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1 1 (February 25, 2020)

handle is hein.crs/govcacn0001 and id is 1 raw text is: FF.ri E~$~ & Updated February 25, 2020 Medicaid Coverage for Former Foster Youth Up to Age 26 Children may enter foster care due to incidents of abuse, neglect, or some other reason that prevents them from remaining with their families. During FY2018, some 687,400 children spent at least a day in foster care. Of the 250,000 children who exited foster care that year, nearly 18,000 emancipated at 18 (or an older age, up to 21, if states extend care). In this context, emancipation means reaching the state legal age of adulthood and not being reunified with family or placed in a new permanent family. The Patient Protection and Affordable Care Act (ACA, as amended; P.L. 111-148) required states, as of January 1, 2014, to provide Medicaid coverage to youth who have emancipated until their 26th birthday. The U.S. Department of Health and Human Services' (HHS') Centers for Medicare & Medicaid (CMS), which administers the Medicaid program, issued a proposed rule in January 2013 and a final rule in November 2016 to specify additional parameters about youths' coverage under the program. T~1&Mdicadid aund Fster Car& Progannm Medicaid, authorized in Title XIX of the Social Security Act (SSA), is a federal-state program that jointly finances medical and related services to a diverse low-income population. To be eligible for Medicaid, individuals must meet both categorical (e.g., elderly, children, or pregnant women) and financial (e.g., income, assets) criteria in addition to requirements regarding residency, immigration status, and U.S. citizenship. For some eligibility groups or pathways, state coverage is mandatory, while for others it is optional. States and territories (states) must submit a state plan to the federal government to describe how they will carry out their Medicaid programs within the federal statute's framework. States that wish to make changes beyond what the law permits may seek CMS approval to waive certain statutory requirements to conduct research and demonstration waivers under Section 1115 of the SSA. The Foster Care, Prevention, and Permanency program, authorized in Title IV-E of the SSA, is a federal-state program that, among other things, jointly finances foster care for children who a state determines cannot safely remain in their homes and who meet federal eligibility rules related to being removed from a low-income household and other factors. The program also provides some support for services to assist older children in foster care, and those who age out, in making a successful transition to adulthood. The Administration for Children and Families (ACF) at HHS administers the Title IV-E program. While in foster care, nearly all children are eligible for Medicaid under mandatory eligibility pathways. This means that states must provide coverage because these children receive assistance under the Title IV-E foster care program, are disabled, or meet other eligibility criteria. Under the Title IV-E program, states must inform foster youth within 90 days prior to emancipation about their future options for health care. Title IV-E also directs states to provide these youth with health information and, as of early 2018, official documentation that they were previously in care. Such documentation may be necessary to determine eligibility for some former foster youth who later apply for Medicaid. Young people who age out of foster care can have significant health needs. In a sample of former foster youth at age 21 in the Midwest, 11% had a health condition or disability that limited their daily activity, compared to 5% of their same-age peers in the general population. The Medicaid pathway for former foster youth is intended to provide necessary health supports in the years immediately after leaving foster care. It parallels another ACA requirement that health insurance companies provide coverage of children up to age 26 under their parents' private health care plans. Medicaid regulation requires states to determine whether current beneficiaries, including youth emancipating from foster care, are eligible for other Medicaid pathways to avoid gaps in coverage. Upon emancipating from foster care, youth may be eligible for mandatory Medicaid pathways available to adults (e.g., pregnancy or disability pathways). If determined eligible, they are to be enrolled via these other pathways (with the exception of a pathway for non-elderly low-income adults that was established under the ACA). However, if these young people do not qualify for other mandatory pathways, or states do not have sufficient information to determine such eligibility, they are to be enrolled in the mandatory Medicaid pathway for former foster youth without interruption in coverage. To be eligible for the former foster youth pathway, individuals must (1) be under age 26; (2) have been in foster care under the responsibility of the State upon reaching age 18 (or any age up to 21 if the state extends federal foster care to that age); and (3) have been enrolled in Medicaid while in such foster care. Unlike most eligibility pathways, the former foster youth pathway is available to eligible youth regardless of income. Based on a 2018 national survey of former foster youth who were age 21 in FY2018, approximately 64% had Medicaid, 18% had some other health insurance, and 19% had neither. e--,N of ,edk-,a .. In the November 2016 final rule, CMS recommended that states use automated transition of eligible individuals to the former foster youth pathway if they are not eligible for other mandatory eligibility pathways. However, some former foster youth, such as those who emancipated before .O 'T p\w -- , gn'a', goo mppm qq\ a , q 'S I 11LULANJILiN,

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