I’ve written before about an unintended flaw in the Affordable Care Act that relates to Medicaid eligibility for former foster youth. The simple use of the words “the” versus “a” state has led to an interpretation of the law that allows states to deny coverage to young adults who were in foster care in a different state. Pennsylvania Senator Casey has proposed legislation, S. 1852, to fix the problem. Although the bill’s summary and language have not yet been released, we know that the bill will require all states to provide Medicaid to former foster youth until age 26, regardless of where they were in foster care. Currently, only 13 states (CA, GA, LA, KY, MA, MI, MT, NM, NY, PA, SD, VA, WI) have opted to cover former foster youth from other states.

Giving states such an option was not what the provision’s chief sponsor, Senator Mary Landrieu (LA), intended based on her remarks on the Senate floor on December 22, 2009 as she described how the provision would mirror the ACA’s most popular provision – allowing young adults to stay on their parents’ health policy. According to the Congressional Record, Senator Landrieu said “…my question was, where do the young people who age out of the foster care system sign up, because they do not have parents? I was proud to work on a provision that Leader Reid included in this bill to ensure that every young person who ages out of the foster care system will be able to stay on Medicaid until the age of 26 starting in 2014 (italics added). Almost 30,000 young people age out of the foster care system every year, having never been adopted or reunified with their birth parents. The fact that they aged out is our failure as government. We have failed them once and we just can’t fail them twice. We must support their transition to adulthood, and guaranteeing access to quality health care will help with that transition.”

Since Senator Casey’s proposal has not yet been posted, it makes us wonder if he proposes a fix for another complication in the provision. Currently, the language restricts eligibility to former foster youth who are not eligible for (described in) or enrolled in any mandatory category of Medicaid eligibility. Without getting into the weeds too much, this means that states are supposed to assess eligibility for the youth for disabled, pregnant women, low-income parent, and poverty level children groups before enrolling the individual in the former foster youth category. But doing so requires a full Medicaid application including information about income and tax filing status when it does not impact the individual’s eligibility as a former foster youth. Alternatively, a simple one-page application would suffice to provide the required information to determine eligibility for a former foster youth.

We believe that former foster youth with disabilities are being routed to coverage that may provide more robust benefits. However, there is no real benefit to the youth to be enrolled as a pregnant woman, low-income parent, or child. In fact, it just presents an opportunity for that individual to slip through the cracks when they give birth or age out of children’s Medicaid. We can fix this by striking “described in” so that eligibility in the former foster youth category is only limited to those who are actually “enrolled” in another category of coverage.

Hats off to Senator Casey for his leadership on this issue. Former foster youth do not have parents to fall back on. Moreover, due to the neglect or abuse they endured as children, they have higher medical and mental health needs. At the very least, we should make sure they can receive the health care services they need to support their transition to independence and adulthood.