A group often overlooked in Medicaid coverage conversations is foster youth. While they are a small segment of the population, youth aging out of foster care have higher physical and mental health care needs than their peers, but often lack health insurance due to high costs. The authors of the Affordable Care Act (ACA) took into account the needs of former foster youth and the fact they don’t have families to fall back on for help when they included a provision allowing former foster youth to continue their Medicaid coverage until age 26. The provision offered them similar protection to young adults who can remain on their parents’ coverage until age 26 under one of the most popular provisions of the ACA.

Medicaid offers former foster youth affordable access to comprehensive medical and mental health care services as they move into adulthood, however, not all those the law intended to help are receiving those benefits. A technical error in the ACA limited this coverage to only those youth who remained in the state in which they were in foster care. The 2018 SUPPORT Act amended the statute, but phases in the fix such that coverage will not be available for all former foster youth who move out of state until 2031.

In our new brief, we discuss ways that states can former foster youth to help this group of young people succeed as they enter adulthood.

Given the high needs of this population and their known Medicaid eligibility, states are encouraged to seek an 1115 demonstration waiver to align coverage for all out-of-state former foster youth under age 26. Nearly half of the states have taken action: 11 states have approved 1115 waivers, 4 states have 1115 demonstration applications pending with CMS, and 6 states are covering all FFY through approved 1902(e)(14) waivers.

Finally, the brief highlights ways that states are simplifying enrollment and boosting outreach and education efforts to this population. For example, California uses a single page application specifically for former foster youth, that bypasses the collection of income and other information which is not relevant for this population. Other strategies include ensuring enrollment in Medicaid’s Former Foster Care Children (FFCC) group prior to exiting foster care, educating youth about Medicaid and how to stay enrolled, and adopting automatic renewal for former foster youth until age 26. For example: proactive enrollment processes in Georgia eliminate the need for youth to complete a Medicaid application and state legislation in Arizona requiring the state to seek a section 1115 demonstration waiver (currently pending) to effectively provide continuous enrollment for the FFCC group until age 26.

Youth health advocates should encourage their states expedite the adoption of this change so former foster youth don’t have to wait until 2031 to receive the benefits the Affordable Care Act intended for them. Outreach, education, and enrollment process simplifications are also critical to ensuring that all former foster youth receive the continuity of Medicaid coverage as they transition toward independence.