A report from the National Center for Children in Poverty highlights a troubling trend where young people, after aging out of the foster care system, are being denied healthcare coverage that the state is legally required to offer. The denials are based on an intersection of the federal Affordable Care Act (ACA), cost considerations, and grammar.
In Brief: Foster Care and Medicaid
Youth in foster care age out of the system at age 18, but sometimes older depending on which state they are in. A provision in the ACA states that young people who were in foster care—and enrolled in Medicaid at the time they aged out of the system—are afterwards eligible for Medicare until age 26, regardless of income. According to the report, there are about 180,000 young people who would fall under this category and should be getting coverage.
The Grammar Thing
Unfortunately, as the report noted, only 13 states are applying the law as directly written. The others are restricting who they give Medicaid to, based on a turn of grammar in the law. The particular provision in the ACA defines eligible youth as those who have been in the custody of “the state”. Much as with the whole kafuffle about healthcare exchanges, the division here is between people who believe the term means “the government” or (in this case) “the state the child aged out of foster care in”. Thirty-seven states meanwhile interpret it as meaning “the state the child aged out of foster care in”. These states are denying Medicaid health insurance under the ACA provision to young adults who left foster care in a different state than the one they currently reside in.
The report notes that cost considerations are the primary barrier to these 37 states adopting a more inclusive view of the law. The report also observes that this may be a faulty line of reasoning. Health care costs for the poor have risen twice as fast in states that declined to expand Medicaid eligibility due to different ACA provisions (seven percent increase versus three percent). Based on this, the report suggests that failing to expand Medicaid coverage to residents who aged out of another state’s foster care may end up costing more in the long run as necessary or preventive medical care is delayed and the young adults wind up in emergency rooms.
The report calls for the adoption of the more inclusive interpretation of the ACA provision as well as employing better methods for informing foster youth of their eligibility and how they can enroll.
“Young people aging out of foster care may be leaving behind critical healthcare coverage,” EurekAlert web site, October 17, 2016; https://www.eurekalert.org/pub_releases/2016-10/cums-ypa101716.php, last accessed October 18, 2016.