested included the following: case 

notes, documentation of medical and mental health services 

provided, the childs initial and most recent case plan, duration of 

the childs stay in foster care, and information regarding the childs 

general well-being.

Interviews

Foster Care Provider Interviews -We use the term foster care 

provider to refer to a foster parent or a staff member of a 

residential facility who is responsible for the child. We conducted 

structured interviews with 46 of the foster care providers 

responsible for the children in our sample between March 21, 2003 

and April 11, 2003 (9 in person and 37 by telephone). We were 

unable to speak with four of the foster care providers despite many 

attempts to reach them. The interviews with foster care providers 

focused on Medicaid programs and services available, training the 

foster care provider received related to the health and well-being of 

children, and their experiences accessing health care services for 

the children included in our sample.

Caseworker Interviews -We conducted structured telephone 

interviews with each childs caseworker between 

March 18, 2003 and April 11, 2003. Each of these interviews 

focused on the caseworkers understanding of the Medicaid program 

and services available, training related to the health and well-being 

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of children, their experiences accessing services, and any barriers to 
health care. Each caseworker spoke specifically about the sampled 
childs case, and generally about his or her own experiences 
working in foster care. We analyzed the caseworkers responses 
and compared them to those of the foster care providers, noting any 
consensus or disagreement within and between the two groups. 
State Agency Officials -To enhance our understanding of the States 
foster care and Medicaid programs, we consulted, both in person 
and by telephone, with representatives from DCFS and the Illinois 
Department of Public Aid. Our discussions covered a wide 
spectrum of information, including the overall provision of Medicaid 
services for children in foster care, Medicaid claims, the States 
Healthworks program, the structure of the States foster care 
service organization, and Medicaid claims for children in foster 
care. 
This inspection was conducted in accordance with the Quality 
Standards for Inspections issued by the Presidents Council on 
Integrity and Efficiency. 
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All sampled children had Medicaid coverage  In Illinois, all children eligible for 
the foster care program are eligible 
and claims for health care services 
for Medicaid. Our review of 
Medicaid claims and interview data indicated that all 50 children in 
our sample had Medicaid coverage. Our analysis of claims data 
revealed that each sampled child had at least one Medicaid claim 
during the period of our review. Table 1 (below) details the total 
number of sampled children who received various types of 
Medicaid-covered services. The claims totals for each of the 
sampled children are provided in Appendix B. 
Table 1: Number and Type of Medicaid Claims 
for 50 Children in the Sample* 
Number of children with  Total number of 
Claim type 
at least one claim  claims 
Physician office  49  990 
Prescription drug  40  1028 
Laboratory  38  396 
Dental  38  357 
Hospital/ASC**  30  173 
Optometry/Audiology  20  65 
Mental health  18  1579 
Diagnostic  16  56 
Physical/Occupational 
12  942 
therapy 
Supplies  12  126 
Transportation  11  231 
Primary care provider fee  11  163 
Social work services  9  66 
Early intervention  6  112 
Case management  5  197 
Total  6,481 
* Claims period: 01/01/00 to 12/31/02, or entry into care to 12/31/02 
**includes emergency room visits 
Source: OIG analysis of Illinois Medicaid claims data 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  10  F I N D I N G S  
All sampled children received their most  Medical Examinations 
recent EPSDT medical examinations, and 
All sampled children received their 
76 percent received their most recent  most recent EP SDT medical 
EPSDT dental examinations, in  examination in accordance with State 
accordance with State guidelines  guidelines and only one foster care 
provider reported having difficulty 
finding a physician to perform an annual EPSDT medical 
examination. Foster care providers apparent ease in finding 
physicians to perform annual medical examinations may be due to 
the fact that Illinois implemented a 13-percent higher 
reimbursement, on average, for physicians who treat children in 
