Medicaid & ACA for children aging out of foster care in VA
How does the Affordable Care Act (ACA) help foster youth?
Medicaid is complicated: ask your social workers for help it's your right!
In Virginia, foster care children under 18 are automatically enrolled in Medicaid and given a health insurance plan. Eligible former foster care youth who had Medicaid and foster care services in any Commonwealth of Virginia at the time of their 18th birthday and are currently under the age of 26 are also eligible for Medicaid health services under the Affordable Healthcare Act or ACA.
Below are some frequently asked questions and answers about healthcare benefits for children in foster care or adults who were once in foster care.
How does the Affordable Care Act (ACA) help former foster youth?
The ACA provides young adults under age 26 with free health insurance through the Medicaid program if they were in foster care on or after their 18th birthday and enrolled in Medicaid.
Who is eligible for Medicaid until age 26 as a former foster youth? How do I find out if I qualify for health coverage under Medicaid as a former foster youth?
You qualify for Medicaid until age 26 in the State where you were in foster care if:
You were in foster care at age 18 or older and enrolled in Medicaid at that time in the Commonwealth; and if you are now applying for Medicaid, and are under age 26.
What if I move to another state after I age out of the foster care system in my current state?
The ACA does not require states to cover former foster youth from other states. Medicaid is only required to give medical insurance until 26 to young adults in the state they were in foster care.
However, some states have decided that they will cover former foster youth from any state. If you move to one of those states, were in foster care at age 18 or older, and were enrolled in Medicaid at that time, you can be covered under the former foster youth category until age 26. Below is a list of states that cover former foster youth no matter what state they were in foster care:
- New York
- South Dakota
Other states that did not take this option have expanded Medicaid, so if you move to a state that does not cover former foster youth, you should still apply because you may be eligible for coverage under another category.
What does it mean, for eligibility purposes, to be in “foster care” at age 18? For eligibility purposes, what kind of placements are considered“foster care”?
For eligibility purposes, to be in “foster care” at age 18, you must be placed by the child welfare agency in one of a number of placements that are defined as “foster care programs and placements” under federal regulations.
The federal regulation defines “foster care” as “24-hour substitute care for children placed away from their birth parents or guardians and for whom the child welfare agency has placement and care responsibility. This includes, but is not limited to, placements in foster family homes, foster homes of relatives, group homes, emergency shelters, residential facilities, child care institutions, and pre-adoptive homes.” 45 CFR § 1355.20
Does “foster care” include kinship care, foster family care, group homes, residential treatment centers, transitional living placement, and supervised independent living placements?
Yes. If you were placed in any of these living arrangements and received services from the child welfare agency, you were in “foster care” as defined above. If you were age 18 or older while in “foster care” and getting Medicaid at that time, you qualify for Medicaid as a former foster youth until age 26 as long as you still live in the State where you were in “foster care” OR you live in one of the states listed above that is covering out of state former foster youth.
Do young adults who were adjudicated delinquent qualify for Medicaid coverage for former foster youth?
Maybe. If you were adjudicated (determined to be) delinquent (by a judge) but placed in a placement defined as “foster care” at age 18 or older and enrolled in Medicaid at that time, you may be eligible under the former foster youth category. You can contact Voices Policy Analyst Allison Gilbreath at email@example.com. We will either assist you directly or connect you with an advocate in your area who can help.
Do foster youth who are not US citizens qualify for Medicaid until age 26 under the former foster youth status?
For a young adult in foster care and enrolled in Medicaid at age 18 to be eligible, they must have US citizenship status or one of the immigration statuses required under federal law for full Medicaid.
The list below provides examples of some of the immigration statuses that former foster youth may have and for which they would be eligible for Medicaid as former foster youth:
- US citizenship
- Refugee status
- Lawful permanent resident (“green card” holder)
- Granted asylum
- Certain victims of human trafficking
- Certain battered spouses and children
- Cuban or Haitian entrants
Young adults who have or had Special Immigrant Juvenile Status (SIJ) usually also have lawful permanent resident status (a “green card”) and are therefore eligible for Medicaid in the former foster youth category if they were in foster care at age 18.
Does eligibility for Medicaid for former foster youth depend on how much money I make?
As a former foster youth, you are eligible for free Medicaid, no matter how much money you make.
This is free health insurance. Do I have to pay anything to receive care/ medical assistance?
You do not have to pay anything to become eligible for coverage in the former foster youth category. That is, you do not have to pay anything to purchase this health insurance. However, you should check with your State to see if you have to pay any co-pays when you are out of care and over the age of 18.
Co-pays are the amount of money you are charged to help pay for the service or treatment cost. If co-pays apply, they are usually minimal, and you may be able to get assistance in paying them. You should not have any co-pays if you live in Virginia, but you may have them if you’ve moved to another state.
Information FOR YOUNG ADULTS WHO ARE STILL IN FOSTER CARE
Suppose I am about to be discharged from foster care at age 18 or older. Do I have to fill out a new application to get Medicaid coverage as a former foster youth?
