Foster Parent Guide
Healthcare & Insurance for Foster Children
Every child in foster care gets full Medicaid coverage. Here's what that actually means day-to-day: getting doctors set up, filling prescriptions, and knowing when to push for specialists.
The short version: You will never get a medical bill for a foster child in your care. Medicaid covers them fully, no premiums, no copays, no deductibles. That said, figuring out how to actually use it (which providers accept it, how prior authorizations work, what happens when a child needs a specialist) takes some learning. That's what this guide is for.
🏥 Medicaid: The Basics
Federal law requires that all children in foster care receive Medicaid coverage. This comes from Title IV-E of the Social Security Act and has been in place for decades. It applies regardless of the child's immigration status, pre-existing conditions, or how long they've been in care.
In Pennsylvania, the program is called Medical Assistance (MA). You'll hear both terms, Medicaid and Medical Assistance, and they mean the same thing in this context.
What's Covered
- ✓All doctor visits (primary care and specialists)
- ✓Dental care (cleanings, fillings, extractions, orthodontia in some cases)
- ✓Vision exams and glasses
- ✓Prescriptions (including psychiatric medications)
- ✓Mental health therapy and counseling
- ✓Behavioral health services
- ✓Hospital stays and ER visits
- ✓Early intervention services (birth to age 3)
- ✓Physical, occupational, and speech therapy
- ✓Medical equipment and supplies
In Pennsylvania, most foster children are enrolled in a managed care plan under Medicaid, typically through a company like UPMC, Aetna Better Health, or Keystone First. Your caseworker or agency will tell you which plan the child is enrolled in when they're placed.
💳 Getting the Insurance Card
When a child is placed with you, they should already have Medicaid active. Getting the actual card in hand can take a little longer, sometimes a week or two after placement.
In the meantime, you can usually get a temporary proof of coverage from the caseworker or by calling the PA Department of Human Services. Don't delay urgent care waiting for the physical card. Providers can verify coverage by phone if needed.
Practical Steps at Placement
- 1.Ask the caseworker for the child's Medicaid ID number right away, you'll need it before the card arrives
- 2.Find out which managed care plan the child is enrolled in (UPMC, Aetna Better Health, Keystone First, etc.)
- 3.Call the plan's member services to confirm coverage and ask for a list of in-network providers near you
- 4.Schedule the required initial medical examination, PA requires this within 30 days of placement
🔍 Finding Doctors Who Accept It
This is the practical challenge most new foster parents hit. Not every doctor's office accepts Medicaid, or more accurately, not every office accepts every Medicaid plan. The managed care layer (UPMC, Aetna, etc.) adds another step.
Call ahead before scheduling. Ask two things: do you accept Medical Assistance, and are you in-network for [specific plan]? Those are different questions and both matter.
Tips for Finding Good Providers
- •Start with your agency: Many agencies keep a list of providers in the area who regularly work with foster families and accept Medicaid
- •Community health centers (federally qualified health centers) always accept Medicaid and tend to be experienced with complex cases
- •Pediatric practices at children's hospitals almost always accept Medicaid, CHOP, Children's of Pittsburgh, etc.
- •Use the member portal on the child's Medicaid plan website to search in-network providers by zip code
Once you find a good pediatrician who accepts Medicaid and genuinely understands foster care, stick with them. That relationship is worth maintaining across multiple placements.
💊 Prescriptions & Medications
Medicaid covers prescriptions for foster children. Most common medications are covered without issue. The complications usually come up with brand-name medications or psychiatric medications that require prior authorization.
Prior Authorization
Some medications need prior authorization, meaning the insurance plan has to approve them before they'll cover the cost. This is common for ADHD medications, psychiatric medications, and some specialty drugs.
If a pharmacy tells you a medication isn't covered, don't give up. Ask the prescribing doctor's office to submit a prior authorization request. It usually takes a few days and is often approved. If denied, you can appeal, or ask the doctor if there's an equivalent covered medication.
Children coming into care often arrive with no medication history. You may not know what they've been prescribed before, or whether they've been taking it consistently. The initial medical exam is a good opportunity to review this with the pediatrician and get a baseline.
Keep a simple medication log for any child in your care: what they take, the dose, and when. This matters a lot when there are caseworker changes or transitions.