State custody, to encourage physician enrollment and participation 
in the Healthworks program.19 
Overall, 70 percent (32/46) of foster care providers reported they 
were familiar with the Illinois Healthworks program, and 
65 percent (30/46) of foster care providers knew the frequency 
schedule of EPSDT medical examinations. Ninety-six percent 
(48/50) of caseworkers knew of the Healthworks program, and 
86 percent (43/50) knew the frequency of required medical 
examinations. We found no association between caseworker tenure 
and knowledge of the frequency guidelines. 
The Illinois DCFS monitors well-child examination compliance 
rates through the biannual Administrative Case Reviews required 
for all children in foster care and publishes monthly reports on 
their findings. As of December 2002, the State found that 
62.4 percent of the 23,332 cases reviewed were in compliance with 
the annual examination requirement. Our finding of a 100-percent 
compliance rate may be due to our analysis of both medical claims 
data and case file documentation, while the State relies on the case 
files alone. Also, if the foster care provider is unable to attend the 
Administrative Case Review, information on recent medical 
examinations is less likely to be updated in the case file. 
19Georgetown University, Child Development Center. (2000). Meeting the Health 
Care Needs of Children in the Foster Care System, Site Visit Report: Healthworks 
of Illinois. Retrieved December 12, 2003 from 
http://gucdc.georgetown.edu/foster.html. 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  11  F I N D I N G S  
Dental Examinations 
We found that 76 percent (31/41) of sampled children received their 
most recent EPSDT dental examinations in accordance with State 
guidelines.20 
We analyzed Medicaid claims and interview data in an attempt to 
identify factors that may explain the difference between the 
children who were current on their dental examination and those 
who were not. Of the 10 children who were past due on their dental 
examination, 5 of the foster care providers stated they were 
unaware of the availability of Medicaid services, whereas only 3 of 
27 foster care providers whose children were current on their dental 
examination were unaware of the availability of Medicaid services. 
Furthermore, 43 percent (16/37) of the foster care providers with 
whom we spoke mentioned some difficulty in finding dental 
providers who accept Medicaid. 21 
Overall, 70 percent (32/46) of foster care providers reported they 
were familiar with the Illinois Healthworks program, and 
65 percent (30/46) of foster care providers knew the frequency 
schedule of EPSDT dental examinations. Ninety-six percent 
(48/50) of caseworkers knew of the Healthworks program, and 
86 percent (43/50) knew the frequency of required dental 
examinations. We did not find any association between caseworker 
tenure and knowledge of the frequency guidelines. 
We detected no differences between the children receiving dental 
examinations and those who did not when analyzing the following 
variables: geographical region, caseworker involvement in the 
childs health care, caseworker caseload size, childs date of entry 
into foster care, total number of placements, total number of 
caseworkers, number of placements per entry, number of 
caseworkers per entry, age of the child, or foster care providers and 
caseworkers knowledge of EPSDT frequency requirements. 
20Percentage of children receiving dental examinations is based on 41 of the 
50 sampled children. Nine children were not included because of their age. 
21Although 41 children were eligible for dental examinations, we were unable to 
speak with 4 foster care providers. 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  12  FF II NN DD II NN GG SS  
Ninety-seven percent of sampled children  Illinois DCFS requires that all 
received Initial Health Screenings within  children entering DCFS custody 
must receive an Initial Health 
required timeframes 
Screening within 24 hours of 
entering DCFS custody in order to document possible acute medical 
problems and abuse and to provide the caseworker with 
appropriate medical information necessary for placement. The 
caseworker is responsible for ensuring that the child receives the 
Initial Health Screening. If the child is discharged from a hospital 
into DCFS custody, the hospital discharge summary substitutes for 
the Initial Health Screening. 
While only 2 children had paid Medicaid claims for an Initial 
Health Screening, our case file review showed that 97 percent 
