The agreed to legislation on opioids (see below), HR 6, fixes a glitch in the ACA that mandates that any young person that ages out of foster care is covered by Medicaid to age 26. Through the work of Congressperson Karen Bass (D-CA), the provision was included in the House version of the opioids legislation but it was not in the Senate bill.

The provisions was included in the Affordable Care Act but because of the way the language was written, it was interpreted by HHS as only applying to states where the young person was in foster care. Young people who were covered but moved to another state perhaps to connect with relatives, to attend college or live in area where state lines are in close proximity (imagine the Washington DC-Virginia-Maryland area) would not be covered by this extended Medicaid coverage unless the state opted to provide that coverage—most states have not. The fix will now extend to youth that have “aged-out” of the system regardless of the state. The legislation also directs HHS to develop state strategies on outreach.

In addition the legislation includes the Youth Medicaid Protection Act that requires that states suspend and not terminate Medicaid for youth (up to 21) who are incarcerated. This change should ensure greater access to Medicaid upon release if they are still eligible. This is critical for youth who need health services of all kinds.

The age 26-ACA provision was originally promoted by Senator Mary Landrieu (D-LA) who worked to add the provision to what ultimately became the ACA. It was designed to mirror ACA protections that allow young adults to age 26 to continue on their parent’s health insurance plans. In the years since the 2010 enactment a fix was not possible because changing anything—especially technical fixes—was so politically toxic when it came to the ACA.

The new provisions, however do not take immediate effect.