The Affordable Care Act (ACA) and Former Foster Youth


When the Affordable Care Act (the ACA) was signed into law, it provided a valuable benefit to young adults by allowing them to stay on their parents’ medical insurance until they reached the age of 26. The ACA’s provision allowing children to stay on their parents’ health insurance to age 26 is one of the law’s most popular provisions, for good reason. It takes most people some time to finish college and establish a career or to find a job that would allow them to obtain and maintain quality health care coverage. The ACA allows young adults to stay on their parents’ insurance and have vital health care coverage throughout college and it gives them time to establish themselves without having to worry about the catastrophic health care bills that would result from a health crisis.   A medical crisis that results in a large medical bill and the often extraordinary debt associated therewith is a difficult issue with which to be burdened at any age, but young adults are especially vulnerable. Young adults had the highest rate of uninsured of any age group and the lowest rate of employee provided coverage when the ACA was signed into law.  Incurring a burdensome medical debt at such a young age can hinder a young adult over the important years when he or she is embarking upon a career, obtaining an education, or otherwise attempting to establish a livelihood.

Given all of this information, Congress left one group of young adults waiting for this coverage. Foster youth have had to wait nearly four years longer than their peers who were not in foster care.  This, even given that the state is the parent of these youth, they are our children. These youth, our children, often have chronic health issues associated with the abuse or neglect which was the reason for their entry into foster care. Many have mental health or emotional health issues, and they do not have access to the familial and social safety net on which their peers can rely. That the ACA has made this group of former foster youth wait for the same coverage their peers enjoy is shameful.

After a nearly four-year wait, beginning in January of 2014, states will be required to provide Medicaid coverage to youth who are under 26 years of age and were in foster care and receiving Medicaid when they attained 18 or such higher age at which the state’s federal foster care assistance ends under title IV-E of the Act (when they reached 18 or aged out of foster care).  Despite the wait, this is excellent news for young adults who were in foster care. Particularly because anyone who meets these requirements is eligible for Medicaid, even if an individual is age 23 and has not had Medicaid coverage for years, if that individual meets the requirements, he or she can obtain Medicaid coverage.

Unfortunately, the Department of Health and Human Services (HHS), which is the agency that creates regulations for the implementation of federal laws, is proposing a regulation that would require states to provide Medicaid to young adults ONLY in the same state in which they were in foster care and not to a young adult who, for example, is attending college in one state but aged out of care in a different state. This is a glaring inequity. The same restriction does not apply to young adults who enjoy the benefit of their parents’ insurance, have the benefit of the familial safety net that parents’ provide, and did not age out of the foster care system.  Given that former foster youth are a very mobile population; this proposed regulation is of concern. Several foster care and children’s advocacy organizations have urged the department of Health and Human Services to issue regulations that would require states to provide foster youth with access to Medicaid coverage, regardless of the state in which they choose to reside.  The final regulations will be released later this year.

You can learn more about this issue from these sources:

Proposed Rule

CAI’s Comments

Children’s Defense Fund: Joint letter sent to HHS regarding the proposed rule


Author: Christina Riehl, Senior Staff Attorney at CAI


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