Foster Care Insurance Plans Leave Kids Without Doctors Willing to Accept Them

When Britany Super learned in early March that UNC Health would not cover her adopted daughter Ollie's CAR T-cell cancer treatment under North Carolina's new foster care insurance plan, the news landed like a verdict. Britany had described the therapy as Ollie's "last option." The 8-year-old had been fighting neuroblastoma since she was a toddler in foster care, and now the very insurance plan designed to help children like her was standing in the way.

The problem was not the treatment itself. It was the network. UNC Health, a state-run system with nearly 4,400 physicians and one of the largest care providers in North Carolina, had not signed on to the state's new Children and Families Specialty Plan when it launched December 1, 2025. That gap left Ollie and her family in more than two months of limbo before UNC Health finally reached an agreement in mid-March with Blue Cross Blue Shield of North Carolina, which runs the plan under the name Healthy Blue Care Together. Even after that deal, some North Carolina doctors still do not accept Healthy Blue insurance.

Ollie's near-miss is not an isolated breakdown. It reflects a structural flaw embedded in how specialized managed care plans for foster children are designed and overseen. North Carolina is one of 14 states operating such plans, which layer an additional insurance structure on top of standard Medicaid, according to the National Academy for State Health Policy. Thousands of doctors whose services were previously covered under Medicaid were not included in the specialized plan when it rolled out, despite the fact that the contract is costing the state $3.1 billion over four years.

The accountability gap runs deeper than one state's rollout problems. Only a handful of states publish data on how these programs are performing, making it nearly impossible to track whether they improve or impede care. Andy Schneider, a research professor at Georgetown University's Center for Children and Families, put it plainly: "The states that are going in this direction, unless they have data to support it, are experimenting. They're putting all their eggs in one basket, so they need to pay close attention."

Four states have launched such plans in just the past five years, and more are expected to follow, said Karen VanLandeghem, senior director of children and family health at the National Academy for State Health Policy. That expansion is accelerating even as the transparency and oversight infrastructure required to catch failures like North Carolina's remain underdeveloped.

Melanie Bush, interim deputy secretary for North Carolina's Medicaid program, said her office has been pressing Healthy Blue to broaden its provider network, even while characterizing the current number as "adequate." That tension between regulatory comfort and on-the-ground reality is precisely where children fall through the cracks. North Carolina had more than 10,800 kids in the foster care system in 2023, the 10th-highest total in the country. Each one of them depends on a plan whose network gaps, prior authorization hurdles, and opaque oversight structure make the promise of seamless care harder to keep than the press releases suggest.

Policy analysts point to several concrete fixes: enforceable network adequacy standards with real penalties for shortfalls, automatic out-of-network approvals when a required specialist is not available in-plan, and dedicated care navigators who can intervene before a family receives a denial notice. Without those guardrails, the next child waiting on a life-saving treatment will be counting on a health system that was not built to catch her.