Making Health Care Access Easier for Young People Leaving Foster Care

Elizabeth Mertinko

Elizabeth Mertinko

Christine Tappan

Christine Tappan

“My transition out of [foster] care was difficult. Probably the most difficult part out of foster care was losing health insurance. I didn’t really think that would be very hard, but it definitely was because it seemed like right after I transitioned out I got sick with a sinus infection … [I didn’t know] where to go or have the money upfront to pay for it. I didn’t realize how expensive health care is until it had to come out of my own pocket.”

—Faith, from the U.S. Department of Health and Human Services Administration for Children and Families video, “Spotlight on National Youth in Transition Database,” from February 2014.

Health care is a basic necessity for all young people. For some of our most vulnerable — those aging out of the child welfare system — health care coverage is particularly vital. Young people who have experienced neglect and/or abuse often have significant health care needs, including physical health issues, behavioral/mental health diagnoses and developmental challenges. While most have coverage while in foster care, like Faith, once they leave, they lack the resources to support their ongoing health care needs. That changed with the passage of the Patient Protection and Affordable Care Act (ACA), which is creating new pathways to health care for current and former foster youth.

[Related: Many Former Foster Youth Unaware of New Health Care Benefits]

Each state manages the health care benefits system for children in and leaving foster care. The majority of young people in foster care, however, are eligible for Medicaid, a program jointly funded by federal and state governments to provide health care coverage to low-income citizens who meet certain eligibility criteria. Most young people in care are eligible for Medicaid through Title IV-E of the Social Security Act, which provides funding to support safe and stable care for children who are removed from their homes.

Once young people leave care, however, maintaining health coverage becomes much more difficult. Unlike young people who grow up in their biological families’ homes and can remain on their parents’ health insurance policies until age 26, for the most part, young people who leave foster care have no such safety net. To help remedy this situation, the ACA created new health insurance eligibility options for youth formerly in foster care so they could more easily maintain coverage into adulthood. The ACA provides for:

  • Medicaid eligibility for the adult group: States have the option to cover the “adult group” added by the ACA (nonpregnant individuals ages 19 through 64 whose household income is no more than 133 percent of the federal poverty level). Because youth who have aged out of foster care are often considered for Medicaid eligibility as a household of one, they can obtain coverage through this provision in the 28 states that currently offer it.
  • Youth formerly in foster care and under age 26: The ACA provides a new, mandated Medicaid eligibility pathway for former foster youth who are no longer in care. Youth are eligible for their state’s full Medicaid coverage regardless of income and regardless of whether their state opted to provide coverage for the “adult group” as described above.
  • Youth who age out of foster care in states that offer the Chafee option: The Chafee Foster Care Independence Act of 1999 provides services and supports to assist youth who are aging out make successful transitions to adulthood. The Chafee Act authorizes states to extend Medicaid coverage to certain youth who age out of foster care. Currently, 30 states offer Medicaid to former foster youth who are not eligible for the mandatory Medicaid groups; 26 of those states do not apply an income limit for them.

Helping young people understand the importance of health insurance and maintaining their physical, mental, emotional and behavioral wellness is a key step in ensuring that those exiting care are best equipped to tackle the opportunities of adulthood. The ACA provides youth leaving care with a health insurance safety net on par with what is available to their peers who did not grow up in the system — and more importantly, helps provide access to necessary health services.

[Related: See Youth Today’s full coverage on foster care]


  • Know your state’s laws and policies regarding Medicaid eligibility. Help young people determine how they might access health insurance and guide them — or link them to someone who can guide them — in applying for and maintaining health care coverage.
  • Talk to young people and help them understand the importance of health care coverage. Educate them about health care costs and the potentially devastating health and financial consequences of not maintaining health coverage.
  • Encourage young people to plan early, so there is no gap in care due to lapses in health insurance coverage as they leave foster care.
  • Assist young people in locating health care providers who will accept Medicaid. Health insurance is only one piece of the puzzle: Finding providers who accept young people’s coverage is critical to their ability to access the care they need.


Elizabeth Mertinko, MSW, is a senior project manager at ICF International, where she is operations manager for Child Welfare Information Gateway, the information service of the Children’s Bureau, U.S. Department of Health and Human Services.

Christine Tappan, MSW, is also a senior manager at ICF International, where she is deputy project director for Child Welfare Information Gateway and has worked extensively with youth-serving programs across human services.

More articles related to this one:

California Photographers Focus on Life After Foster Care in New Book

The One Question Foster Care Workers Need to Ask Themselves

Legislation Would Keep Foster Kids From Having to Change Schools

We Know How to Help Foster Kids Despite Past Trauma

Op-Ed: I Chose the Wrong Mom


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