In a new analysis, Georgetown’s Center for Children and Families and Community Catalyst, take a look at key provisions of the Affordable Care Act (ACA) that hold the promise of improving the health and well-being of the nation’s foster care children and youth. According to government statistics, there were more than 400,000 children and youth living in foster care in 2010. Often as the consequence of maltreatment, these children have high rates of acute and chronic medical, mental health and developmental problems, making high-quality health care coverage a top priority for them.
The key ACA provisions explored in the new issue brief include the following:
MEDICAID COVERAGE FOR FORMER FOSTER YOUTH. Perhaps the most significant provision in the ACA for foster care youth – effective January 1, 2014 – is a requirement that states make former foster care children eligible for Medicaid until they reach the age of 26, provided that they turned 18 while in foster care, and were enrolled in Medicaid at that time. This provision is aimed at giving these young adults the same opportunity for health insurance coverage as a many of their peers who will be eligible for coverage under a parent’s insurance policy until age 26.
MATERNAL, INFANT AND EARLY CHILDHOOD HOME VISITING PROGRAMS. The ACA provides funding for states to expand their maternal, infant and early childhood home visiting programs—programs that have been shown to prevent child maltreatment (and therefore, foster care placement). Additionally, funds from these programs can also be used to assist and support current foster parents and/or pregnant or parenting foster youth.
HEALTH HOMES. The ACA provides incentives for state Medicaid programs to create “health homes” for children and adults with chronic health conditions (including mental health conditions and substance abuse). Since individuals who are or were in the foster care system are at especially high risk for chronic health problems, they stand to benefit substantially from the coordinated and person-centered health care and social services that can be provided in “health homes.”
INCREASED FLEXIBILITY TO PROVIDE HOME AND COMMUNITY-BASED SERVICES. The ACA will also make it easier for states to use Medicaid’s home and community-based services for populations a state chooses to target such as foster or former foster children. This provision could play a significant role in increasing access to mental, emotional, and behavioral health services for children in the foster care system—a population with a sharply elevated need for such services.
POWER OF ATTORNEY REQUIREMENT. Another ACA provision aimed at former foster care children in particular is meant to encourage them to consider who should make medical decisions on their behalf if they are unable to do so. The law requires all foster care transition plans to provide information about how to designate a health care proxy or power of attorney under the state’s laws.
While all of these provisions stand to benefit a particularly high-need population and we commend Congress for recognizing their unique needs, it will be incumbent upon advocates to ensure that states maximize the opportunities provided by the ACA by enacting these provisions fully and effectively. Advocates will also have a crucial role to play in outreach and education to both foster youth and those working with and supporting foster youth to make sure they are aware of these important new services and coverage opportunities.