In that case, you should be automatically enrolled in the “Medicaid-to-26” category. Still, you should follow up with your social worker, Guardian ad Litem (GAL), and judge to make sure. During your transition planning, you should bring up your eligibility and enrollment and make sure steps are taken and put into your transition plan to ensure you’ll be enrolled.
If you need help or support in asking these questions and having them answered, please contact Voices Policy Analyst Allison Gilbreath at firstname.lastname@example.org. This office will either assist directly or connect you with an advocate in your area who can help.
What should I do to ensure I am covered by Medicaid until I am 26, after leaving foster care?
Your social worker at the time you left care should do the work to make sure you are covered under the former foster youth category. Still, you can do a few things to help ensure your health insurance is in place when you leave care.
- Make sure your transition plan states that your social worker will complete your State’s process for getting you enrolled in Medicaid or will help you enroll if you do not have a process in place, and what your permanent mailing address will be.
- Ask the judge presiding over your case to document your eligibility in the former foster youth category in your discharge order, and ask the judge for proof from your social worker that you are enrolled. Many states have court rules mandating that your transition plan must contain specific information about your health insurance coverage.
- Ask for a copy of your State’s discharge form, so you have proof that your case was closed, so you have documentation of your former foster care status if needed in the future.
- Ask the court to issue an order at your transition hearing that explains that you were in foster care at age 18 and enrolled in Medicaid. This can serve as additional proof of your former foster care status.
- If you have any questions about how to talk to the judge or what to say, you can show these questions to your Guardian Ad Litem (GAL) and ask him or her to do it for you.
After I leave care, what actions do I have to take to make sure I keep my insurance coverage as a former foster youth until age 26?
If you live in Virginia, you will need to make sure your mailing address is accurate each year of your coverage. You will receive your annual coverage notice and other important information in the mail. Make sure you look out for, open, and read carefully any mail about your Medicaid coverage.
Suppose you are unsure of your mailing address or think you might be moving from place to place. In that case, you arrange for your local social services agency to your mailing address—be sure to check in with them regularly (at least once a year, but ideally more) to see if you’ve received any mail.
Information FOR FORMER FOSTER YOUTH WHO WERE IN CARE AT AGE 18 AND ARE UNDER AGE 26
I have been out of care for a while and found out about this new opportunity for health insurance for former foster youth. How do I go about applying for health care coverage under Medicaid for former foster youth?
If you are not currently in care, are under the age of 26, and think you may be eligible, you should apply for Medicaid in any of the ways listed in our How To Apply section. When you are filling out the application, look out for a question about whether you were in foster care at age 18 or older, and make sure you check “yes.”
I’m moving from Virginia to another state that does accept out-of-state youth into its Medicaid-to-26 program, but they’re asking me for verification. How do I prove that I was in foster care at age 18?
First, find out what documentation the State you’re moving to will accept as proof of your former foster youth status. (If you don’t know or can’t easily find out, please contact Voices and for help: email email@example.com or call 804-649-0184)
Once you’ve done this, you can contact your social worker directly to help with any documentation you need, or if you’re having trouble making contact or would prefer not to, you can email/call Em Parente at the Virginia Department of Social Services for assistance: Em.firstname.lastname@example.org or (804) 726-7538.
I already have health insurance through my school or work, so why should I sign up for Medicaid for former foster youth instead of sticking with my current insurance?
Medicaid for former foster youth provides you with certain benefits that you may not receive with your current insurance. For example:
Medicaid for former foster youth is free insurance: You pay $0 for your insurance regardless of how much money you make.
You can keep your coverage until age 26, even if you start earning more money, change jobs, or leave school.
I already have Medicaid because I am low-income: Why should I enroll in Medicaid for former foster youth instead of remaining with the coverage I receive for being low-income?
The Medicaid coverage available to former foster youth may include certain benefits not available to people enrolled in other Medicaid categories. For example, suppose you are enrolled in Medicaid for former foster youth. In that case, you stay covered until your 26th birthday, even if your income changes.
Information FOR FORMER FOSTER YOUTH WHO ARE PARENTS
Do my children/ spouses automatically qualify for Medicaid because I am a former foster youth?
Your children or other family members do not automatically qualify for Medicaid because you are a former foster youth. But your children/ spouse may be eligible for Medicaid based on other reasons (for example, based on your income or due to a disability).
When you sign up for Medicaid for yourself, you should also ask about and apply for your children’s health insurance. As a former foster youth, eligibility does not depend on your income. But suppose you are applying for coverage for your children. In that case, you should answer income questions to determine if your children qualify for coverage based on your family’s income.
If I am a pregnant woman, and I was formerly in foster care will Medicaid for former foster youth cover all of my maternity medical expenses?
Medicaid for foster care youth will cover maternity medical expenses for pregnant women, however, co-pays and other expenses may apply. However, they are typically minimal, and you may be able to get assistance in paying for them.
If I want to put my foster child on my health care plan even though I am not their biological or adoptive parent, am I allowed to?
Generally speaking, you can include any child who fits the following criteria: Age– Your child has to be under the age of 26. For a child to qualify as your dependent, you have to be their biological parent, stepparent, adoptive parent, or foster parent.
Please do not hesitate to contact us if you have any questions on healthcare and foster care and adoption.