The National Center for Children in Poverty has released a new policy paper on the status of Medicaid access for young people formerly in foster care. The paper, FOSTERING HEALTH: The Affordable Care Act, Medicaid, and Youth Transitioning from Foster Care, describes the impact of a provision in the ACA that requires that youth that exited foster care at 18 or later are covered by Medicaid to age 26. The coverage by Medicaid is required regardless of whether states take the Medicaid option under the ACA. Because of the way the language was written in the law the mandate does not necessarily cover youth who aged out in one state and have moved to another state. According to the brief:
“…an alarming majority of states are denying Medicaid coverage to young people who aged out of foster care in other states. In fact, on April 1, 2016, only 13 states had opted to extend Medicaid coverage to all former foster youth, regardless of the state in which they aged out…no reliable data exist on the number of young people who have been denied Medicaid coverage because they moved to a state not [extending coverage]…
The states that do extend Medicaid to 26 regardless of what state a young person aged out of foster care are, California, Georgia, Kentucky, Louisiana, Massachusetts, Michigan, Montana, New Mexico, New York, Pennsylvania, South Dakota, Virginia, and Wisconsin.
There are bills that would clarify that the coverage extends to all 50 states and Washington DC, the Health Insurance for Former Foster Youth Act (S.1852), was introduced on July 23, 2015, and sponsored by Robert P. Casey, Jr. (D-Pennsylvania) and the House version of the bill (H.R.3641) was introduced on September 29, 2015, and sponsored by Representatives Karen Bass (D-California) and Jim McDermott (D-Washington). They have not seen action because the Congress has refused to make any technical fixes to the ACA wanting to kill the law rather than amend it.
The provision which had been championed by Senator Mary Landrieu (D-LA) was intended to mirror provisions in the ACA that allow parents to keep their adult children on their health insurance to age 26. States have not acted for a variety of reasons, lack of clarity on the provision, attempts to save state dollars by not extending coverage, and lack of information on how to document whether a young person was in foster care—especially in another state. The ACA extended this coverage retroactively to young people who had aged out before the law’s passage if the young person had not reached age 26.
Regarding documentation, the Families First Act, as part of the amendments to Title IV-B does direct states to provide documentation to youth that age out as part of the information package young people are to receive before transition. Another possible reason for lack of state action is that many state child welfare agencies are frequently challenged in coordinating and accessing services via state Medicaid programs. As the paper highlights, states had the option to expand Medicaid coverage to those formerly in foster care until their 21st birthday under Chafee Independent Living program but only 30 states had taken that option and that provision had an income limit of 130 percent of poverty. This law does not have any such income limit.
States have also raised the cost of verifying eligibility as a major barrier. Some have pointed to the fact that there is no electronic data system in place that would enable them to quickly verify that a young person had been in foster care until age 18 in another state, and hence is categorically eligible for Medicaid coverage under the ACA until age 26.