California's decade of child welfare reforms—including priority placement with families over institutions and expanded kinship care support—requires coordination across healthcare, education, and social services systems. For Medicaid managed care organizations, these shifts affect care for foster children and families receiving behavioral health services, though the piece focuses primarily on child welfare policy rather than Medicaid program specifics. The discussion of trauma-informed care, social determinants, and post-system support touches on areas where MCOs interface with child welfare agencies.

HHS has rescinded the Richardson Waiver, eliminating its longstanding commitment to seek public input before changing Medicaid policies. Because Medicaid is classified as a grant program under the Administrative Procedures Act, CMS may now adopt or revise managed care regulations without formal notice-and-comment periods unless other specific laws require it. This shift could significantly accelerate regulatory changes affecting MCOs and state Medicaid programs, though the extent to which CMS will use this authority remains unclear.

Healthcare providers serving children in foster care face significant challenges including incomplete medical records, behavioral health access barriers, and care disruptions from placement changes. The piece outlines specific strategies for MCOs and providers to leverage Medicaid EPSDT benefits, coordinate with child welfare agencies, and establish medical homes to address gaps—particularly critical given that 30% of foster children don't receive required screenings and 80% have mental health needs. It positions managed care organizations as key partners in creating specialized care models and reimbursement structures to support this vulnerable population.

A consulting firm helped Drexel University identify and access public funding mechanisms—likely including Medicaid supplemental payment programs and provider reimbursement strategies—to maintain operations at St. Christopher's Hospital for Children, a safety-net pediatric facility serving a medically underserved Philadelphia community. The case illustrates how Medicaid financing tools can be leveraged to sustain critical pediatric infrastructure serving vulnerable populations, though the piece is primarily a client testimonial rather than substantive policy analysis.

Sellers Dorsey has published a strategic guide based on California's approach to integrating health and social services within its Medicaid safety-net system, aimed at improving outcomes for underserved populations. The playbook provides actionable frameworks for safety-net leaders to implement similar transformation strategies in their own Medicaid programs. This is particularly relevant as states increasingly look to California's innovations—including CalAIM and whole-person care models—as templates for managed care delivery system reform.