MEDICAID TO 26: FAQS FOR PROFESSIONALS
As of January 1, 2014, the Affordable Care Act (ACA) provides Medicaid until age 26 for former foster youth who were enrolled in Medicaid when they turned 18 or aged out of care. This means that young people can get Medical Assistance (MA) if they were in foster care in Pennsylvania or any other state at age 18 or older.
Are you implementing extended Medicaid coverage for former foster youth in your state? Download our checklist on effective implementation for state advocates.
(aa) are under 26 years of age;
(bb) are not described in or enrolled under any of subclauses (I) through (VII) of this clause or are described in any of such subclauses but have income that exceeds the level of income applicable under the State plan for eligibility to enroll for medical assistance under such subclause;
(cc) were in foster care under the responsibility of the State on the date of attaining 18 years of age or such higher age as the State has elected under section 675 (8)(B)(iii) of this title; and
(dd) were enrolled in the State plan under this subchapter or under a waiver of the plan while in such foster care. 42 U.S.C.A. 1396a (a)(10)(A)(i)(IX)
FAQs For Professionals And Advocates
How does the Affordable Care Act (ACA) help former foster youth?
The ACA requires states to provide young adults under 26 with free health insurance coverage if they were in foster care on or after their 18th birthday and receiving Medicaid at that time.
Who is eligible for Medicaid until age 26 as a former foster youth?
Young adults qualify for Medicaid until age 26 in the state where they were in foster care if:
- They were in foster care at age 18 or older and enrolled in Medicaid at that time in the state they are now applying for Medicaid, and
- They are under age 26.
What if the young adult moves to another state after they age out of foster care?
Currently, states are only required to cover former youth who were in foster care in their state under the “Medicaid to 26 for former foster youth” category. However, some states have decided that they will cover former foster youth from any state. This means if the young adult moves to one of those states that covers foster youth from any state and was in foster care at age 18 or older and enrolled in Medicaid at that time, the young adult will be covered under the former foster youth category until age 26. Below is a list of states that cover former foster youth no matter what state they were in foster care:
- New Mexico
- New York
- South Dakota
Questions About General Eligibility
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, youth 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 young adults were placed in any of these living arrangements by the child welfare agency, they were in “foster care” as defined above. If young adults were age 18 or older while in “foster care” and enrolled in Medicaid at that time, they qualify for Medicaid coverage as a former foster youth until age 26 as long as they still live in the state where they were in “foster care” OR they live in one of the states listed above.
Are young adults who were adopted or entered into a 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 young adults 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, young adults may be eligible for the former foster youth coverage. For example, if young adults were in extended foster care, placed in a supervised independent placement at age 18, and then adopted at age 19, they are likely eligible for Medicaid until 26 under the former foster youth category.
Because under Fostering Connections, your state may have enacted legislation that allows young adults to remain in foster care until age 21, it is likely that some young adults will enter kinship, guardianship, or adoption after reaching age 18 and therefore may be eligible for the former foster youth coverage.
Does the “foster care” placement need to be funded by Title IV-E funds for young adults to be eligible?
No. As long as the placement is the type listed in the regulation mentioned above, it does not matter if is funded by federal foster care maintenance payments or state or local funds.
Do delinquent youth qualify for Medicaid coverage for former foster youth?
If the young adult was delinquent, but placed in a placement defined as “foster care” at age 18 or older and enrolled in Medicaid at that time, he or she would be eligible under the former foster youth category. Because many (formerly) delinquent young adults are placed in “foster care” type placements, many will be eligible for Medicaid coverage until age 26.
Do former 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.
Is there an income requirement or limit for eligibility?
NO. As a former foster youth, young adults are eligible for free Medicaid no matter how much money they make or save.
This is free health insurance. Do eligible individuals have to pay anything to receive care?
Young adults do not have to pay anything to become eligible for coverage in the former foster youth category. That is, they do not have to pay anything to purchase this health insurance coverage. However, if the young adult is out of care and over age 18, they may be asked to pay copays for certain treatments. Copays are an amount of money charged to help pay for the cost of the service or treatment. Here are some examples of copays: $1.00 generic prescriptions; $1.00 for outpatient psychotherapy; $3.00 a day for hospital stays with a maximum of $21.00 for a hospital stay.
A young adult cannot be denied a service or treatment because you cannot afford a copay. They will receive the service or treatment, but will be billed for the copay.
Can youth who were in foster care in one state at age 18 and move to another state after leaving care get Medicaid as a former foster youth in the state where they 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 a young adult moves to another state find out if that state is covering out of state former foster youth so they will know if they will have access to this coverage if you move.
Note, many states have expanded Medicaid, so even if the state is not covering former foster youth, they may still be eligible for Medicaid under another category.
Where can I find the policy for how young adults should be enrolled in Medicaid as a former foster youth in Pennsylvania?
Section 312. 81 of the Medical Assistance Handbook, Medical Assistance for Former Foster Care Recipients, describes the process that the county assistance office must follow to enroll young adults. You can get to the Index to the Handbook by clicking here.
A special policy was created for young adults who age out of foster care in Philadelphia County. This policy was created because the child welfare agency in Philadelphia closes cases electronically, not by submitting a CY-60. That policy, which was issued on August 6, 2014 in an Information Memorandum, can be found here.
