Libby Foster

Areas of Focus

Libby brings deep expertise in child welfare policy, Medicaid financing, and cross‑system program design, with a focus on services for children with complex behavioral health needs. Her work spans congregate care reform, foster care specialty managed care, therapeutic and residential service models, and strategies to reduce length of stay and reliance on institutional settings.

Libby regularly advises clients on aligning child welfare program goals with Medicaid authorities, including state plan services, waivers, and managed care arrangements. She has extensive experience translating federal policy frameworks—such as Title IV‑E and the Families First Prevention Services Act (FFPSA)—into operationally feasible and financially sustainable program designs. Her work emphasizes evidence‑based policy, defensible financing structures, and clear accountability for outcomes.

In addition to program design, Libby supports rate setting, incentive design, and performance metric development for child welfare and Medicaid initiatives. She facilitates stakeholder engagement with providers and community partners and regularly advises state leadership on policy and financing strategies. Her approach prioritizes cross‑agency collaboration—particularly between Medicaid and child welfare agencies—and data‑driven methods to strengthen care continuums, maximize federal funding, and improve service delivery.

Libby collaborates closely with multidisciplinary teams and state partners across Medicaid, child welfare, and behavioral health agencies, with experience spanning multiple states and delivery models. Her work focuses on leveraging existing resources more effectively through cross‑agency coordination rather than creating duplicative systems.

Prior Experience

Libby is an accomplished leader in child and family services with extensive experience advancing innovative, evidence‑based, and data‑driven practices. Over the course of a 20‑year career, prior to joining Milliman, she worked across four states (NY, NC, IL, and WI), gaining a deep understanding of differing child welfare program designs and operating environments. She has developed and tested new service delivery models, led large federally funded research initiatives, and designed custom program data systems. Her work includes managing statewide service expansions, supporting organizational culture change, and partnering in the development of advanced analytics tools to improve outcomes for youth in foster care. Libby has also led large teams and cross‑departmental improvement initiatives. In addition, she has partnered closely with executive leadership on strategic planning and business expansion, secured exclusive statewide contracts, and integrated comprehensive data systems.