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Penny Wise and Pound Foolish: How Proposed Cuts to Medicaid Threaten the Health of Youth who Age-Out of Foster Care

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The adoption of the Patient Protection and Affordable Care Act (ACA) in 2009 marked a truly significant policy win for children in foster care. By automatically extending Medicaid eligibility to youth aging out of the system through age 26, beginning in 2014, the ACA finally addressed a major component of this relative abandonment of foster children by at least ensuring the continuation of health and mental health care and related support services that are so critical to their well-being.

Yet, Congressman Denny Rehberg (R-MT), Chairman of the House Appropriations Subcommittee on Labor, Health and Human Services, and Education, has introduced legislation that would nullify the ACA’s essential benefits to hundreds of thousands of young people. Ironically titled “The Common Sense Deficit Reduction Act,” the measure seeks to repeal these critical provisions of the ACA. Although introduced as an allegedly “sensible move” toward fiscal responsibility, the bill is anything but sensible or fiscally responsible. Balancing the budget on the backs of one of our nation’s neediest populations and forcing these youth to navigate health care coverage, on their own, seems antithetical to notions of sound fiscal and public health policies. Tossing foster children off their health care plan will result in spending more in the long run, which is why the provision originally passed with broad support.

The need for access to health care for foster kids is well documented. Under the current system, states have the option to extend Medicaid to foster youth up to age 19 or 21, using funds under a myriad of federal programs. Despite these coverage options, the majority of foster youth that receive health care through Medicaid end up losing this coverage once they age out of care. In fact a study conducted by Mathematica Policy Research found that between one-third and one-half of youth lost their Medicaid coverage within a month after leaving foster care. This considerable variability in access across programs, and the numerous restrictions on eligibility have become major barriers to ensuring that former foster youth retain health care access once they age out of care.

Moreover, the Midwest Evaluation of the Adult Functioning of Former Foster Youth Study, conducted in 2007 by the Chapin Hall Center for Children at the University of Chicago, found that only half of young adults surveyed reported having medical insurance, and even fewer – only 39 percent – had dental insurance. A significant number of youth reported not having received medical care in the previous year, and cited a lack of insurance as the primary reason for not accessing care.

The period of transition from adolescence to adulthood is turbulent for all youth. It is not uncommon for young adults to experience unemployment, remain in their parent’s homes, and delay other traditional markers of adulthood well into their twenties, especially given the current state of the economy. Thanks to the ACA-provided option to remain on their parents’ health insurance plan up to age 26, these kids currently have one less serious financial challenge with which to struggle.

Foster youth deserve the same stability and continuity in care as their peers. This already at-risk population, navigating through a turbulent life-stage transition period, should not have to literally struggle to access fundamental health care resources at an age when most of their peers are simply worrying about their weekend plans. To the contrary, protecting the health and well-being of this highly vulnerable population should be a national priority.