Young adults have historically been among the demographic groups with the highest rates of uninsurance. Many of these young adults are just joining the workforce and are unable to secure jobs with health benefits. In fact, nearly two out of five young adults ages 19 to 29 were without health insurance in 2011, with those in low- and moderate-income households most at risk of being uninsured.

Fortunately, about 13 million young adults have been able to secure coverage by staying on their parent’s plans thanks to the Affordable Care Act. But what about those who don’t have parents in their lives?

With support from the Annie E. Casey Foundation, Georgetown CCF and Community Catalyst joined forces to delve into this question. What we found is that Medicaid has been an important lifeline for children and youth in foster care throughout their childhood.  Thanks to the ACA, it can remain a vital resource as they transition to adulthood.

The Affordable Care Act authors understood the importance of coverage for these young people and included a provision to keep them covered under Medicaid to age 26, effective January 1, 2014. Much like the parallel provision in the ACA that enables young adults to return to their parents’ insurance until the age of 26, this provision provides a similar safety net for former foster youth provided they are in foster care at the age of 18.

Nearly all children in foster care are enrolled in Medicaid, and many continue to receive Medicaid when they leave foster for adoption or kinship care. The medical needs of youth in foster care are often complex and require a more robust source of coverage than many of their non-foster care peers. Seeing these needs, some states have taken advantage of the option to expand Medicaid eligibility for former foster care youth up to age 21.  But in states that have not taken this option, these youth are transitioning from foster care into independent living but lose the one constant source of coverage they have had throughout their years in the child welfare system. The ACA will ensure that no matter where they live, every youth aging out of foster care keeps their coverage.

Regulations on this provision have not yet been issued, so many questions remain as to how this aspect of the ACA will be implemented. These include:

• Will this coverage extend to foster youth turning 18 between now and January 1, 2014 (when the provision takes effect), or must a child turn 18 after January 1, 2014 to qualify for it?
• What steps must states take to identify eligible youth and inform them of their ongoing eligibility for coverage?
• Can this provision be applied to youth who turn 18 while in the juvenile justice system but who have been or will become foster youth before reaching independence?

In the months ahead, it will be important for the federal government to address these and other key questions to ensure that the provision provides stable insurance coverage to this vulnerable population during their transition to adulthood.

States will also have a critical role to play to implement the provision effectively.  We suggest they start with the following steps.

• Develop efficient and effective mechanisms for former foster youth to continue their Medicaid coverage by providing a simple application process that does not involve burdensome documentation requirements.
• Assess applicable benefit packages to ensure that they are appropriate for the specific health needs of former foster youth. For example, program administrators could evaluate whether covered behavioral health benefits are sufficient for a population that has an especially high need for these services.
• Determine the most effective ways to inform foster parents and youth about the opportunity for former foster youth to qualify for Medicaid. Important resources for this educational process include the youth’s social worker and his or her health care providers, including behavioral health care providers.
• Use other provisions of the Affordable Care Act, such as home visiting, health homes, and home- and community-based services, to improve the health and well-being of children and youth in foster care as well as those who have aged out of foster care but still need support to successfully transition into adulthood.

Medicaid has been a stable, secure source of health care coverage for foster care youth—an inherently transient population—for many years.  Thanks to the Affordable Care Act, these young people can continue to rely on Medicaid it for health care coverage as they struggle to gain solid footing in adulthood. To learn more about this important coverage expansion and other key provisions affecting children in foster care, please see our brief Child Welfare and the Affordable Care Act: Key Provisions for Foster Care Children and Youth or our earlier Say Ahh! post.