Report: States’ Choices Decide if Former Foster Youth Get Healthcare
Washington, D.C.—A little-known Affordable Care Act (ACA) provision has the potential to improve the health of young adults who often have significant health care needs and are more likely to be uninsured than their peers: former foster youth. But a new report finds that, like better-known ACA provisions, states’ implementation decisions will effectively determine whether these youth who have experienced abuse and neglect and spent time in foster care get access to the care they need. The Affordable Care Act and Youth Aging Out of Foster Care: New Opportunities and Strategies for Action recommends specific actions states can take to successfully enroll and cover youth under this provision.
The paper was co-authored by Dina Emam, research associate at The Urban Institute, and Olivia Golden, executive director of the Center for Law and Social Policy (CLASP). It was commissioned by the State Policy, Advocacy, and Reform Center, an initiative housed at the bipartisan children’s advocacy organization First Focus and funded by two philanthropies with long-standing track records of investment in preventing and effectively responding to child abuse and neglect: the Annie E. Casey Foundation and the Jim Casey Youth Opportunities Initiative.
“One of the most popular parts of health reform is coverage for kids up to age 26 on their parents’ insurance. The law affords equal treatment for youth who aged out of foster care, having spent time in care as a result of abuse or neglect,” said First Focus President Bruce Lesley.
The ACA requires states to provide Medicaid coverage for young adults under age 26 who “aged out” of foster care and were receiving Medicaid at that time. The provision took effect this year. Like the coverage for young adults up to age 26 on their parents’ policies, this requirement applies in all states—not just in states that have chosen to expand Medicaid.
Tens of thousands of young people who have aged out of foster care in recent years are now eligible for coverage. Between 20,000 and 30,000 foster children typically age out of foster care each year, meaning that they reach the age at which foster care ends in their states without having been adopted, reunified with their parents, or placed with guardians. If effectively implemented, the ACA provision could cover nearly 100,000 young adults through 2017 alone.
The paper recommends eight steps states can take to maximize the provision’s reach and value:
- Automatically enroll children aging out of foster care this year;
- Coordinate child welfare and Medicaid agency outreach efforts to find and enroll former foster youths who aged out before 2014;
- Train Medicaid agency staff on the ACA’s special eligibility and benefits provisions for former foster youth;
- Train child welfare agency staff to help former foster youth – many of whom have been uninsured their entire adult lives – get the care they need;
- Design Medicaid benefits that respond to the distinct health needs of former foster youth, by connecting Medicaid staff with child welfare agency staff;
- Recognize that former foster youth typically face extraordinarily unstable lives, and prioritize continuity in health care as a way to offer stability;
- Ensure that former foster youth who aged out of care in other states can cross state lines without becoming uninsured, and
- Explore strategies for ensuring that former foster youth who enter guardianship rather than aging out also can count on health insurance.
“This provision matters greatly to the life prospects of former foster youth, because the research shows that they experience disproportionate health and mental health challenges compared to other young adults,” said Golden. “It is a particularly powerful example of the broader potential of the ACA to open doors for poor and vulnerable families, including those involved in the child welfare system, by treating medical and behavioral health problems that previously caused enormous suffering and hindered success in school, on the job, and as parents.”
While the ACA provision is new, some states have experience to build on in implementing these steps. For example, take step 1, automatic enrollment. Urban Institute researchers studied states that implemented a similar (but much shorter) extension of health insurance to former foster youth under the so-called Chafee option, finding that states such as Louisiana, Massachusetts, and Washington, that automatically enrolled youth in Medicaid as they aged out, were more likely to keep them covered by health insurance than states that required youth to take extra steps. An early example of Step 7 is California where state law now extends Medicaid eligibility to otherwise-eligible young adults who aged out of foster care in other states.
“States can be heroes for young people facing incredible odds, but that means making the right policy choices,” said Lesley.
The Affordable Care Act and Youth Aging Out of Foster Care draws from Golden's and Emam’s “How Health Care Reform Can Help Children and Families in the Child Welfare System: Options for Action.” The latter paper was published by the Urban Institute’s Low-Income Working Families project with support from the Annie E. Casey Foundation.