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33 Child L. Prac. 1 (2014)

handle is hein.journals/chilawpt33 and id is 1 raw text is: HEALTH MATTERS Expanded Medicaid F ormer foster youth are vulnerable to poor overall health upon exiting foster care.2 They are at greater risk of homelessness, substance abuse, dis- abilities, and mental health issues than the general population.3 In a recent study, 51 % of young women who aged out of foster care were pregnant at least once by age 19, even after con- trolling for race/ethnicity.4 The disturbing health outcomes for these youth may reverse course now that the Patient Protection and Affordable Care Act (Affordable Care Act or ACA) expands Medicaid coverage for youth who age out of foster care. States must make such youth, known as former foster care children,'5 eligible for Medicaid under the ACA until they turn 26. Youth are eligible provided they: 1. were in foster care when they turned 18 or aged out of foster care as defined by the state in which they aged out,6 2. were receiving Medicaid when they exited care,' and 3. are not otherwise eligible for, or enrolled in, mandatory coverage.' Expanded Medicaid will help youth who have aged out of foster care for both preventative and nonroutine medical care through age 26.9 Howev- er, categorical Medicaid eligibility for former foster care children may cre- ate unintended consequences related to permanency, portability, and coverage requirements. Coverage for Youth Aging Out of Foster Care, by Eliza M. Hirst Expanding the Affordable Care Act In 1999, under the Chafee Act, Con- gress permitted states to expand Med- icaid coverage to youth aging out of foster care through age 21 (the Chafee Option). About 30 states elected to create a new category of Medicaid coverage to former foster youth. 10 The Chafee Option does not require enrollment in Medicaid by age 18 in foster care (in contrast to the ACA), but coverage under the Chafee Option ends at age 21. Currently, 20 states that chose not to earmark a Medicaid program through the Chafee Option will now be required to create a former foster care Medicaid category. For a list of states that currently have a Chafee Medicaid category for former foster youth visit: http://aspe.hhs.gov/hsp/13/Chafee- MedicaidReport/rpt2.cfm. On July 15, 2013, the Centers for Medicaid & Medicare Services (CMS) determined the parameters for Medicaid eligibility under the ACA for former foster youthII and further ruled the new ACA coverage supersedes categorical Medicaid eligibility under Chafee.12 Two important features to Medicaid coverage under the ACA are: 1. There is no financial means test for Medicaid coverage of former fos- ter care youth, unlike many other eligibility categories. 13 2. Medicaid eligibility is both proac- tive and retroactive. Youth who age out of foster care after Janu- ary 1, 2014, will be eligible for Medicaid coverage until they turn 26. Former foster youth who aged out of care previously and are under age 26 (youth born after 1988), will also be eligible. 14 However, identifying youth who qualify may be difficult once they have exited foster care. (See box, p. 6) Eligibility Requirements While some youth who age out of fos- ter care may be eligible for Medicaid under other categories of coverage, they will be assigned to Medicaid un- der their status as a former foster care child unless they qualify under a (Cont'd on p. 6) What's Inside: 2 CASE LAW UPDATE 8 ETHICS UPDATE The Duty of Competence in the 21st Century 9 VIEWPOINT Adoption Bonuses and Broken Adoptions 12 RESEARCH IN BRIEF 15 EXPERT EXCHANGE Interviewing Persons with Disabilities 16 TIPS & TRENDS 5 Strategies for Improving Well-Being www.childlawpractice.org

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