Do children in foster care receive appropriate treatment for asthma?

• Asthma and persistent asthma was more prevalent among children in foster care.
• Stable foster care in a home setting was associated with better asthma management.
• Children living in congregate care fared worse on measures of health care utilization.
• Children in congregate care had 4 times the rate of hospitalization due to asthma.
• Children in congregate care had fewer outpatient visits for asthma.

Asthma is the most common childhood chronic disease, and children in foster care have the highest rates of chronic conditions of any studied child population. The purpose of this study is to determine whether there are disparities in asthma management and health care utilization between children in foster care and other children covered by Medicaid in the state of Illinois. We use performance measures developed by the state child welfare system as well as those developed by the National Committee on Quality Assurance and used throughout the country. The study sample was drawn from linked administrative data on children in foster care and paid Medicaid claims. In order to determine the influence of living arrangement setting within the child welfare system, children in foster care were further grouped according to whether they lived in a stable home setting, a stable congregate care setting, or other living arrangement. We found that children living in home settings performed better on most performance measures than income-eligible Medicaid children. In contrast, children with asthma living in congregate care were particularly vulnerable as reflected in poor asthma care measurements and high utilization of hospitalizations despite positive performance on indicators of medication use. This population presents a significant challenge to the child welfare and health care delivery systems.