(30/31)22 of the sampled children entering State custody received 
their Initial Health Screening or were discharged from the hospital 
into DCFS custody. 
During the course of the interviews, no caseworkers reported 
having knowledge of problems obtaining Initial Health Screenings. 
The Initial Health Screening can take place at a hospital or clinic 
24 hours a day, 7 days a week, or at a physicians office during 
business hours. The ability to take a child to a medical provider at 
any time of the day, coupled with the fact that the Initial Health 
Screening is one of the first medically-related tasks a caseworker 
must provide when a child enters State custody, may explain the 
high percentage of sampled children receiving this service. 
Only 42 percent of sampled children received  Illinois DCFS requires that 
all children entering DCFS 
Comprehensive Health Evaluations within 
custody receive a 
required timeframes	
Comprehensive Health 
Evaluation within 21 days of entering State custody, which includes 
an in-depth physical examination and comprehensive medical and 
psychosocial history. The medical professional conducting the 
Comprehensive Health Evaluation also initiates the Health 
Passport during the visit. The foster care provider is generally 
22Because our Medicaid claims data ranged from January 1, 2000 to December 31, 
2002, we only reviewed the 31 children for this service who entered State custody 
on or after January 1, 2000. 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  13  F I N D I N G S  
responsible for scheduling and taking the child to the 
Comprehensive Health Evaluation. 
We found that 42 percent (13/31)23 of the sampled children entering 
DCFS custody received their Comprehensive Health Evaluation 
within required timeframes. Our review of claims data and case 
files revealed that an additional 42 percent (13/31) of the sampled 
children in foster care had their Comprehensive Health Evaluation 
outside the required timeframe, ranging from 22 days to 266 days. 
We could not find any evidence for a Comprehensive Health 
Evaluation for five children. Only one child had a Medicaid claim 
for a Comprehensive Health Evaluation. None of the caseworkers 
or foster care providers indicated problems obtaining 
Comprehensive Health Evaluations for the sampled children. 
A possible explanation of why sampled children in compliance with 
the Comprehensive Health Evaluation requirement is lower than 
the percentage in compliance with the Initial Health Screening 
requirement may be that access to Comprehensive Health 
Evaluation prov iders is more limited. While the Initial Health 
Screening is available 24 hours a day, the Comprehensive Health 
Evaluation is available only during regular business hours with a 
preference toward selected primary care providers. Also, foster care 
providers are generally responsible for obtaining the 
Comprehensive Health Evaluations after a child is placed with 
them, whereas caseworkers are responsible for obtaining an Initial 
Health Screening within 24 hours of custody. 
Only 1 of 14 sampled children received a Mental  Illinois DCFS requires that all 
Health Screen within required timeframes	 children 5 years of age or older 
entering DCFS custody receive a 
Mental Health Screen within 21 days of entry. The medical 
professional conducting the Comprehensive Health Evaluation also 
conducts the Mental Health Screen during the same visit. 
Fourteen sampled children were at least 5 years of age when 
entering DCFS custody. Of these 14 children, only 1 child received 
a Mental Health Screen within required timeframes. Our review of 
23Because our Medicaid claims data ranged from January 1, 2000, to 
December 31, 2002, we reviewed case files for the receipt of a Comprehensive 
Health Evaluation for only the 31 children who entered State custody on or after 
January 1, 2000. 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  14  F I N D I N G S  
case files demonstrated that an additional 2 children had their 
Mental Health Screen, but beyond the required timeframes ranging 
from 33 days to 84 days. None of the caseworkers indicated they 
were aware of problems obtaining Mental Health Screens at the 
Comprehensive Health Evaluation. 
Because the Mental Health Screen occurs at the same time as the 
Comprehensive Health Evaluation, we expected the sampled 
children would have received a Mental Health Screen at the same 
rate they received Comprehensive Health Evaluations. We could 
not identify a reason why the Mental Health Screens were not 
conducted. 
