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McClatchy-Tribune  04/30/2014 12:08 PM ET
States enroll former foster youth in Medicaid [Stateline.org :: ]

April 30--One of the Affordable Care Act's successes is a provision that allows young people up to 26 years old to remain on their parents' health insurance. Under a similar, but less-known provision, young adults who have been recently released from foster care can also get Medicaid coverage, regardless of their incomes. An estimated 180,000 foster care alumni became eligible on Jan. 1.

About 26,000 young adults 18 to 22 years old are released from foster care each year and left to fend for themselves without state protections. The age that a young adult in foster care loses benefits varies across the states. The new health care provision for former young people without parents in the picture grants them full Medicaid coverage until age 26 in the state where they lived when they left foster care.

For states, the trickiest part may be finding these young adults. Only about 20 percent of the nation's roughly 400,000 children in foster care are adopted each year, according to the U.S. Department of Health and Human Services. About 50 percent are reunited with their families. The rest run may die, move in with relatives, transfer to an institutional setting or be assigned temporary guardians.

The provision for young adults with parents ran smoothly from the start and was praised by both allies and critics of the Obama administration. More than 6.6 million young adults who likely would not have qualified before the ACA were signed up in the first year of the health care act.

The state-run process for finding and enrolling former foster youths, however, is getting off to a slow start. In fact, most states have no way to measure whether the former foster kids are signing up.

"The states we've heard from have far fewer enrollees than expected," said Shadi Houshyar, vice president at First Focus, which advocates for children. What should be a straightforward process, she said, has been complicated by a lack of federal guidance. "There's a knowledge gap out there," Houshyar said. "States need an instruction manual."

Considering the many other ACA implementation duties, few states have made enrollment of young adults leaving foster care in Medicaid a priority. Their numbers are relatively low.

And former foster youths are among the most in need since they have much higher rates of serious medical and behavioral health problems than the same age group in the rest of the population. They are also more likely to go without health insurance.

Between 35 percent and 60 percent of this population have at least one chronic or acute health condition that needs immediate treatment, and 50 percent to 75 percent have behavioral or social competency issues that may require treatment, according to a report by the Congressional Research Service. Medicaid claims data show that as many as 57 percent of youths in foster care have a mental disorder.

Because of their relatively poor health, foster youths cost Medicaid two to three times as much as other youths enrolled in Medicaid. But not providing Medicaid coverage for former foster kids would be even more expensive for states, a new report from First Focus argues.

In addition to enrolling former foster children in traditional Medicaid, First Focus recommends states target the high-need, high-cost group for care coordination designed to reduce hospitalizations and other health care and social services costs over the long run.

Off the Grid

As a group, foster alumni relocate frequently to pursue education, find jobs or reunite with family. More than a fifth of them are homeless at least once within a year of leaving foster care, according to the First Focus report.

Once they leave the state child welfare system, tracking them down can be a challenge, said Tricia Brooks, senior fellow at Georgetown University's Center for Children and Families. States need to share best practices on how to locate and enroll these vulnerable young adults, she said.

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