{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T07:52:17Z","timestamp":1783497137117,"version":"3.55.0"},"reference-count":46,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>The burden of the US opioid crisis has fallen heavily on children, a vulnerable population increasingly exposed to parental opioid use disorder (POUD) in utero or during childhood. A paucity of studies have investigated foster care involvement among those experiencing parental opioid use during childhood and the associated health and health care outcomes.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine the health and health care outcomes of children experiencing POUD with and without foster care involvement.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This population-based cohort study used nationwide Medicaid claims data from January 1, 2014, to December 31, 2020. Participants included Medicaid-enrolled children experiencing parental opioid use\u2013related disorder during ages 4 to 18 years. Data were analyzed between January 2023 and February 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Person-years with (exposed) and without (nonexposed) foster care involvement, identified using Medicaid eligibility, procedure, and diagnostic codes.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The main outcomes included physical and mental health conditions, developmental disorders, substance use, and health care utilization. The Pearson \u03c72<\/jats:sup> test, the t<\/jats:italic> test, and linear regression were used to compare outcomes in person-years with (exposed) and without (nonexposed) foster care involvement. An event study design was used to examine health care utilization patterns before and after foster care involvement.<\/jats:p><\/jats:sec>Results<\/jats:title>In a longitudinal sample of 8\u202f939\u202f666 person-years from 1\u202f985\u202f180 Medicaid-enrolled children, 49% of children were females and 51% were males. Their mean (SD) age was 10 (4.2) years. The prevalence of foster care involvement was 3% (276\u202f456 person-years), increasing from 1.5% in 2014 to 4.7% in 2020. Compared with those without foster care involvement (8\u202f663\u202f210 person-years), foster care involvement was associated with a higher prevalence of developmental delays (12% vs 7%), depression (10% vs 4%), trauma and stress (35% vs 7%), and substance use\u2013related disorders (4% vs 1%; P<\/jats:italic>\u2009&amp;lt;\u2009.001 for all). Foster children had higher rates of health care utilization across a wide array of preventive services, including well-child visits (64% vs 44%) and immunizations (41% vs 31%; P<\/jats:italic>\u2009&amp;lt;\u2009.001 for all). Health care utilization increased sharply in the first year entering foster care but decreased as children exited care.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study of Medicaid-enrolled children experiencing parental opioid use\u2013related disorder, foster care involvement increased significantly between 2014 and 2020. Involvement was associated with increased rates of adverse health outcomes and health care utilization. These findings underscore the importance of policies that support children and families affected by opioid use disorder, as well as the systems that serve them.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.10432","type":"journal-article","created":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T15:01:08Z","timestamp":1715180468000},"page":"e2410432","source":"Crossref","is-referenced-by-count":8,"title":["Foster Care and Health in Medicaid-Enrolled Children Experiencing Parental Opioid Use Disorder"],"prefix":"10.1001","volume":"7","author":[{"given":"Ang\u00e9lica","family":"Meinhofer","sequence":"first","affiliation":[{"name":"Department of Population Health Sciences, Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nisha","family":"Chandra","sequence":"additional","affiliation":[{"name":"Medical College, Weill Cornell Medicine, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desislava","family":"Byanova","sequence":"additional","affiliation":[{"name":"Independent Researcher, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine M.","family":"Keyes","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Columbia University Medical Center\/New York State Psychiatric Institute, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,5,8]]},"reference":[{"issue":"9","key":"zoi240380r1","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1001\/jamapediatrics.2019.1738","article-title":"Trends in foster care entry among children removed from their homes because of parental drug use, 2000 to 