iStock_000003423772MediumAs Medicaid turns 50, we reflect on its milestones in providing health care coverage for vulnerable youth in this country, including children in the child welfare and juvenile justice systems and those with serious behavioral health challenges.

Signed into law on March 23, 2010, the Affordable Care Act (ACA) expands Medicaid coverage to former foster children up to age 26. 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), must have been enrolled in Medicaid while in foster care and not yet reached the age of 26.

This provision is a significant step towards equalizing insurance coverage among young adults, placing youth aging out of foster care on par with their peers who are able to stay on their parents’ insurance until age 26, allowing them to explore educational and professional opportunities that do not offer insurance coverage.

Given that former foster youth have well-documented and often significant health care needs, these young people should be eligible for Medicaid coverage in any state, and once enrolled, should be able to retain their coverage irrespective of changes in residency. Yet in their interpretation of the statute, 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. As a result, to date, only 13 states have taken up the option to extend coverage to youth who age out in another state.

Unfortunately, with a majority of states opting to not cover youth aging out in other states, many young people will be left without essential medical coverage. It is critical that we remove any barriers to coverage for young people aging out of care, and that includes removing the eligibility restriction tied to residency. Senator Bob Casey (D-PA) has introduced the Health Insurance for Former Foster Youth Act of 2015, which does just that. We also expect a companion bill to be introduced in the House in the near term. This is very promising for the future of young people who have aged out of foster care and depend on Medicaid for essential health and behavioral health care.

One of the most popular parts of health reform in the ACA is coverage for kids up to age 26 on their parents’ insurance plan. The expansion of Medicaid to cover youth previously in foster care to age 26 is a significant victory for this population and has the potential to provide equal treatment in cases where the state steps in to care for children removed from the home as a result of abuse or neglect. However there are still barriers in this coverage that need to be removed to ensure that children aging out of the foster system are given the same benefits as their peers, and this includes removing the eligibility restriction tied to residency.

#Medicaid provides critical health coverage for youth aging out of foster care: v/ @First_Focus #KeepingUSHealthy
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Want to learn more? First Focus is a bipartisan advocacy organization dedicated to making children and families the priority in federal policy and budget decisions. Read more about our work on child abuse and neglect.

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