Only 18 children had a Medicaid claim for mental health related 
services and 86 percent (1352/1579) of the mental health claims 
were for the 5 children in residential facility placements.24 There 
were two children diagnosed with Attention Deficit and 
Hyperactivity Disorder and Post Traumatic Stress Disorder with no 
Medicaid mental health claims. All other children with a diagnosed 
mental health disorder had at least one Medicaid mental health 
claim, and three children with no mental health disorders also 
received mental health services as evidenced by claims data. We 
did not evaluate the adequacy of the mental health services 
provided. 
Medicaid funds allocated to Healthworks do not include specific 
payments for mental health services, and Medicaid funds to provide 
mental health services for children in State custody are managed 
separately by DCFS. The provision of mental health services 
through private agencies is included as part of its contracted 
payment from DCFS. Thus, mental health services provided by 
these agencies would not necessarily be billed to Medicaid. 
24 One child was recently transferred from a residential facility to a foster home and 
the most recent placement is reflected in Appendix A. 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  15  F I N D I N G S  
Health Passports are in only 48 percent of case  The Illinois Health Passport 
files and are not updated at the Administrative  satisfies the Federal requirement 
that a childs health record be 
Case Review 
reviewed, updated, and supplied to 
the foster care provider when they are placed in foster care. The 
Health Passport also is required to be reviewed and updated at 
each Administrative Case Review. 
Seventy-four percent (34/46) of the foster care providers 
interviewed stated they received a medical history at the time of 
placement, and 87 percent (40/46) of their caseworkers reported 
having a medical history available. Thirty-eight caseworkers 
indicated that they provided the foster care provider with the 
sampled childs medical history, and 34 foster care providers 
indicated they received it, demonstrating that the initial transfer of 
medical history information is occurring in 85 percent (34/40) of the 
cases where the information is available. 
Upon our review, however, we identified copies of the Health 
Passport in only 48 percent (24/50) of the case files. Only eight of 
these copies were up-to-date and only two copies contained all the 
required medical information.25  A vulnerability to losing parts of a 
childs medical history is created if information is not recorded 
timely in the Health Passport, or if the Health Passport is never 
initiated. In some instances, the sample childs Health Passport 
was missing information even though the required medical 
information was available in other case file documentation. 
One caseworker reported that they did not have the Health 
Passport because the foster parent had lost it. These situations 
raise the possibility that children might receive duplicate services 
or that needed services may be delayed or not obtained. 
Only 54 percent (27/50) of case files contained documentation that a 
6-month Administrative Case Review had been conducted within 
the last 6-month period. The Health Passports are to be reviewed 
and updated at the time of each Administrative Case Review, but 
this appears not to be occurring in all cases. Of the Administrative 
Case Reviews completed for our sample, 44 percent (12/27) had no 
documentation indicating that the childs health passport was 
25Required information includes, if available: immunizations, illnesses, allergies, 
medications, medical conditions, dental examinations, vision and hearing 
screenings, medical examinations, and other pertinent information. 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  16  F I N D I N G S  
reviewed and updated as required. An additional 15 percent (4/27) 
of the case files indicated a review had taken place but contained no 
Health Passport or plan for remediation. 
Six foster care providers reported that the lack of medical history 
adversely affected the health of the child. Specifically, foster care 
providers stated the lack of medical history made it difficult to care 
effectively for the children placed with them, made it difficult to 
answer basic questions about the childs past medical care, and 
caused other problems, such as subjecting the child to repeated 
immunizations because records of previous immunizations were 
unavailable. 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  17  R E C O M M E N D A T I O N S