2017.","volume":"173","author":"Meinhofer","year":"2019","journal-title":"JAMA Pediatr"},{"key":"zoi240380r2","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/j.childyouth.2018.05.015","article-title":"The role of substance use in child welfare caseloads.","volume":"90","author":"Ghertner","year":"2018","journal-title":"Child Youth Serv Rev"},{"key":"zoi240380r3","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1016\/j.chiabu.2018.10.001","article-title":"State-level variation in the relationship between child removals and opioid prescriptions.","volume":"86","author":"Quast","year":"2018","journal-title":"Child Abuse Negl"},{"key":"zoi240380r4","doi-asserted-by":"publisher","first-page":"52","DOI":"10.1016\/j.addbeh.2019.01.015","article-title":"The relationship between foster care entries and high-dose opioid prescribing in California.","volume":"93","author":"Quast","year":"2019","journal-title":"Addict Behav"},{"issue":"2","key":"zoi240380r5","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1001\/jama.2020.24991","article-title":"Neonatal abstinence syndrome and maternal opioid-related diagnoses in the US, 2010-2017.","volume":"325","author":"Hirai","year":"2021","journal-title":"JAMA"},{"key":"zoi240380r6","doi-asserted-by":"publisher","DOI":"10.1016\/j.childyouth.2019.06.016","article-title":"How many children live with adults with opioid use disorder?","volume":"104","author":"Bullinger","year":"2019","journal-title":"Child Youth Serv Rev"},{"issue":"4-6","key":"zoi240380r7","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1080\/1067828X.2021.1971130","article-title":"The consequences of postnatal parental opioid misuse on child well-being: a scoping review.","volume":"29","author":"Day","year":"2020","journal-title":"J Child Adolesc Subst Abuse"},{"issue":"9","key":"zoi240380r8","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.1016\/j.clinthera.2019.06.003","article-title":"The impact of the opioid epidemic on children and adolescents.","volume":"41","author":"Winstanley","year":"2019","journal-title":"Clin Ther"},{"key":"zoi240380r9","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1186\/s13034-019-0266-3","article-title":"The effects of parental opioid use on the parent-child relationship and children\u2019s developmental and behavioral outcomes: a systematic review of published reports.","volume":"13","author":"Romanowicz","year":"2019","journal-title":"Child Adolesc Psychiatry Ment Health"},{"key":"zoi240380r10","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1016\/j.chiabu.2016.12.009","article-title":"Adverse childhood experiences among children placed in and adopted from foster care: evidence from a nationally representative survey.","volume":"64","author":"Turney","year":"2017","journal-title":"Child Abuse Negl"},{"issue":"4","key":"zoi240380r11","doi-asserted-by":"publisher","first-page":"e1142","DOI":"10.1542\/peds.2015-2656","article-title":"Health care issues for children and adolescents in foster care and kinship care.","volume":"136","author":"Szilagyi","year":"2015","journal-title":"Pediatrics"},{"issue":"5","key":"zoi240380r12","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-1118","article-title":"Mental and physical health of children in foster care.","volume":"138","author":"Turney","year":"2016","journal-title":"Pediatrics"},{"issue":"2","key":"zoi240380r13","doi-asserted-by":"publisher","first-page":"336","DOI":"10.1542\/peds.2006-1995","article-title":"The impact of placement stability on behavioral well-being for children in foster care.","volume":"119","author":"Rubin","year":"2007","journal-title":"Pediatrics"},{"issue":"2","key":"zoi240380r14","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1111\/cfs.2009.14.issue-2","article-title":"Mental health of current and former recipients of foster care: a review of recent studies in the USA.","volume":"14","author":"Pecora","year":"2009","journal-title":"Child Fam Soc Work"},{"issue":"1","key":"zoi240380r15","first-page":"148","article-title":"Starting young: improving the health and developmental outcomes of infants and toddlers in the child welfare system.","volume":"78","author":"Silver","year":"1999","journal-title":"Child Welfare"},{"issue":"4","key":"zoi240380r16","doi-asserted-by":"publisher","first-page":"386","DOI":"10.1001\/archpedi.1995.02170160040006","article-title":"Health status of children in foster care: the experience of the Center for the Vulnerable Child.","volume":"149","author":"Halfon","year":"1995","journal-title":"Arch Pediatr Adolesc Med"},{"key":"zoi240380r17","doi-asserted-by":"publisher","first-page":"108","DOI":"10.1016\/j.childyouth.2017.02.004","article-title":"Adverse childhood experiences