States Helping Foster Care Youth, After "Emancipation"

STATES HELPING FOSTER CARE YOUTH, AFTER “EMANCIPATION”

Volume 28, Issue 486 March 5, 2007

Matthew Gever

If five more states act this year, all 50 will have expanded health coverage to a particularly vulnerable population: the approximately 20,000 young people who “age out” of foster care every year, generally by turning 18 years old. States have acted because the vast majority of these youth face enormous difficulties transiting into adulthood.

The Urban Institute says that as many as 80 percent of this population requires some form of mental health intervention, and over half have chronic conditions, such asthma, cerebral palsy, obesity and substance abuse, according to Jerry Friedman, executive director of the American Public Human Services Association (APHSA).

The APHSA has just released a report that examines how states are extending coverage to emancipated youth and the cost estimates of doing so. The most popular route has been to extend Medicaid to aged-out foster youth using the so-called “Chafee option.” Contained in a 1999 law named after its sponsor former Sen. Lincoln Chafee, this option allows states to extend Medicaid coverage up to age 21 for those residing in foster care on their 18^th birthdays. Seventeen states have used the Chafee option to extend coverage, and officials in another five states reported they would consider doing so in the 2007 legislative sessions.

In 2001, Texas used the Chafee option when it enacted SB 51. This bill amended the Human Resources Code to extend Medicaid coverage to emancipated youth until the month of their 21st birthday. “This provision at least provides these young adults with some means of security for everything from regular appointments to emergencies which could prevent them from spending unnecessary hours in an emergency room to the direness of being homeless,” said Texas Sen. Carlos Uresti. For the 2007 session, Sen. Uresti has introduced SB 938, which provides for medical assistance to former foster care adolescents aged 21 to 25 who are enrolled in higher education for at least 12 credits per semester.

The remaining 28 states and the District of Columbia use a variety of other methods to extend coverage, such as the medically needy category, 1115 waivers, the State Children’s Health Insurance Program and general assistance based on income and resources.

States now have an additional way to expand coverage—the 2005 Deficit Reduction Act (DRA). The DRA allows states to create specific benefit packages for selected populations without having to first obtain a federal waiver.

While no state has yet used the DRA to specifically address foster youth, at least four states have enacted benefit flexibility options for various populations in their Medicaid programs.

For example, the Idaho Legislature used the DRA in 2006 to develop a series of population-specific Medicaid benefit packages. Among these is the Benchmark Basic Plan, which provides standard Medicaid benefits as well as Early Periodic Screening, Diagnosis and Treatment (EPSDT) services and enhanced mental health services to youth up to age 21. Many post-foster youth would be eligible for these benefits.

Only time will tell if states will choose to use the DRA to create a special benefit package for this admittedly rather small population. Last year, approximately 24,000 individuals aged out of the system. In 1998, that number was just over 17,000.

Costs Vary, Needs Great

The costs for providing coverage to this group vary from state to state, ranging from $111 per person/per month in a managed-care setting in California, up to $350 per person/per month in South Carolina, according to the APHSA survey, which was conducted in the fall of 2006. “It does cost financial resources, but the gains by far outweigh the resources given out in the long run,” said Sen. Uresti.

“These are kids who need more attention from the behavioral health system,” said Gary Stangler of the Jim Casey Youth Opportunities Initiative. “For example, they’ve been on medication while in foster care. Suddenly they’re 18, they’re released by the system and the medication that has stabilized their condition is no longer available.”

According to the nonprofit Network on the Transitions to Adulthood, one recent study found that 37 percent of foster youth aged 17–20 had not completed high school or gotten a GED. Foster kids more often become involved in crime or are victims of crime than their peers, they are more frequently homeless, less likely to be employed than their peers, and more likely to rely on public assistance.

Several states have developed streamlined enrollment for foster care youth, as the process of enrolling in coverage can be overwhelming. “I find it intimidating, and I ran three different state human services programs,” said Friedman. For example, Texas, California, Florida and South Dakota automatically enroll individuals into Medicaid once they age out of the system, while Kansas has a specific application form for this group. “Teenagers are not quick to apply for Medicaid,” said Stangler. “They don’t think about it until there is an episode for which they need medical care.”