Last Wednesday Senator Bob Casey (D-PA) offered an amendment in a committee deliberation to assure Medicaid coverage for young people who had been in foster care.  Under the ACA a young person who exits foster care at 18 (or older) is covered by Medicaid to age 26.  There has been a complication with the provision because HHS has indicated that the coverage (which is mandatory for all states regardless of whether they expand Medicaid under the ACA) does not carry over if a young person was in foster care in one state and lives in a different state. The Casey amendment was offered at a Senate Finance Committee debate over a health care provision dealing with veterans.  He withdrew the amendment because it was ruled not germane to the legislation being voted on.

Senator Casey indicated that he was offering the amendment to clarify Congress’s intent with regards to states’ obligation to extend Medicaid coverage to former foster youth. To qualify, individuals must be under the responsibility of the state when they turn 18 (or older, if the state’s federal foster care assistance under title IV-E continues beyond that age), and to enroll in or maintain Medicaid eligibility, they must have been enrolled in Medicaid while in foster care and not yet reached the age of 26.

On January 22, 2013, CMS issued a proposed rule in the Federal Register, which clarified CMS’s interpretation that a youth is only eligible for Medicaid coverage in the same state in which he or she was in foster care at age 18 and enrolled in Medicaid. CMS gave states the option to cover youth under this group who were in foster care and Medicaid in any state at the relevant point in time but did not require that they do so. On July 15, 2013 CMS published the final rule, clarifying several outstanding issues but did not revisit the state option.  CMS has indicated that it cannot interpret the statute in a more expansive way.