among youth aging out of foster care: a latent class analysis.","volume":"74","author":"Rebbe","year":"2017","journal-title":"Child Youth Serv Rev"},{"issue":"3","key":"zoi240380r18","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1111\/cfs.2006.11.issue-3","article-title":"Early outcomes for young adults transitioning from out-of-home care in the USA.","volume":"11","author":"Courtney","year":"2006","journal-title":"Child Fam Soc Work"},{"issue":"12","key":"zoi240380r19","doi-asserted-by":"publisher","first-page":"2337","DOI":"10.1016\/j.childyouth.2012.08.011","article-title":"Substance use among current and former foster youth: a systematic review.","volume":"34","author":"Braciszewski","year":"2012","journal-title":"Child Youth Serv Rev"},{"issue":"3","key":"zoi240380r20","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1111\/cfs.2006.11.issue-3","article-title":"Assessing the educational achievements of adults who were formerly placed in family foster care.","volume":"11","author":"Pecora","year":"2006","journal-title":"Child Fam Soc Work"},{"issue":"8","key":"zoi240380r21","doi-asserted-by":"publisher","first-page":"1453","DOI":"10.2105\/AJPH.2008.142547","article-title":"Pathways to and from homelessness and associated psychosocial outcomes among adolescents leaving the foster care system.","volume":"99","author":"Fowler","year":"2009","journal-title":"Am J Public Health"},{"issue":"6","key":"zoi240380r22","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0067405","article-title":"Harnessing the Medicaid Analytic eXtract (MAX) to evaluate medications in pregnancy: design considerations.","volume":"8","author":"Palmsten","year":"2013","journal-title":"PLoS One"},{"issue":"9","key":"zoi240380r23","doi-asserted-by":"publisher","first-page":"1222","DOI":"10.1002\/pds.v28.9","article-title":"Validation of mother-infant linkage using Medicaid case ID variable within the Medicaid Analytic eXtract (MAX) database.","volume":"28","author":"Knox","year":"2019","journal-title":"Pharmacoepidemiol Drug Saf"},{"issue":"3","key":"zoi240380r28","doi-asserted-by":"publisher","first-page":"227","DOI":"10.1177\/1077559517712261","article-title":"Can Medicaid claims validly ascertain foster care status?","volume":"22","author":"Raghavan","year":"2017","journal-title":"Child Maltreat"},{"issue":"3","key":"zoi240380r30","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1016\/j.dhjo.2008.04.002","article-title":"Does race influence age of diagnosis for children with developmental delay?","volume":"1","author":"Mann","year":"2008","journal-title":"Disabil Health J"},{"key":"zoi240380r33","doi-asserted-by":"publisher","DOI":"10.1016\/j.childyouth.2020.105336","article-title":"Parental drug use and racial and ethnic disproportionality in the U.S. foster care system.","volume":"118","author":"Meinhofer","year":"2020","journal-title":"Child Youth Serv Rev"},{"issue":"4","key":"zoi240380r34","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1089\/cap.2022.0092","article-title":"Psychotropic medication prescribing: youth in foster care compared with other Medicaid enrollees.","volume":"33","author":"Keefe","year":"2023","journal-title":"J Child Adolesc Psychopharmacol"},{"issue":"5","key":"zoi240380r37","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1111\/add.2004.99.issue-5","article-title":"The impact of parental problem drug use on children: what is the problem and what can be done to help?","volume":"99","author":"Barnard","year":"2004","journal-title":"Addiction"},{"issue":"1","key":"zoi240380r38","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2018-1656","article-title":"Children in the opioid epidemic: addressing the next generation\u2019s public health crisis.","volume":"143","author":"Feder","year":"2019","journal-title":"Pediatrics"},{"issue":"6","key":"zoi240380r41","doi-asserted-by":"publisher","first-page":"728","DOI":"10.1176\/appi.ps.202000388","article-title":"Parental drug use and family reunification.","volume":"72","author":"Sanmartin","year":"2021","journal-title":"Psychiatr Serv"},{"issue":"3","key":"zoi240380r42","first-page":"367","article-title":"Foster care and Medicaid managed care.","volume":"82","author":"Leslie","year":"2003","journal-title":"Child Welfare"},{"issue":"6, pt 2","key":"zoi240380r43","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1542\/peds.89.6.1230","article-title":"Children in foster care in California: an examination of Medicaid reimbursed health services utilization.","volume":"89","author":"Halfon","year":"1992","journal-title":"Pediatrics"},{"issue":"3","key":"zoi240380r45","doi-asserted-by":"publisher","first-page":"478","DOI":"10.2105\/AJPH.2007.117408","article-title":"Longitudinal