State Faces Tough Task Getting Former Foster Youth Health Coverage

Among the more popular aspects of the Affordable Care Act is a provision that allows young people to stay on their parents’ health insurance plan until age 26. But a similar, little-known provision of the federal health reform law also grants certain young people who were formerly in foster care extended health coverage through Medicaid, the joint state-federal insurer, until the same age.

State officials say they expect to enroll thousands of former foster youth in the extended Medicaid coverage this year with the help of outreach efforts. But the responsibility of locating and enrolling these young people, which falls on individual states because the U.S. child welfare system is state-run, could prove daunting.

As of Jan. 1, former foster youth under the age of 26 who received health benefits when they aged out of the foster care system became eligible to keep or reapply for Medicaid regardless of income. In Texas, about 1,500 foster care youth, who are more likely to face health challenges, including untreated medical and mental health problems, age out of the state’s system every year. 

That means the state is now responsible for tracking down thousands of former foster care youth who may be eligible for extended health coverage.

Patrick Crimmins, a spokesman for the Texas Department of Family and Protective Services (DFPS), which administers the state’s foster care program, said contractors and organizations that serve current and former foster youth are working to get the word out.

DFPS now includes information about extended Medicaid coverage — which is provided through the Former Foster Care Children’s Program — in life skills training classes and "aging out" seminars for foster youth, Crimmins said. He added that information about extended Medicaid coverage is also posted on DFPS’s website and on its Texas Youth Connection initiative’s website.

“Overall, DFPS is making every effort to notify young adults formerly in foster care of the new Medicaid program,” Crimmins said.

The Texas Health and Human Services Commission predicts that the outreach efforts will yield high enrollment figures. HHSC estimates it will serve an average of 1,498 former foster youth each month of fiscal year 2014 and a monthly average of 4,952 individuals in fiscal year 2015. 

But child advocates say the state isn’t doing enough to locate former foster youth. Ashley Harris, a child welfare policy associate at Texans Care for Children, said the state’s efforts focus mostly on current foster care youth and not on those who have already aged out of the system.

“These are probably the most vulnerable group of young adults because they are no longer being served by a system, an agency or a community provider,” Harris said.

Harris suggested that outreach efforts by the state should include local hospitals, homeless shelters and other emergency providers, which are more likely to serve former foster youth who no longer receive transitional services offered by the state.

Before the ACA provision went into effect, Texas provided “transitional Medicaid” coverage for some foster youth under the age of 21 through the state’s Medicaid for Transitioning Foster Care Youth program.

Under the ACA, the state split Medicaid coverage into two plans based on age. Former foster youth in the first coverage plan must request to be switched to a second plan when they turn 21, but advocates like Vicki Spriggs, CEO of Texas Court Appointed Special Advocates, said the state should automatically enroll them in the second coverage plan. 

Whether outreach efforts prove effective, however, won't be clear for several months.

HHSC spokeswoman Linda Edwards Gockel said the commission is estimating a 75 percent participation rate in extended Medicaid among eligible former foster youth. But it is unclear when the state will provide exact figures on how many former foster youth are back on Medicaid. Edwards Gockel said it will take about eight months to compile enrollment estimates.

This story was produced in partnership with Kaiser Health News, an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.