Glitch in Law Leaves Former Foster Care Youth Without Health Insurance

Kaiser Health News leads off an article with the story of a young woman who’d aged out of foster care and moved to another state, where she soon came down with a bad ear infection. She went to a hospital and discovered she was no longer covered by Medicaid.

So this young adult, now on her own, had to clean out her bank account and borrow to pay for the antibiotics she needed. And all because of another drafting glitch in the Affordable Care Act — a wrong word buried deep in the 974-page text.

Limited Parity for Former Foster Care Youth

As you probably know, the ACA allows young adults to remain covered under their family’s health insurance plan until they’re twenty-six. This has protected some 5.7 million of them from the risks of insufficient health care and/or catastrophic bills.

But it’s of no help to young adults whom a state assumed responsibility for because it decided that their parents couldn’t or wouldn’t fulfill their responsibilities. The ACA tries to extend protection to these youth.

It requires states and the District of Columbia to cover them up to twenty-six under their Medicaid program if the youth had been in their foster care program when they reached the age of “emancipation” from the child welfare system.

But it doesn’t require states or the District to cover these youth if they move to another state. Nor to transfer them to their Medicaid programs when the youth move in.

This, at any rate, is how the federal agency responsible for Medicaid interprets the wording, though the drafters clearly intended to provide parity for all young adults.

No Continuous Coverage … or Perhaps Any

Former foster care youth can secure Medicaid coverage, if they’re eligible according to their new home state’s standards. But they have to go through the whole enrollment process just like any other adults.

In the best of cases, they’ll have no health insurance for awhile — perhaps longer than most because the state may insist on checking information that could be hard to verify, e.g., income, residency.

In the worst of cases, no health insurance period. That’s most likely in the 19 states that won’t expand their Medicaid programs to cover everyone (except some immigrants) with an income no higher than 133% of the federal poverty line — actually, 138% because of a technicality in the ACA.

If our former foster care youth have incomes at or above 100% of the FPL — and the savvy or assistance needed — they can purchase subsidized health insurance on the exchange for eligible residents in their new state. That too could leave them without coverage for awhile.

But some will fall between the cracks. Fifteen states exclude all childless adults from their Medicaid programs, including those too poor to buy on an exchange. An additional seven cover only those who meet criteria set by approved pilot projects.

The Letter of the Law, Not the Spirit in DC

We can generally look to the District for enlightened healthcare policies. But unlike thirteen states, it’s decided not to recognize the Medicaid eligibility of former foster care youth who become residents.

The Department of Health Care Finance says it can’t readily verify their eligibility because there’s no national database. True enough. But couldn’t the agency ask the youth’s former home states to verify? That doesn’t seem to me so “administratively burdensome” as it claims.

Couldn’t it at least develop some agreement with Maryland, where I’m told many of the District’s aged-out foster care youth move? (No agreement with Virginia would be needed because it’s one of the thirteen that’s exercised its flexibility to provide continuous Medicaid coverage.)

Health Care Finance needn’t assume any burden, however. At least one state just takes a youth’s word for his/her former foster care status and Medicaid enrollment — an option the federal administrative agency expressly allows.

A Nationwide Fix

Bills in both the House and Senate would correct the drafting error so that all former foster care youth have the protection Congress intended.

All they’d do — because all that’s needed — is change “or” to “and” in one paragraph “the” to “a” in two other paragraphs of the Social Security Act that the ACA amended.

Are the bills going to go anywhere in this Congress, with Republican majorities intent on dismantling the ACA? A rhetorical question, of course.

So at least for the time being, former foster care youth must depend on state and District officials for the affordable health insurance they need. Seems to me the District should be out in front here, instead of doing the least it legally can.

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