Most children enter out-of-home care in a poor state of health. For many, placement in a stable environment with competent foster caregivers can be a positive and nurturing experience. The out-of-home care system, however, may not respond appropriately to children with multiple or complex health problems. Chronic forms of abuse and neglect that most often result in out-of-home placement frequently include the neglect of basic preventive and primary health care. Research suggests that health care services for children are most effective when they are freely accessible and comprehensive. Nonetheless, few child welfare agencies have specific policies and programs to address children's health care needs. Obstacles to child health care and approaches to providing health care services for children in the out-of-home care system are discussed. Health care standards for children in placement are examined, particularly with respect to initial health screening, health care records, comprehensive health assessment, primary health care, health care information management, and health care organizational and administrative structures. A research agenda is proposed to refine and direct future child welfare policies and practices. 38 references and 1 figure