🧠 Mental Health Services
Most children who come into foster care have experienced trauma. A lot of them need mental health support, and Medicaid covers it. Therapy, counseling, psychiatric evaluations, and behavioral health services are all included.
In Pennsylvania, behavioral health services for children in foster care run through the county Mental Health/Intellectual Disabilities (MH/ID) office or through the managed care plan. This is sometimes a separate card or authorization process from regular medical care. Your caseworker should help connect you.
Trauma-Focused Therapy
Ask specifically for a therapist trained in Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). This is the evidence-based approach for children who've experienced trauma and it's covered by Medicaid. Not every therapist has this training, it's worth asking.
Behavioral Support in the Home
For children with significant behavioral challenges, you may be able to get in-home behavioral support services covered by Medicaid. These are workers who come to your house to help the child (and you) build skills. Ask the caseworker or the child's therapist about BHRS (Behavioral Health Rehabilitation Services) in Pennsylvania.
👨⚕️ Specialist Referrals
Foster children often need specialists, developmental pediatricians, neurologists, audiologists, orthopedists, and so on. Medicaid covers these visits. The process is pretty much the same as with any insurance: get a referral from the primary care doctor, then schedule with an in-network specialist.
The main friction point is finding specialists who accept Medicaid. In some areas and specialties, wait times can be long. If a child has a known need coming into placement, start the referral process early.
Developmental Pediatrics
If a child has developmental concerns, delays in speech, motor skills, or social development, ask for a referral to a developmental pediatrician. Children under 3 can also be referred to Early Intervention, which is a separate system (funded by the state) that provides evaluations and services at no cost. Early Intervention is worth pursuing aggressively for young children.
🦷 Dental & Vision
Both are covered. Dental care includes cleanings, x-rays, fillings, extractions, and in some cases orthodontic treatment. Vision includes eye exams and glasses. You'll need to find dentists and optometrists who accept Medicaid, which is usually easier than finding specialists.
Many children coming into care haven't had dental care in a while. Don't be surprised if there's a lot of catch-up work needed. Schedule a dental exam early.
A note on glasses: if a child is prescribed glasses through Medicaid, there may be a limited selection at covered providers. Some families pay a small amount out of pocket to get frames the child actually likes. Totally optional, but kids are more likely to wear glasses they chose themselves.
❓ Common Questions
Do I need permission from the caseworker before taking the child to the doctor?
For routine and urgent medical care, generally no, you can take the child without prior approval. For elective procedures, surgeries, or major dental work, you typically need the caseworker's sign-off since the child is in the legal custody of the county. When in doubt, give the caseworker a quick heads-up.
What if a child already has a doctor they've been seeing?
Try to keep that relationship if you can, especially for kids who have any continuity with providers. Check whether that doctor accepts the child's Medicaid plan. If they don't, the caseworker may be able to help arrange a continuity of care exception.
Who signs medical consent forms?
The county agency (via the caseworker) holds medical consent authority for children in foster care in Pennsylvania. In practice, foster parents handle routine care and sign forms as the child's caregiver, but for anything significant, the caseworker may need to formally consent. Get clarity on this with your specific agency at the start of the placement.
What if a treatment gets denied by Medicaid?
You can appeal. Start with the managed care plan's appeal process. If that doesn't work, you can request a fair hearing through the state. Your agency may also be able to advocate on your behalf. Don't accept the first 'no' if the treatment is genuinely needed.
What happens to the child's Medicaid when they're reunified or move to another placement?
Medicaid follows the child, not the placement. When a child leaves your care, their coverage continues, you just won't be the one using it anymore. Make sure to pass along any medical records, medication lists, and provider information to help with continuity.
✅ The Bottom Line
The coverage is good. Better, honestly, than what many working families have. No bills, no copays, and a wide range of services covered. The learning curve is mostly practical, figuring out which providers to call, how to get prior authorizations, and who to contact when something doesn't work.
Connect with other foster parents in your area. They'll know which pediatricians, dentists, and therapists are good and actually accessible. That local knowledge is worth more than any list we could give you.
And if you hit a wall (a denial, a long wait, a provider who won't help), your caseworker and your agency are there to advocate. Use them.
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