When One Word Makes All the Difference

When One Word Makes All the Difference

An immensely popular provision of the Affordable Care Act (ACA) allows youth to stay on their parents’ insurance until age 26. A similar provision enables youth aging out of foster care to stay on Medicaid until age 26, but one small drafting error derailed the plan for many youth who move. Because the law says states must cover youth that were “under the responsibility of the State” on the date that they age out of foster, the federal administration interpreted this to mean states need only cover former foster youth who are in the same state where they received foster care. So if a former foster youth moves states for a job or to go to college, that individual may no longer be covered. Some states have received federal approval (waivers) to cover youth who move states, but the majority do not. Many of the states that do not cover former foster youth who age out in a different state have not expanded Medicaid, making it difficult to find alternative health care coverage.

Congressional Research Service, Medicaid Coverage for Former Foster Youth Up to Age 26, Oct. 26, 2018.

Fortunately, Congress came up with a fix. Last October’s SUPPORT for Patients and Communities Act fixes the ACA loophole by substituting the word “a” for “the,” thereby allowing former foster youth to keep Medicaid coverage even if they move states.  But here’s the catch: due to a delayed effective date, the fix only helps those who turn 18 on or after January 1, 2023. As a practical matter, children currently as young as 15 years old may not benefit from the fix. For the next nine years, some former foster youth will still be subjected to a patchwork of coverage, and only be able to get Medicaid in a minority of states.

To help former foster youth now, states need to take action. Some states already cover this group through a combination of authorities. The SUPPORT Act also requires the administration to issue guidance to states on best practices for “removing barriers and ensuring streamlined, timely access to Medicaid coverage for former foster youth up to age 26…” HHS should use this opportunity to clarify state options for coverage and encourage states to provide this essential coverage.

Youth aging out of foster care already face many barriers to stability, including high rates of unemployment and homelessness. Additionally, these barriers compound the harm experienced by Black or African American and American Indian/Alaskan Native youth who are disproportionately represented in the foster care system. Of all the barriers former foster youth face, access to health care should not be one of them.

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