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Medicaid to 26 for Former Foster Youth: An Update on the State Option and State Efforts to Ensure Coverage for All Young People Irrespective of Where They Aged Out of Care (October 2014)


Shadi Houshyar State Policy Advocacy and Reform Center

October 2014



Signed into law on March 23, 2010, the Affordable Care Act (ACA) makes notable improvements to Medicaid and the Children’s Health Insurance Program (CHIP) and ensures that millions of Americans have access to affordable health coverage through insurance exchanges.



Among the ACA provisions that took effect in 2014 were several new requirements that are critical for foster children and other vulnerable youth. Most notably, the law expands Medicaid coverage to former foster children up to age 26. To qualify, individuals must be under the responsibility of the state when they turn 18 (or older, if the state’s federal foster care assistance under title IV-E continues beyond that age), and to enroll in or maintain Medicaid eligibility, they must have been enrolled in Medicaid while in foster care and not yet reached the age of 26.



Recognizing the importance of health care coverage for youth who age out of foster care, Congress specifically provided Medicaid coverage for this population in the ACA. The provision equalizes insurance coverage among young adults, placing youth aging out of foster care on par with their peers who are able to stay on their parents’ insurance until age 26 by allowing them to explore educational and professional opportunities, many of which do not often come with insurance coverage. Medicaid coverage will help young people become successful adults by ensuring that they, like their peers, have health care coverage and by removing barriers to success in post-secondary education and employment that can result from unexpected health care costs, unmet medical needs, and unaffordable insurance premiums or co-payments. This provision is mandatory, and was not impacted by the Supreme Court decision to give states the option to expand Medicaid to all adults with an income up to 133 percent of the federal poverty level (FPL).



This policy brief provides an overview of the new mandatory Medicaid coverage for former foster youth under the ACA, highlighting relevant Centers for Medicare and Medicaid Services (CMS) regulatory activity to date and additional concerns regarding the “state option”; in particular, the interpretation by CMS that states have the option, but are not required, to cover former foster care children who aged out of foster care in another state. It further summarizes state progress in taking up this option to provide coverage for former foster youth, irrespective of where they aged out of care, and makes recommendations for what more should be done to ensure access to coverage for every young person aging out of care.

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