At long last, a fix in the Affordable Care Act’s Medicaid coverage for former foster youth up to age 26 is back on the table in Congress. I last wrote about this issue almost three years ago, so it has taken far too long for Congress to correct a technical error in the drafting of one of the ACA’s non-controversial provisions – extending coverage in Medicaid for foster youth who are aging out of the child welfare system.
Given the time lapse, let’s back up and explain the issue. One of the most popular, noncontroversial outcomes of the ACA (yes, there are a few!) is allowing young adults to remain enrolled on their parents’ health plan until the age of 26. But foster youth who age out of the child welfare system do not have parents to fall back on. More importantly, 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.
What is most frustrating is that the error – the inclusion of the word “the” versus “a” state – was never intended. But this seemingly small mix-up in wording results in a very different legal interpretation so that a former foster youth is only guaranteed coverage as long as s/he remain in the same state where they were in foster care and enrolled in Medicaid. This means that youth who move out of state to take a job or go to school, or simply move across the border in urban areas to secure more affordable housing are out of luck.
The proposed language also fixes another problem – requiring states to screen former foster youth for eligibility in other income-based Medicaid categories (i.e. children’s Medicaid in states that cover 19- and 20-year old, pregnant women, and low-income parents). There is no benefit to young adults to be enrolled as a pregnant woman, low-income parent, or child. In fact, it just presents an opportunity for individuals to slip through the cracks when they give birth or age out of children’s Medicaid. The new language allows states to verify former foster youth status and enroll them in Medicaid if they are not enrolled under another category. No longer are states required to screen for other categories, which includes a full income-based eligibility determination. This change paves the way for simplified application forms for former foster youth like the one California uses.
The proposal also takes another positive step. It directs CMS to identify best practices for states to:
- remove barriers and ensure streamlined, timely access to Medicaid coverage for former foster youth up to age 26;
- track the Medicaid coverage status and verify Medicaid eligibility for such youth; and,
- conduct outreach and raise awareness among former foster youth regarding Medicaid coverage options.
This is a simple fix and surely one that Congress can get behind. The provision may move forward in the House of Representatives as part of legislation to address the opioid epidemic. It was among the bills that were approved by the House Energy and Commerce Committee. So far there is no sign that this is moving forward in Senate.
It’s appropriate for Congress to consider the needs of foster children as part of their response to the opioid epidemic given that this crisis has accelerated the placement of more children in foster care while their parents receive the treatment that they need to tackle the disease of addiction.