33 Child L. Prac. 1 (2014)

handle is hein.journals/chilawpt33 and id is 1 raw text is: 


      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

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:
    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:
     The Duty of Competence
     in the 21st Century

     Adoption Bonuses and
     Broken Adoptions
     Interviewing Persons with
     5 Strategies for Improving


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