Read the #HealthCareFFY Issue Paper: Youth Who Relocate From Another State

Former foster youth should be eligible for Medicaid until age 26 regardless of the state they reside.  Currently federal guidance does not mandate coverage of youth when they relocate from the state in which they were in foster care.  To cover these youth--”relocators”--states must apply for a Medicaid 1115 Waiver.  Currently, only some states have applied for Medicaid 1115 waivers to serve out of state youth.   Whether a former foster youth has insurance coverage should not depend on the state in which they live.  Youth should be able to relocate for education, a job, or to gain support from family or friends without fear of losing Medicaid. 

There should be a federal fix to ensure young people retain coverage when moving states (note: federal legislation has been introduced, see H.R.4998 / S.1797). In the meantime, states should take action to ensure youth who relocate to their jurisdiction are covered by applying for a 1115 Waiver. 

Watch and listen to a recording of the #HealthCareFFY Webinar below:

Medicaid coverage under the FFY provision should be maintained until young people reach age 26 without the young adult having to take any action or submit additional information. Foster youth between ages 18 and 26 may move several times when they leave care, for school, jobs, or to be closer to family or friends. Renewal notices sent through the postal service may be missed causing a youth to lose coverage despite maintaining eligibility. Individuals should be automatically renewed unless information is presented that indicates the a young person is no longer eligible (e.g. youth has moved out of state). This, in fact, is consistent with existing federal law.  

Because former foster youth are eligible for Medicaid until age 26 regardless of income, simplifying the application process for young people who have not maintained seamless coverage will facilitate access to health insurance.  Medicaid applications can be lengthy and require income and other information that is not required for eligibility as a FFY.  Creating a foster youth specific application or amending the general Medicaid application so that a former foster youth would not be prompted to enter information that is not required will result in more young people completing Medicaid applications and establishing eligibility.   

Eligibility for coverage will be maintained until age 26 without the individual having to take any action or submit additional information.  Nearly all individuals in the former foster care group remain eligible until age 26 unless they move out of state or become eligible for Medicaid coverage under another program. For example, when former foster youth become pregnant or become a parent/caretaker relative they may qualify for Medicaid but under another category of coverage. 

Development of a plan for data collection and analysis will allow child welfare and Medicaid agencies to identify youth before they age out so that action can be taken to assure coverage in the FFY group without any gaps. This should include using data to identify the number of youth who are successfully enrolled in the FFY category and continue coverage as well as to identify and target eligible youth who are not covered. Further, case-level data should be shared between the child welfare and Medicaid agencies to better understand youth enrollment. In FosterClub’s 14-state survey only 4 States reported they were tracking Medicaid to age 26 data. 

States must have an array of outreach strategies to reach young people who are leaving the child welfare system and those who work with them so that they are aware of FFY coverage and how to maintain it.  Because young people are especially mobile, comprehensive and creative strategies must be used.  Outreach strategies include messaging, training, and communications materials that explain to youth and stakeholders FFY coverage, its importance, and all the policies and procedures to secure and maintain coverage. States should have a dedicated website or resource page that is a one-stop place for state specific info as well as contact info for someone who can help if a youth is encountering barriers.

The Centers for Medicare and Medicaid Services (CMS) are providing states the option to impose work requirements on Medicaid recipients through 1115 Waivers. Access to health care is impeded by work requirements; however, If states do opt to impose work requirements, former foster youth should be exempt. Imposing such a requirement treats former foster youth differently than their peers who have the support of family and can remain on their parents’ insurance until age 26 regardless of whether they work or not.