HMO to Provide Care for Children in Foster Homes; Abri Health Plan Gets Pending Contract for Pilot Program
In a pilot program considered the first of its kind in the country, Abri Health Plan, a new Medicaid HMO, has won a pending contract to care for about 3,500 children in foster care and two affiliated programs in Milwaukee County.
The contract from the Department of Health and Family Services could be worth $14 million to $15 million a year, said Jayne Wick, Abri’s executive vice president.
The goal is to coordinate and track care for a group of children whose lives often have little stability and who frequently have behavioral problems.
“What we are trying to do is build a model that can be taken to other counties and other states, which is to provide good managed care for foster children,” Wick said.
Children in foster care; in kinship care, in which a child is placed with a family member other than a parent; and in subsidized adoption are eligible for health care through the Medicaid program.
Abri received a letter of intent from the state earlier this summer and hopes to have a contract in place in the fall.
In a Medicaid HMO, the state pays a fixed amount each month to provide care to people who are eligible for Medicaid or BadgerCare.
As of July, Wisconsin had 356,747 people, primarily children and their parents, enrolled in 13 Medicaid HMOs.
Last month, Children’s Hospital and Health System Inc. won approval from the state insurance commissioner to set up a Medicaid HMO.
Under the pending contract, the state will pay Abri an average of about $350 a month per child the exact amount will vary to provide health care for the children, Wick said.
Last fall, about 3,500 children on any given month were in foster care or the two affiliated programs.
The children in the programs on average have higher health care expenses, particularly for behavioral health.
“We saw a need in the market and an opportunity,” Wick said.
Abri plans to contract with Wraparound Milwaukee to oversee the behavioral health for the children in the HMO.
Wraparound Milwaukee, a program within the Milwaukee County Health and Human Services Department, provides mental health care to children with serious emotional and mental health needs.
The organization already has a network of therapists and other professionals as well as services such as crisis intervention, said Bruce Kamradt, the director of Wraparound Milwaukee.
“It makes sense for them,” Kamradt said. “They don’t have to re- create that.”
Abri, founded last year, was capitalized with an investment of $1.2 million, Wick said.
The company’s initial investors include Serve-U Pharmacies, a pharmacy benefits manager.
The HMO is drawing on subcontractors to handle such tasks as claims administration.
It is also contracting with the Independent Physicians Network, a group of independent doctors that contracts with health plans, to see patients and provide such services as monitoring use.
Abri has about 3,800 people eligible for Medicaid and BadgerCare enrolled in its health plan.
Wick said the contract will be significant for the new HMO.
“It gives us scale,” she said.
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