Implementing the ACA’s Extension of Medicaid to Former Foster Youth

It should be one of the health reform law’s most straightforward provisions: young adults who were in foster care and enrolled in Medicaid at the age of 18 (or older in states that extend foster care beyond the 18th birthday) get Medicaid coverage until they turn 26. But a wrinkle developed when HHS released proposed regulations in January, making it a state option to cover young adults who aged out of the foster care system in a different state. Child welfare stakeholders have pointed to the Congressional record as evidence of lawmakers’ intent to cover all former foster care youth, regardless of whether they move to a different state.

It would be a shame to deny former foster youth access to critical health care they need to become independent adults just because they move to another state. Often as the consequence of maltreatment, children and youth in foster care have high rates of acute and chronic medical and developmental problems. Children in foster care use mental health services, both inpatient and outpatient, at a rate 15-20 times higher than the general pediatric population. Approximately 80 percent of children in foster care have a chronic medical condition, and 25 percent have three or more chronic health problems.

While we await the final rule to determine whether HHS will broaden the law’s impact, it’s time to start thinking about how to reach out and ensure that eligible former foster youth get enrolled. To explore outreach opportunities and other policy implications, CCF recently teamed up with advocates in California, New York and Maryland under the Atlantic Philanthropies Kidswell project to host a webinar. If you missed the webinar, you can listen to a recording and access the powerpoint slides here.

During the webinar, Bridget Walsh of the Schuyler Center for Analysis and Advocacy talked about the work advocates are doing in New York to develop partnerships and outreach to the broader child welfare community. Of particular note, they are engaging former foster youth directly in the planning and implementation process. Leigh Cobb of Maryland Advocates for Children and Youth talked about the discussion in Maryland to extend coverage to eligible youth from other states.

In addition to targeted outreach and enrollment efforts, it will be important for state Medicaid and child welfare agencies to find streamlined, and preferably electronic, ways to confirm eligibility for former foster youth who qualify. Annual renewal of coverage should be limited to reconfirming state residency. Presumptive eligibility, whereby designated entities can enroll foster youth temporarily while the state confirms that eligibility, can be a useful tool for connecting these youth to coverage. Additionally, and regardless of whether HHS changes the rule to require states to cover all foster youth, it would be helpful for HHS and the states to put their heads together to figure our an easy way to confirm eligibility across states. For example, HHS could develop a national registry accessed through the federal data services hub, that states use to submit names of youth as they transition out of foster care and can be tapped to confirm eligibility in another state.

We’ll continue to explore issues related to connecting former foster youth to Medicaid as we move closer to full implementation of the ACA. For more information on other provisions of the law that impact foster youth, check out this brief that CCF and our colleagues at Community Catalyst prepared for the Annie E. Casey Foundation.

Tricia Brooks
Tricia Brooks is a Senior Fellow at the Center for Children and Families

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