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The Affordable Care Act’s Impact for Former Foster Youth

By Cara Baldari

January 17, 2013

One of the most popular and bipartisan parts of the Affordable Care Act (P.L. 111–148, P.L. 111–152) is the provision allowing youth up to age 26 to remain on their parents’ health insurance. Yet there are thousands of youth who “age out” of foster care (meaning they no longer qualify for foster care services) each year and cannot take advantage of this option.

This is particularly troublesome because while the transition to adulthood is a challenging time for any young adult, former foster youth have an even greater set of challenges. Most former foster youth have experienced severe trauma, which can greatly compromise their development and well-being. On top of this, most youth age out of the child welfare system without the supports needed to successfully transition to independent adult life. Twelve to 36% of former foster youth experience homelessness because they lack access to adequate housing upon leaving foster care, and the few federal programs that include services for transitioning youth are severely under-funded.

Therefore, while it is important that foster children and youth are eligible for Medicaid while in foster care, it is equally important that youth continue to be eligible for Medicaid once they age out of the child welfare system. As a group, these youth are particularly in need of continued health coverage during their transition to adulthood.

Seeing the need to provide equal treatment for former foster youth under the Affordable Care Act (ACA) by guaranteeing health coverage up to age 26 (as other youth are able to remain of their parents’ health insurance), First Focus and others worked with Senator Mary Landrieu’s (D-LA) office to include a provision in the Affordable Care Act to allow former foster youth to be automatically eligible for Medicaid up to age 26. Therefore, starting January 1, 2014, former foster youth who were in foster care and receiving Medicaid coverage at age 18 can continue receiving this coverage until age 26.

Although it was a big win for this provision to be included in the ACA, many questions remain as to which former foster youth would be eligible for this expansion of Medicaid coverage, and how this provision would be administered at the state level. Earlier this week, the Centers for Medicare and Medicaid Services (CMS) released a proposed rule (42 CFR Parts 430, 431, 433, 435, 440, 447, and 457; 45 CFR Part 155; [CMS-2334-P]; RIN 0938-AR04) that addressed some of these questions. The proposed rule addresses the coordination of Medicaid, CHIP and the Exchange in ACA implementation and clarifies the provision addressing Medicaid coverage for former foster youth.

First Focus is pleased that this rule clarifies statutory language with respect to Medicaid eligibility for former foster care youth, and thinks the proposed rule is a big win for former foster youth. However, we have some concerns, specifically around CMS’ interpretation of Medicaid coverage as limited to the same state in which a youth was in foster care at age 18. While CMS gives states the option to cover youth who were in foster care and Medicaid in any state at age 18, it does not require that they do so. Former foster youth are an especially vulnerable and highly mobile population. They should be eligible for Medicaid coverage in any state, and once enrolled, should be able to retain their coverage regardless of where they live.

Further details on some of our initial analysis can be found here, and we will be continuing to provide information and resources in the coming weeks on the impacts of the ACA on our nation’s most vulnerable children and youth.

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