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Are You Ready for Health Care Enrollment?

By Tim Briceland-Betts

October 1 marked the start date for enrollment in the new health care program under the Affordable Care Act (ACA), and coverage begins on January 1, 2014. Many millions of Americans and potential clients of child welfare programs are now eligible to sign up for quality, affordable health insurance that wasn't available before. Child welfare case workers and caregivers can play a critical role in helping children and families access the new program. For children in the child welfare system, Medicaid coverage will continue with one major improvement: Starting on January 1, all young people who transitioned out of care will be eligible for coverage under Medicaid until they reach age 26.

The new health program means that for the first time, millions of children, youth, and families will have meaningful access to health care coverage that will significantly increase their health status. In many states, a significant expansion of Medicaid will begin and be available to low-income families. Even if your state has decided not to expand Medicaid, the new health care coverage will be available to low and moderate-income families with substantial subsidies through federally run exchanges. Information is available on resources, eligibility, and how to apply in your state at You can obtain information about Medicaid and the Children's Health Insurance Program, and learn more about health coverage programs for children in your state, by visiting

Access to health care is a significant factor in whether families come into contact with the child welfare system. Children in foster care are at higher risk for physical and mental health issues, stemming from the maltreatment that led to their placement or from preexisting health conditions and unmet long-term health care needs. Medicaid covers basic health care needs for children in foster care and serves as the major source of coverage for special services. These include rehabilitative services, targeted case management, and inpatient psychiatric services. Federal law and regulations require states to provide Early and Periodic Screening, Diagnosis and Treatment (EPSDT) services to Medicaid-eligible children under the age of 21. The EPSDT program is an essential element of providing health care to children in foster care and screens children to uncover physical challenges, mental health problems, developmental delays, and dental needs.

For young people, the lack of health care poses a substantial risk. Studies have shown that almost a fourth of former foster youth had experienced some form of posttraumatic stress later in life. The extension of Medicaid coverage, under the ACA, with a comprehensive benefits package (including EPSDT) will mean the difference between being able to see a doctor and going without treatment for a much-needed health or mental health disorder. Under the ACA, caseworkers will be required to help youths navigate and process information regarding their health care needs while in transition and thereafter, specifically coverage options and health care power of attorney resources. This will also likely reduce the number of uninsured youth while providing a stable safety net to address their overall health needs.

The new health law contains strong Maintenance of Effort requirements on states to maintain eligibility for their Medicaid/Children's Health Insurance Programs (CHIPs). States will be barred from limiting their eligibility for children in Medicaid and CHIPs through 2019, and for adults in Medicaid until 2014, when coverage through new health benefit exchanges is will be available. This has already been a huge shield for children in states that were considering reducing Medicaid or CHIP eligibility.

The ACA provides funding for CHIP through 2015, continues the authority for the program through 2019, and provides financial assistance to states to help facilitate and continue to ensure access to coverage. For CHIPeligible children who cannot enroll in the program due to federal allotment caps, a screening process will be established to determine if they are eligible for Medicaid; if they are not; they will be eligible for tax credits in a plan that is certified to be comparable to CHIP in the exchange.

All of these improvements in benefits can significantly improve the health outcomes of many children, youth, and families that come to our agencies.

Make sure you are ready to assist children and families in signing up for the health care coverage for which they are eligible. Check out the websites referenced above, be ready to provide assistance and answers, and help fill out applications for the new health system.

Tim Briceland-Betts is co-director of CWLAs Government Affairs department.


A bipartisan effort in Florida concluded with Governor Rick Scott signing into law a bill that keeps foster homes open to young adults until age 21, a three-year extension of the current system, in which they must leave once they turn 18. The Nancy C. Detert Common Sense and Compassion Independent Living Act, signed in June, is "the most important bill the governor will have signed all year," the eponymous senator proclaimed upon its passage.

The bill allows young adults about to turn 18 the option of staying in their foster or group home or receiving a stipend to live on their own; if they choose the latter option, they will receive assistance with managing their money.

Moreover, the transitional period from foster child to independent adult will start earlier, with the Department of Children and Families now required to create a plan upon the adolescent's 17th birthday addressing housing, health insurance, education, employment, and other services. According to Children's Home Society, 60% of foster children who have aged out have a child of their own within four years, 33% are homeless within three years, and 25% of males will be incarcerated; by constructing a longer-lasting, more comprehensive support system, the bill aims to remedy these problems and lower the excessive numbers.

Another important byproduct of the legislation is that kids can stay in the same house throughout school. Currently, approximately 70% of teens in the foster care system have not yet graduated from high school or received their general equivalency diploma by the time they turn 18, and interrupting their schooling with the harsh transition of a move exacerbates the difficulties they already face in school. The new system, then, is designed to improve at least in part the educational attainment of foster children. The law goes into effect on January 1, 2014, and will affect approximately 1,300 adolescents each year, per data from the past three years.


A recent campaign to mitigate child abuse in Montgomery County, Maryland, encouraged adults to help children in the community by reporting suspected abuse or becoming foster parents or mentors. April was designated Child Abuse Prevention Month as part of a national effort, and county officials have been giving three presentations a month about warning signs of abuse.

Coupled with the dramatic increase in reported instances of abuse following the widely publicized 2011 Penn State sexual abuse scandal, this heightened vigilance has led to an unmanageable number of investigations across the county, to the tune of a 12% rise over the last two years. To address this unforeseen problem, county and state officials passed legislation in early July to implement a twotiered system for these investigations.

Under the new response structure, officials can differentiate between high-risk allegations, such as sexual and continued physical abuse, and low-risk ones, such as leaving a young child at home without a babysitter. While high-risk investigations could result in the child being placed in foster care, social workers will aim to resolve the latter cases through training to help families take better, safer care of their children.

The goal is not to remove children from their parents' care, especially when the offending incident is isolated and poses no imminent physical danger. The low-risk designation, then, will not only ease the burden on investigators, allowing them to focus on more urgent cases, but also emphasize to families that the system is trying to work with, not against, them.

Moreover, parents found guilty of low-risk abuse will no longer be added to a registry, on which their presence could hamper their chances of being hired for a job involving contact with children or even chaperoning a school field trip.

Approximately 60% of abuse investigations throughout the state of Maryland would be categorized as low-risk as they often involve neglect--an issue exacerbated by widespread financial issues. In the case of a home-alone child, for instance, a parent may have had to take a night shift as a second job without being able to afford a sitter.

Montgomery is one of five counties in Maryland--the others being Frederick, Washington, Allegany, and Garrett-- that is set to implement the tiered system as a test case before officials extend it to the rest of the state, a change they hope to make next year. Nationally, it has already been adopted by more than 20 states, including the District of Columbia.

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