May is National Foster Care Month, and it is a great time to reflect on the unique health needs of youth who are or have been in foster care and how the Affordable Care Act (ACA) helps to support these individuals.

Nationwide, 640,000 youth were in foster care in 2012, with 400,000 in foster care at any given time. Each year, 10 percent of foster youth age out of foster care when they reach their program’s maximum age and must begin living independently. Foster youth and former foster youth are at elevated risk for chronic mental and physical illnesses as a result of their stressful upbringing. Post-traumatic stress disorder (PTSD) is twice as common among foster care youth as it is among Iraq combat veterans. Compared to those with no foster care background, foster youth have twice the risk of depression, are more likely to suffer from anxiety or attention hyperactivity disorder, and are more likely to attempt suicide. Nearly 60 percent are on antidepressants. In addition to mental illness, common physical ailments include growth failure, asthma, anemia, and neurodevelopmental delay. Most of these conditions are chronic and require ongoing care.

Furthermore, it’s estimated that LGBT youth comprise somewhere between five and ten percent of the foster youth population. As our partners at the Center for American Progress acknowledge, “LGBT youth continue to be disproportionately represented among homeless youth in our country, and their experiences of homelessness continue to be characterized by violence, discrimination, poor health, and unmet need.” We know, for example, that LGBT youth in foster care need a wide range of physical and mental health services, but often times, confront significant challenges in obtaining these supports because of their sexual orientation or gender identity. The ACA is positioned to better support these disparities, but the first step in addressing them lies in acknowledging where the system’s shortfalls occur.

Fortunately, the ACA includes several provisions geared toward supporting foster youth and former foster youth, including a provision extending Medicaid eligibility up to age 26 for youth who age out of foster care. All states are required to implement this provision regardless of their decision to expand their Medicaid program to cover adults under 138 percent of the federal poverty level (FPL). Approximately 180,000 former foster youth are currently eligible nationally, and an estimated 25,000 more will become eligible each year. However, for one subset of this population, accessing coverage might not be as easy as we would hope: federal rules currently give states the option of whether or not to extend coverage to former foster youth who aged out of foster care in a different state. Eleven states have already chosen to extend coverage to these young adults, and we hope to get all 50 states on board to honor one another’s commitment to serving all former foster youth.

California is a great example of a state where this is already happening: the state legislature passed a law extending Medicaid to former foster youth who aged out elsewhere, and now advocates at Children Now are working to reach all former foster youth through channels such as their excellent Covered til 26 website. Moreover, county and state administrators are working to ensure that former foster youth face a minimal burden in obtaining and keeping their coverage, using auto enrollment whenever possible and reaching out to other states’ child welfare services to verify individuals’ foster care history. Meanwhile, in Virginia, advocates at Voices for Virginia’s Children and their colleagues are working to pass a budget amendment that would provide for the extension of Medicaid eligibility to former foster youth from outside the commonwealth.

Ensuring that all former foster youth have access to Medicaid coverage—no matter where they choose to live—is an important, if little known, ACA implementation issue. We urge all advocates to explore their state’s current plans for covering this population and to advocate for policies that will ensure all former foster youth have access to the coverage and care they need.