RECOMMENDATIONS 
The EPSDT program is intended to detect various health needs. 
However, if children do not receive required health care services or 
medical information is not updated and given to the foster care 
providers, childrens health may be negatively affected. Therefore, 
we recommend that: 
ACF work with the Illinois DCFS to increase the number of: 
o	 Comprehensive Health Evaluations and Mental Health Screens 
received within required timeframes 
o	 Health Passports that are (1) updated on an ongoing basis, 
(2) reviewed for accuracy and completeness during the 
Administrative Case Review, and (3) copied each time the 
health information is updated, so that a copy of the most recent 
health passport is maintained in the case file and provided to 
the foster care provider 
CMS work with ACF and the Illinois Department of Public Aid to: 
o	 Prevent potentially unnecessary costs to the Medicaid program 
resulting from duplicate services provided as the result of 
incomplete and outdated Health Passports 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  18  R E C O M M E N D A T I O N S  
AGENCY COMMENTS 
ACF indicated the background information included in this report 
provided a useful perspective of the problem and the case file 
documentation and analysis of claims data were informative. 
ACF noted that it is working with DCFS to improve the provision of 
health and mental health services to children in foster care and 
that the provision of these services will be addressed in Illinois 
Program Improvement Plan in response to a Child and Family 
Services Review. Child and Family Services Reviews measure 
individual States performance related to the health and well-being 
of children in the child welfare system. 
CMS agrees in part with our recommendation, recognizing the 
concern about the potential for Federal and State funds being 
unnecessarily expended for duplicate Medicaid services; however, 
CMS believes DCFS should work to better inform foster care 
parents and providers of the availability of services and the State 
requirements under the Healthworks and Passport program. 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  19  A P P E N D I X ~ A  
 
