Department of Health and Human Services 

OFFICE OF 

INSPECTOR GENERAL 

Inspector General 

FEBRUARY 2004 

OEI-07-00-00642 

-

CHILDREN’S USE OF HEALTH 

CARE SERVICES WHILE IN 

FOSTER CARE: ILLINOIS 
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 inspec tions) 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. 
ABSTRACT

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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS i 
EXECUTIVE SUMMARY

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 childspecific 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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS ii 
EXECUTIVE SUMMARY EXECUTIVE SUMMARY 

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 physician’s 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 child’s foster care provider. 

OEI - 07 - 00 - 00642 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS iii 
EXECUTIVE SUMMARY EXECUTIVE SUMMARY 

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 child’s health records be provided to the 

foster care provider at the time of the child’s 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 child’s 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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS iv 
EXECUTIVE SUMMARY 

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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS v 
TABLE OF CONTENTS

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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 
INTRODUCTION

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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 1 
INTRODUCTION INTRODUCTION 

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 Children’s 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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INTRODUCTION 

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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 3 
INTRODUCTION 

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. Illinois’s 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 

children’s 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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INTRODUCTION 

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 child’s 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 child’s health providers, a record of the child’s 

immunizations, the child’s known medical problems, the child’s 

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 child’s 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 

child’s 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 child’s case file. 

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INTRODUCTION 

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 

child’s health information into the service plan, to review and update the Health 

Passport, assess the status of the child’s 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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INTRODUCTION 

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 randomlysampled 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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 7 
INTRODUCTION 

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 child’s 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 child’s initial and most recent case plan, duration of 

the child’s stay in foster care, and information regarding the child’s 

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 child’s caseworker between 

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

focused on the caseworker’s understanding of the Medicaid program 

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

OEI - 07 - 00 - 00642 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 8 
INTRODUCTION 

of children, their experiences accessing services, and any barriers to 

health care. Each caseworker spoke specifically about the sampled 

child’s 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 State’s 

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 State’s 

Healthworks program, the structure of the State’s 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 President’s Council on 

Integrity and Efficiency. 

OEI - 07 - 00 - 00642 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 9 
FINDINGS

All sampled children had Medicaid coverage In Illinois, all children eligible for 

and claims for health care services the foster care program are eligible 

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* 

Claim type Number of children with 

at least one claim 

Total number of 

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 

therapy 12 942 

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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 10 
FINDINGS 

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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 11 
FINDINGS 

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 

child’s health care, caseworker caseload size, child’s 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 provider’s and 

caseworker’s 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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 12 
FINDINGS FINDINGS 

Ninety-seven percent of sampled children Illinois DCFS requires that all 

received Initial Health Screenings within children entering DCFS custody 

required timeframes must receive an Initial Health 

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 physician’s 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 

Comprehensive Health Evaluations within all children entering DCFS 

required timeframes custody receive a 

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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 13 
FINDINGS 

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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 14 
FINDINGS 

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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 15 
FINDINGS 

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 

Case Review that a child’s health record be 

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 child’s 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 

child’s 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 child’s 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 child’s 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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 16 
FINDINGS 

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 child’s 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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 17 
RECOMMENDATIONS

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, children’s 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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 18 
RECOMMENDATIONS 

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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 19 
OEI - 07 - 00 - 00642 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : LLINOIS 20

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.

ID Sex Age

(years)

Placement

setting

Entries

into foster

care (1)

Months since

last entry (2)

Placements

since last

entry (3)

Months since

last

placement (2)

Caseworkers

since last

entry

Months

caseworker

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

APPENDIX~A

I
APPENDIX~A 

ID Sex Age 

(years) 

Placement 

setting 

Entries 

into foster 

care (1) 

Months since 

last entry (2) 

Placements 

since last 

entry (3) 

Months since 

last 

placement (2) 

Caseworkers 

since last 

entry 

Months 

caseworker 

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 child’s 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 child’s 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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 21 
OEI - 07 - 00 - 00642 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : LLINOIS 22

Medicaid Claims for Sampled Children

The table below indicates each child’s 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

ID Physician’s 

office

Dental

services

Prescription 

medications

Mental health

services

Health 

Passport in 

case file

IHS(1) CHE(2) MHS(3) Medical Dental

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

APPENDIX~B

I
APPENDIX~B 

Number of Medicaid Claims Initial Examinations (4) Current EPSDT 

ID Physician’s 

office 

Dental 

services 

Prescription 

medications 

Mental health 

services 

Health 

Passport in 

case file 

IHS(1) CHE(2) MHS(3) Medical Dental 

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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 23 
APPENDIX~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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 24 
APPENDIX~C

OEI - 07 - 00 - 00642 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 25
APPENDIX~C 

OEI - 07 - 00 - 00642 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 26
 APPENDIX~C 

OEI - 07 - 00 - 00642 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 27
� APPENDIX ~ D

OEI - 07 - 00 - 00642 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 28
ACKNOWLEDGMENTS

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 C HILDREN’ S USE OF H EALTH C ARE WHILE IN F OSTER CARE : ILLINOIS 29