States Could Have the Opportunity to Bolster and Speed Up Coverage for Former Foster Care Youth

Longtime readers of Say Ahh! and fellow health policy wonks will know that one of the most bipartisan provisions of the Affordable Care Act extended Medicaid coverage for youth aging out of the foster care system until age 26 if they were enrolled before their 18th birthday. (If not, Tricia Brooks has chronicled all the past developments.) While statements from the policy’s champions indicated that Congressional intent was to have this provision apply broadly, the U.S. Centers for Medicare and Medicaid Services interpreted it narrowly, giving states the option to deny coverage for former foster youth if they aged out of the foster system in another state.

Thankfully Congress rectified this policy glitch in 2018 through the SUPPORT for Patients and Communities Act, and current law requires every state to offer Medicaid coverage to any former foster youth up to age 26 starting January 1, 2023. Until then, former foster youth who have aged out of the system in another state and don’t reside in the 13 states that cover former foster care youth who aged out in another state will have to navigate finding coverage on their own, or go without. Fragmented Medicaid coverage is especially problematic since COVID-19 doesn’t know state boundaries and every state is in the midst of recovery from its health and economic impacts.

Recent legislation introduced by Senator Casey and Representative Bass would speed up the timeline for the foster care-to-26 fix and broaden its reach. The Dosha Joi Immediate Coverage for Former Foster Youth Act would amend the SUPPORT Act to require states to ensure such Medicaid eligibility immediately and the Expanded Coverage for Former Foster Youth Act broadens the categories of former foster youth that would be eligible for Medicaid to 26 coverage, eliminating the qualification that former foster youth must be enrolled in Medicaid while in the foster care system. The legislation would also expand eligibility to include foster youth who left for legal guardianship with a kinship caregiver and foster youth who were emancipated from foster care prior to turning 18.

Both pieces of legislation include a required outreach component, obliging Medicaid programs and child welfare agencies in each state to collaborate and establish a program to increase enrollment of current and newly eligible former foster youth for Medicaid to 26 coverage. Nearly 40 child health and welfare groups, including the American Academy of Pediatrics, support these proposed bills that would eliminate barriers to Medicaid coverage.

It is clear that children in foster care often have complex physical and mental health care needs that must be addressed. And we know that the adverse childhood experiences and the trauma of foster care does not end at a former foster youth’s 18th birthday but can continue to impact their health and wellbeing long after leaving the system. The transition out of foster care is often an arduous one, impacting educational, employment, and subsequently, health outcomes. In line with the ACA’s vision for ensuring all young people have continuity of health coverage as they make major life transitions to post-secondary school or work, it only makes sense that coverage for former foster youth that adequately addresses their healthcare needs should continue with them as well.

Margaux Johnson-Green is a State Health Policy Analyst with the Georgetown University Center for Children and Families.