Questions For Young Adults Who Are Still In Foster Care
If A Young Adult Is About To Discharge From Foster Care At Age 18 Or Older, Do They Have To Fill Out A New Application To Get Medicaid Coverage As A Former Foster Youth?
It depends. In some states, if the young adult is currently in foster care and will be discharging when they are age 18 or older, they will be enrolled automatically in Medicaid under the former foster care category when they are discharged. In other states, the young adult will need to enroll.
What can be done to make sure everything is done so that a young adult is covered under the former foster youth category when they leave care?
Many states will have processes in place to make sure young adults are automatically enrolled when they discharge. If a process is not in place, there are a few things you can do to help make sure a young adult’s health insurance is in place when they leave care. Because the transition plan requirement of the Fostering Connections Act requires that specific information be provided about health insurance and meeting health care needs, the following can be part of the discharge plan and/or transition hearing:
- Make sure the transition plan states that the child welfare worker will complete the state’s process for enrolling the youth in Medicaid or will assist the youth to enroll if no process exists.
- Ask that the court document that the youth’s eligibility in the former foster youth category and the procedure through which he or she will be enrolled in health insurance.
- Ask that the youth be provided a copy your state’s foster care discharge form, so they have proof that their case was closed. They may need this documentation of former foster care status in the future.
- Ask the court to issue an order at the transition hearing that states that the youth was in foster care at age 18 and enrolled in Medicaid. This will serve as additional proof of former foster care status.
- Make sure information about the youth’s health plan and treatment providers are included in the transition plan and that the health plan card will be provided to the youth prior to discharge.
Does the young adult get to keep the same insurance card when they leave care?
It depends. In some states, the young adult should keep the same insurance card. In some states, the young adult may receive a new card. Make sure information about the young adult’s health plan and treatment providers are included in the transition plan and that the health plan card will be provided to them prior to discharge.
After a young adult leaves care what actions do they take to make sure they keep their insurance coverage as a former foster youth until age 26?
It depends. In some states, young adults are automatically re-enrolled. In other states, young adults will have to complete a renewal application each year. Make sure the young adult knows the state’s practice so they can comply with all renewal procedures and that this information is included in the transition plan.
Questions For Young Adults Who Were Previously Adjudicated Delinquent
Do Delinquent Youth Qualify For Medicaid Coverage For Former Foster Youth?
If the young adult was delinquent, but placed in a placement defined as “foster care” at age 18 and enrolled in Medicaid at that time, he or she would be eligible under the former foster care category. In many states, delinquent youth are placed by the court in living arrangements that are considered “foster care” under the federal definition. As mentioned above, these include: kinship care, family foster homes, group homes, residential treatment centers, transitional living programs, and supervised independent living. Delinquent youth who were in these placements at age 18 and under the court’s jurisdiction would be eligible for Medicaid until 26 under the former foster care category.
Questions For Former Foster Youth Who Were In Care At Age 18 And Are Under Age 26
How Do Youth Who Have Been Out Of Care For A While And Just Found Out About This New Opportunity For Health Insurance Apply?
Young adults who are not currently in care, are under age 26, and may be eligible, should apply for Medicaid. When they are filling out the application they should look out for a question about whether they were in foster care and check “yes.”
Some states are doing targeted outreach to former foster youth who may be eligible and helping them enroll. Such efforts are highly recommended given the high health care needs of former foster youth and the risk that they will not be insured.
How do former foster youth prove their former foster youth status?
Check your state’s process for verification. States may elect to let young adults “attest” to their former foster youth status rather than requiring documentation. Some states may accept verbal verification of former foster youth status from the state in which the youth was in foster care, while others require more official documentation like a court order or letter from the child welfare agency.
Are there any income requirements or limits for eligibility?
NO. As former foster youth, young adults are eligible for free Medicaid no matter how much money they make or save.
If a young adult already has health insurance through their school or work why should they sign up for Medicaid for former foster youth?
Medicaid for former foster youth provides certain benefits that youth may not receive with their current insurance. For example:
- It’s free insurance. Young adults pay $0 for their insurance regardless of how much money they make. While there may be some copays after the young adult leaves care or turns 21; they will not need to pay for insurance.
- The young adult can keep their coverage until age 26 even if they start earning more money, change jobs, or leave school.
If a young adult already has Medicaid why would they enroll in Medicaid coverage as a former foster youth?
Medicaid available to former foster youth may include certain benefits that are not available to people enrolled in other Medicaid categories. For example, if the young adult is enrolled in Medicaid for former foster youth, they stay covered until their 26th birthday even if their income changes. That is why it is important that they inform their County Assistance Office caseworker of their former foster care status as it may result in improved coverage.
Questions For Former Foster Youth Who Are Parents
Do The Children Of Young Adults Who Are Eligible For Medicaid As Former Foster Youth Automatically Qualify For Medicaid?
NO. The children of former foster youth do not automatically qualify for Medicaid because the parent is a former foster youth. But their children may qualify for Medicaid based on other reasons (for example, based on the parent’s income or due to a disability). When the parent goes to sign up for Medicaid for herself, she should also ask about and apply for health insurance for her children. As a former foster youth, eligibility does not depend on income. But if the parent is applying for coverage for her children, she should answer income questions in order to determine if her children qualify for coverage based on her income.