Columbia University Mailman School of Public Health

After Foster Care, Moving Toward Opportunity Can Mean Leaving Behind Critical Health Coverage, According to New NCCP Report
Policy brief reveals former foster youth often lose federally mandated Medicaid coverage due to state interpretations of the Affordable Care Act

This press release has been edited to include a quote from Dr. Amy Dworsky, co-author of the Fostering Health policy brief.

NEW YORK, October 17, 2016 — States are required to provide health insurance to young people who have aged out of the foster care system until their 26 th birthday.  Although the intent of the provision is to mirror the extended coverage available to young adults whose parents have private health insurance, varying interpretations of the provision by states have effectively blocked many youth formerly in foster care from accessing their federally mandated coverage, according to a new report from the National Center for Children in Poverty (NCCP) at Columbia University’s Mailman School of Public Health.

An estimated 180,000 young people who have aged out of the foster care system are eligible for extended health care coverage.  However, only 13 states have made Medicaid coverage available to all former foster youth who reside in their state, regardless of the state in which they aged out, according to Fostering Health: The Affordable Care Act, Medicaid, and Youth Transitioning from Foster Care.

“It’s encouraging that some states have been trailblazers in promoting the health of children while they’re in foster care — from ensuring health care access and coordination through electronic health care passports to establishing data-sharing requirements,” said Renée Wilson-Simmons, NCCP director and report co-author. “However, several states are undoing that good work once young people leave the system, just because they aged out in another state.”

Under the ACA, young people who were in foster care and enrolled in Medicaid on their 18 th birthday — or older in states that extend foster care beyond age 18 — are eligible for Medicaid until age 26, regardless of their income. Despite this seemingly straightforward provision, some states have denied coverage based on an interpretation of the provision’s wording that defines eligible youth as those who had been in the custody of "the state" rather than “a state.” Those states have taken that distinction to mean that the ACA mandates that states extend Medicaid coverage to young people who were in that state’s custody when they aged out of care (“the state”), and not to young people who were in the custody of another state (“a state”).

"Young adults whose parents have private health insurance can stay on their parents' insurance until age 26 regardless of where they live," said report co-author Amy Dworsky, a research fellow at Chapin Hall whose career has focused on studying vulnerable youth populations. "Young adults who aged out of foster care should not have to choose between pursing educational or employment opportunities in another state and remaining in the state where they aged out so they don’t lose their health insurance coverage."

The report also found that while states have identified cost as the major barrier to a more inclusive interpretation of the ACA provision, denying Medicaid coverage to former foster youth may actually cost states more money in the long run. Costs to provide health care to the poor have risen twice as fast as In states that declined to expand Medicaid eligibility as part of the ACA compared to those that extended benefits to more low-income residents — 6.9 percent versus 3.4 percent. The report suggests that the 37 states that have not provided Medicaid coverage to young people who exited foster care from other states will likely incur even higher medical costs as well, particularly if these young people delay seeking needed medical care and wind up in an emergency room.

To better support the health needs of those who have transitioned from foster care, the report calls for removing the hurdles over which these young people must jump to get the care to which they are entitled, whether they choose to remain in their “home state” after aging out or not. The center’s recommendations included streamlining the process for applying for health coverage and using more creative means to inform foster youth of their eligibility and how to enroll.

For more information on the National Center for Children in Poverty, visit

The National Center for Children in Poverty (NCCP) is a nonpartisan public policy research center dedicated to promoting the economic security, healthy development, and well-being of America's low-income children and their families. Part of Columbia University's Mailman School of Public Health, NCCP uses research to inform policy and practice with the goal of ensuring positive outcomes for our nation's children.