Sampled Children 
The table below is merely descriptive in nature and describes the 
demographic characteristics of each sampled child and his or her 
foster care placement history at completion of our interviews in 
April 2003. 
 
Entries  Placements  Months since  Caseworkers  Months 
Age  Placement  Months since 
ID Sex  into foster  since last  last  since last  caseworker 
(years)  setting  last entry (2) 
care (1)  entry (3)  placement (2)  entry  with case (2) 
1  F  10  Kinship  1  17  2  7  3  2 
2  M  3  Kinship  1  21  1  21  1  21 
3  M  3  Family  1  27  3  17  4  3 
4  M  1  Family  1  16  1  16  2  1 
5  F  9  No Interview  1  104  2  102  3  16 
6  F  11  Family  1  9  3  9  1  9 
7  F  1  Kinship  1  20  1  20  3  2 
8  F  4  Family  1  16  4  2  3  6 
9  M  4  Family  1  47  1  47  3  9 
10  F  11  Family  1  71  4  26  8  23 
11  M  10  Family  1  88  5  28  3  4 
12  M  10  Family  1  17  3  2  1  17 
13  M  12  Kinship  1  46  4  15  3  17 
14  F  4  Family  1  32  4  19  2  5 
15  M  9  Kinship  1  14  1  14  1  14 
16  M  7  Family  2  24  2  6  1  24 
17  M  4  Family  1  28  3  15  2  8 
18  F  17  Family  1  61  6  19  2  16 
19  M  13  Kinship  1  58  1  58  3  1 
20  F  8  No Interview  1  68  2  26  3  23 
21  F  1  Family  1  16  1  16  2  4 
22  M  8  Family  1  58  1  58  1  58 
23  M  13  Kinship  1  81  2  72  5  1 
24  M  8  Kinship  1  50  2  17  2  35 
25  F  17  Kinship  2  85  5  13  5  24 
26  M  17  Family  1  35  5  10  3  2 
27  F  4  Family  1  15  2  8  2  6 
28  F  7  Family  2  26  3  15  2  25 
29  F  8  Family  1  12  2  11  1  12 
30  M  16  Residential  1  29  3  19  1  29 
31  F  15  Family  1  30  2  28  3  15 
32  M  8  Kinship  1  95  3  15  2  1 
  OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN FOSTER CARE:  ILLINOIS  20 
  A P P E N D I X ~ A  
Entries  Placements  Months since  Caseworkers  Months 
Age  Placement  Months since 
ID Sex  into foster  since last  last  since last  caseworker 
(years)  setting  last entry (2) 
care (1)  entry (3)  placement (2)  entry  with case (2) 
33  M  2  Family  1  27  1  27  2  23 
34  F  15  Residential  1  20  3  14  4  6 
35  F  5  Family  1  29  2  25  2  24 
36  M  1  Family  1  16  1  16  1  16 
37  M  5  Family  1  38  2  12  4  5 
38  F  12  Residential  1  28  2  14  1  28 
39  M  2  Family  1  25  1  25  2  21 
40  M  5  No Interview  1  23  2  23  2  6 
41  F  13  Residential  1  17  9  13  3  4 
42  M  3  Family  1  36  1  36  1  36 
43  M  12  Family  1  82  2  59  3  3 
44  M  5  Kinship  1  60  2  48  3  10 
45  M  10  Kinship  1  116  2  75  2  8 
46  F  12  Family  2  33  3  9  3  14 
47  F  18  No Interview  1  73  1  73  4  4 
48  F  6  Family  2  16  1  16  2  16 
49  M  3  Family  1  39  1  39  2  22 
50  F  15  Family  1  15  3  10  1  15 
KEY 
(1) Entries into foster care refers to the number of times a child 