patterns of health insurance coverage among a national sample of children in the child welfare system.","volume":"98","author":"Raghavan","year":"2008","journal-title":"Am J Public Health"},{"issue":"9","key":"zoi240380r46","doi-asserted-by":"publisher","first-page":"1430","DOI":"10.1377\/hlthaff.2021.00073","article-title":"The Affordable Care Act increased Medicaid coverage among former foster youth.","volume":"40","author":"Bullinger","year":"2021","journal-title":"Health Aff (Millwood)"},{"key":"zoi240380r24","unstructured":"Other chronic health, mental health, and potentially disabling conditions. Chronic Conditions Data Warehouse. Accessed February 22, 2024. https:\/\/www2.ccwdata.org\/web\/guest\/condition-categories-other"},{"key":"zoi240380r25","unstructured":"Information Gateway. Health-care coverage for children and youth in foster care\u2014and after. Child Welfare Information Gateway. January 2022. Accessed August 1, 2023. https:\/\/www.childwelfare.gov\/resources\/health-care-coverage-children-and-youth-foster-care-and-after\/"},{"key":"zoi240380r26","unstructured":"Stoltzfus? E. A detailed overview of program eligibility and funding for foster care, adoption assistance and kinship guardianship assistance under Title IV-E of the Social Security Act. Congressional Research Service. October 26, 2012. Accessed August 1, 2023. https:\/\/crsreports.congress.gov\/product\/details?prodcode=R42792"},{"key":"zoi240380r27","unstructured":"Administration for Children & Families Children\u2019s Bureau. Title IV-E Foster Care Eligibility Reviews Fact Sheet. Children\u2019s Bureau. Accessed September 10, 2023. https:\/\/www.acf.hhs.gov\/cb\/fact-sheet\/title-iv-e-foster-care-eligibility-reviews-fact-sheet"},{"key":"zoi240380r29","unstructured":"Centers for Medicare & Medicaid Services. Early and periodic screening, diagnostic, and treatment. Medicaid.gov. Accessed September 10, 2023. https:\/\/www.medicaid.gov\/medicaid\/benefits\/early-and-periodic-screening-diagnostic-and-treatment\/index.html"},{"key":"zoi240380r31","unstructured":"Administration for Children & Families Children\u2019s Bureau. Trends in foster care and adoption: FY 2012\u20132021. Children\u2019s Bureau. March 20, 2024. Accessed October 17, 2023. https:\/\/www.acf.hhs.gov\/cb\/report\/trends-foster-care-adoption"},{"key":"zoi240380r32","unstructured":"Child population by race and ethnicity in United States. Annie E. Casey Foundation; Kids Count Data Center. Last updated July 2023. Accessed September 10, 2023. https:\/\/datacenter.aecf.org\/data\/tables\/103-child-population-by-race-and-ethnicity#detailed\/1\/any\/false\/1095,2048,574,1729,37,871,870,573,869,36\/68,69,67,12,70,66,71,72\/423,424"},{"key":"zoi240380r35","unstructured":"Allen? K; Center for Health Care Strategies. Health screening and assessment for children and youth entering foster care: state requirements and opportunities. Center for Health Care Strategies. November 2010. Accessed September 10, 2023. https:\/\/www.chcs.org\/media\/CHCS_CW_Foster_Care_Screening_and_Assessment_Issue_Brief_111910.pdf"},{"key":"zoi240380r36","unstructured":"Stoltzfus? E, Baumrucker? E, Fernandes-Alcantara? A, Fernandez? B. Child welfare: health care needs of children in foster care and related federal issues. Congressional Research Service. November 19, 2014. Accessed September 10, 2023. https:\/\/sgp.fas.org\/crs\/misc\/R42378.pdf"},{"key":"zoi240380r39","unstructured":"Child Welfare Information Gateway. Supporting successful reunifications. Child Welfare Information Gateway. 2017. Accessed September 10, 2023. https:\/\/www.childwelfare.gov\/pubPDFs\/supporting_reunification.pdf"},{"key":"zoi240380r40","unstructured":"Child Welfare Information Gateway. The opioid crisis. Children\u2019s Bureau. Accessed September 10, 2023. https:\/\/web.archive.org\/web\/20230605070956\/https:\/\/www.childwelfare.gov\/topics\/systemwide\/bhw\/impact-substance\/opioid-crisis\/"},{"key":"zoi240380r44","unstructured":"Geen? R, Sommers? A, Cohen? M. Medicaid spending on foster children. Urban Institute. August 2005. Accessed August 1, 2023. https:\/\/webarchive.urban.org\/UploadedPDF\/311221_medicaid_spending.pdf"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2818408\/meinhofer_2024_oi_240380_1714484148.08525.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,8]],"date-time":"2024-05-08T15:01:13Z","timestamp":1715180473000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2818408"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,8]]},"references-count":46,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.10432","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,8]]}}}