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Federal Gov. Eliminates Barriers to Medicaid Eligibility for Former Foster Care Youth

Janice Meinert

The Affordable Care Act of 2010 granted permission for state Medicaid programs to enroll former foster care children in Medicaid who:

  • Are under age 26;
  • Are not eligible for or enrolled in another mandatory eligibility group;
  • Were in foster care under the responsibility of the state in which the individual is seeking Medicaid eligibility upon attaining age 18 (or such higher age as the state has elected in its title IV-E plan); and
  • Were enrolled in Medicaid in such state while in such foster care
     

Former foster care children (FFCC) meeting the above criteria and otherwise not already enrolled in Medicaid, could receive Medicaid until age 26, regardless of their income or resources.

However, under the current statute and regulations, the FFCC group is limited to individuals who were in foster care in the same state in which they seek to establish eligibility in the FFCC group.

The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities (SUPPORT) Act expands Medicaid eligibility to individuals who were in foster care from other states and simplifies eligibility determinations and enrollment processes for this population.  These changes became effective, with certain limitations, on January 1, 2023 as described in the State Health Official letter from CMS dated December 16, 2022. The SUPPORT Act makes two important changes to the eligibility requirements for the FFCC group:

First, the SUPPORT Act eliminates the requirement that an individual is not eligible for another mandatory eligibility group (other than the adult group) to be eligible for the FFCC group.  This change means that a person may be enrolled in the FFCC group even if the individual meets the eligibility requirements for a separate mandatory group, so long as the individual is not actually enrolled in such group.  This change will streamline states’ enrollment process by eliminating the need to screen former foster care youth for possible eligibility in other Medicaid categories.

Second, the SUPPORT Act requires that states cover under the FFCC group individuals who aged out of foster care in a state other than the state where they currently live and are seeking Medicaid coverage.

These changes will apply exclusively to individuals who turn 18 on or after January 1, 2023. This means that: (1) the original eligibility requirements for the FFCC group will continue to apply for youth formerly in foster care who turn 18 prior to January 1, 2023; and (2) all of the new requirements will apply exclusively to those who turn 18 on or after January 1, 2023.

However, states may utilize authority under section 1115 of the Social Security Act to align the eligibility rules for youth formerly in foster care who turn age 18 before January 1, 2023, to those who turn age 18 on or after January 1, 2023, so that states can effectively apply the SUPPORT Act’s FFCC group eligibility changes to all individuals.