has entered State custody (i.e., number of foster care episodes).

(2) Months since last entry is the length of time from the date of 

the childs most recent entry into State custody until 

April 2003, which coincides with the period of interviews with 

caseworkers and foster care providers. Months since last 

placement is the length of time from the date of the most recent 

placement to the date the foster care provider was interviewed. 

Months caseworker with case is the length of time from the date 

the caseworker initially took over the foster childs case until the 

date the caseworker was interviewed. 

(3) Placements since last entry refers to the number of placement 

settings (e.g. Foster Home A, Foster Home B, Metro Residential 

Facility) a child has experienced during the most recent entry into 

foster care. 

OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  21  A P P E N D I X ~ B  
Medicaid Claims for Sampled Children 
The table below indicates each childs receipt of required services 
and total claims for January 1, 2000 to December 31, 2002, or entry 
into care to December 31, 2002, whichever is shorter. 
 
  Number of Medicaid Claims    Initial Examinations (4)  Current EPSDT 
Health       
Physicians  Dental  Prescription  Mental health 
ID  Passport in  IHS(1)  CHE(2)  MHS(3)  Medical  Dental 
office  services  medications  services 
case file         
1  9  0  2  0  N  N*  N  N  Y  N 
2  32  0  192  0  N  N*  N    Y   
3  14  1  72  87  N  N*  N*    Y  Y 
4  41  0  6  0  N  N*  Y    Y   
5  11  20  2  0  Y        Y  Y 
6  5  6  3  2  N  N*  N  N  Y  Y 
7  25  0  9  0  Y  N*  N    Y   
8  3  3  0  0  Y  N*  N*    N*  Y 
9  12  0  16  0  Y        Y  N* 
10  12  12  1  0  N        Y  Y 
11  5  14  5  0  Y        Y  Y 
12  11  16  9  0  N  N*  N  N  Y  Y 
13  3  5  0  20  Y        N*  N* 
14  39  5  5  0  Y  N*  N*    Y  Y 
15  3  3  0  0  N  N*  N  N  N*  Y 
16  22  12  0  2  N  N*  N*  N  Y  Y 
17  9  4  2  0  Y  N*  N    Y  Y 
18  16  18  22  0  Y        N*  Y 
19  19  0  0  0  Y        Y  N 
20  41  4  35  18  N        Y  Y 
21  16  0  20  0  Y  N*  N*    N*   
22  28  6  57  2  N        Y  Y 
23  4  10  0  0  Y        Y  Y 
24  21  6  26  0  Y        Y  Y 
25  13  9  11  8  Y        N*  N 
26  19  6  89  455  Y  N*  N  N  Y  N 
27  28  5  5  0  N  N*  N*    Y  Y 
28  9  5  2  8  N        Y  N 
29  4  4  6  0  Y  N*  N  N  N*  Y 
30  8  14  9  369  N  N*  N*  N  Y  N 
31  9  15  0  0  Y  N*  N*  N*  Y  Y 
32  38  17  60  0  N        Y  Y 
33  53  0  34  0  N  Y  N*    Y   
34  6  14  6  90  N  Y  N  N  N*  Y 
  OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN FOSTER CARE:  ILLINOIS  22 
  A P P E N D I X ~ B  
Number of Medicaid Claims  Initial Examinations (4)  Current EPSDT 
Health 
Physicians  Dental  Prescription  Mental health 
ID  Passport in  IHS(1)  CHE(2)  MHS(3)  Medical  Dental 
office  services  medications  services 
case file 
35  31  7  25  0  N  N*  N  Y  N 
36  3  0  12  0  Y  N  N  N* 
37  27  3  42  17  N  N*  N  Y  N* 
38  15  9  7  9  N  N*  N  N  Y  N 
39  87  0  21  0  N  N*  N  N* 
40  34  3  4  2  Y  N*  N*  Y  Y 
41  56  7  89  429  Y  N*  N  N  Y  Y 
42  0  6  22  0  Y  N*  N*  N* 
43  9  13  0  0  Y  Y  N 
44  42  0  10  2  N  Y  N 
45  17  13  67  57  N  N*  Y 
46  4  4  0  2  N  N*  N  N  Y  Y 
47  33  14  1  0  N  Y  Y 
48  29  38  6  0  N  N*  N*  N  Y  Y 
49  5  0  0  0  Y  N*  N  Y 
50  10  6  16  0  Y  Y  Y 
KEY 
(1) IHS (Initial Health Screening; required within 24 hours of 
custody) 
(2) CHE (Comprehensive Health Evaluation; required within 
21 days of custody) 
(3) MHS (Mental Health Screen; required within 21 days of custody 
for children in foster care aged 5 years and above) 
(4) Initial Examinations: Y indicates that initial medical/dental 
examination was received within required timeframes, as evidenced 
by a Medicaid claim. N indicates examination was not received 
within required timeframes. N* indicates that Medicaid claims 
data did not support a positive finding, but evidence was found in 
the case file to support the positive finding. Shaded areas indicate 
children who were not eligible for the service due to age or date of 
entry into the system, which was outside the scope of claims data. 
Current EPSDT Examinations: Medical/Dental: Y indicates that 
an EPSDT medical/dental examination was received according to 
Illinois Healthworks frequency timeframes, as evidenced by a 
Medicaid claim. N indicates examination was not received 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  23  A P P E N D I X ~ B  
according to Illinois Healthworks frequency timeframes. 
N* indicates that Medicaid claims data did not support a positive 
finding, but evidence was found in the case file to support the 
positive finding. Shaded areas indicate children who were not 
eligible for the service due to age or date of entry into the system, 
which was outside the scope of claims data. 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  24  A P P E N D I X ~ C

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 A P P E N D I X ~ C  
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  26
   A P P E N D I X ~ C  
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  27
   A P P E N D I X   ~   D

OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  28
 A C K N O W L E D G M E N T S

This report was prepared under the direction of Brian Pattison, 
Regional Inspector General for Evaluation and Inspections in 
the Kansas City Regional Office, and Gina Maree, Assistant 
Regional Inspector General. Other principal Office of Evaluation 
and Inspections staff who contributed include: 
Deborah Walden, Team Leader 
Brian T. Whitley, Lead Analyst 
Zula Crutchfield, Program Analyst 
Tricia Fields, Program Analyst 
Steven Milas, Program Analyst 
Linda Paddock, Program Analyst 
Elander Phillips, Program Analyst 
Dennis Tharp, Program Analyst 
Michala Walker, Program Analyst 
Linda Hall, Program Specialist (Washington, D.C.) 
Barbara Tedesco, Mathematical Statistician (Baltimore) 
OEI-07-00-00642  CHILDRENS USE OF HEALTH CARE WHILE IN F OSTER CARE:  ILLINOIS  29