Much has been made (rightly!) of the Affordable Care Act (ACA) provisions that have transformed health care for young Americans such as the provision that allows most young adults under 26 to remain on their parents’ health plans. As noted in a previous blog in this space, an additional 2.5 million young adults have gained coverage whether or not they are financially dependent upon their parents, living at home, employed, offered insurance through their employer (as of 2014) or attending college. With the anniversary of the enactment of the ACA coming up in just two short days, it’s worth recalling this impressive gain for young adults as they transition from childhood into adulthood.
Just like other young adults, foster care alumni often find it difficult to find affordable health insurance at the age of 18 or 21. However, unlike other young adults, foster care alumni have less access to employer-sponsored health insurance and lack parents that can provide access to such a plan. One of the lesser known provisions of the ACA ensures that, starting in 2014, Medicaid coverage will be available to young adults up to age 26 who were formerly in the foster care system. This expansion represents the most comprehensive and profound legislation for this high-risk population in decades. For youth who age out of care at 18, this means finding their way as adults with affordable, comprehensive health insurance for another eight years. For those in areas where they have the option to stay in care until age 21, this means much the same thing for another five years.
And as with many ACA provisions, getting implementation right with this part of the law will be crucial to ensuring that its promise becomes a reality for children on the verge of adulthood. To this point, one of the key policy questions to consider is: how will youth that are no longer in the foster care system but eligible to continue their Medicaid coverage on January 1, 2014 be identified and maintain their access to Medicaid?
A paper published last year (that was also discussed in this space previously) in the Michigan Journal of Social Work and Social Welfare provides reason for hope that this question can be answered well by documenting the tremendous progress that has been made over the years to improve access to health insurance for foster youth. Legislators and policymakers have not ignored the plight of older foster youth. To the contrary, targeted legislation has received wide-spread, bipartisan support throughout 25 years of changing political administrations. Even in the difficult political atmosphere that accompanied the passing of the ACA, provisions for foster youth were left intact.
When working toward implementation of the ACA for foster youth, the principle that should guide implementation decisions is that this population deserves to access health insurance in the same way their peers have access: whether or not they are financially independent, living at home, employed, offered insurance through their employer or attending college. Let’s ensure foster youth are treated the same as 2.5 million of our children are now treated, with uncomplicated access to care until the age of 26.
Both the ability of young adults to remain on their parents’ health plans and the Medicaid expansion for former foster youth demonstrates the ACA’s commitment to ensuring that children remain healthy as they become adults. We’ve made extraordinary initial progress to date and now we need to keep moving forward and work tirelessly to ensure that all children—especially those most at risk—are able to continue to benefit from all the ACA has to offer.
—Aisha Amanda Marie Hunter, Program Assistant, Policy Reform & Advocacy, The Annie E. Casey Foundation
& Nicole Tambouret, Project Director, New England Alliance for Children’s Health