Medicaid to 26 FAQs: General Eligibility

This FAQ represents the interpretation of Juvenile Law Center. We will update this FAQ as we learn new information, so please check back frequently for updates. While these questions and answers are Pennsylvania-specific, many could apply in other states.

If you're a child welfare professional with questions, visit our child advocate FAQ's page.

What does it mean to be in “foster care” at age 18? What kind of placements are “foster care”?

For the purposes of eligibility, to be in “foster care” at age 18, you must be placed by the child welfare agency in one of a number of placements that are defined as “foster care” under the federal regulations.

The federal regulation defines “foster care” as “24-hour substitute care for children placed away from their parents or guardians and for whom the child welfare agency has placement and care responsibility. This includes, but is not limited to, placements in foster family homes, foster homes of relatives, group homes, emergency shelters, residential facilities, child care institutions, and preadoptive homes.” 45 C.F.R. § 1355.20

Does “foster care” include kinship care, foster family care, group homes, residential treatment centers, transitional living placement, and supervised independent living placements?

Yes. If you were placed in any of these living arrangements and received services from the child welfare agency, you were in “foster care” as defined above. If you were age 18 or older while in “foster care” and getting Medicaid at that time, you qualify for Medicaid as a former foster youth until age 26 as long as you still live in the state where you were in “foster care” OR you live in one of the states listed above that is covering out of state former foster youth.

Are young adults who were adopted or entered into kinship guardianship arrangement eligible for Medicaid as a former foster youth?

It depends. Kinship guardianship or an adoptive placement is not considered “foster care.” However, if you were in a placement that was considered “foster care” and enrolled in Medicaid at age 18 or older before being adopted or entering a kinship guardianship arrangement, you may be eligible for the former foster youth coverage. For example, if you were in extended foster care, placed in a supervised independent placement at age 18, and then adopted at age 19, you are likely eligible for Medicaid until 26 under the former foster youth category.

Do young adults who were adjudicated delinquent qualify for Medicaid coverage for former foster youth?

Maybe. If you were adjudicated (determined to be) delinquent (by a judge), but placed in a placement defined as “foster care” at age 18 or older and enrolled in Medicaid at that time, you may be eligible under the former foster youth category depending how your state runs its juvenile justice system. You should apply and see if you are eligible.

Do foster youth who are not U.S. citizens qualify for Medicaid until age 26 under the former foster youth status?

For a young adult who was in foster care and enrolled in Medicaid at age 18 to be eligible, they must have U.S. citizenship status or one of the immigration statuses required under federal law for full Medicaid coverage. The list below is not exhaustive, but provides examples of some of the immigrations statuses that former foster youth may have, and for which they would be eligible for Medicaid as a former foster youth:

  • U.S. citizenship
  • Refugee status
  • Lawful permanent resident ("green card" holder)
  • Granted asylum
  • Certain victims of human trafficking
  • Certain battered spouses and children
  • Cuban or Haitian entrants

Young adults who have or had Special Immigrant Juvenile Status (SIJ) usually also have lawful permanent resident status (a "green card") and are therefore eligible for Medicaid in the former foster youth category if they were in foster care at age 18.

Does eligibility depend on how much money I make?

NO. As a former foster youth, you are eligible for free Medicaid no matter how much money you make.

This is free health insurance. Do I have to pay anything to receive care?

You do not have to pay anything to become eligible for coverage in the former foster youth category. That is, you do not have to pay anything to purchase this health insurance. However, you should check with your state to see if you have to pay any copays when you are out of care and over age 18. Copays are an amount of money you are charged to help pay for the cost of the service or treatment. If copays apply, they are usually very small and you may be able to get assistance in paying them.

I was in foster care in one state at age 18 and may move to another state after I leave care, can I get Medicaid as a former foster youth in the state where I now live?

Not necessarily. The ACA does not require states to cover former foster youth from other states. Some states have decided that they will cover young adults who were in foster care in other states, but not all have decided to do so. For a full list, see the list of states under the second question in this FAQ. Before you move to another state you should find out if that state is covering out of state former foster youth so you know if you will have access to this coverage if you move.

Other states that did not take this option have expanded Medicaid, so if you move to a state that is not covering former foster youth, you should still apply because you may be eligible for coverage under another category.