By Shadi Houshyar

Today, the Senate Finance Committee is marking up legislation to allow companies to hire veterans without requiring that they be counted as full-time workers under the Affordable Care Act’s (ACA) employer mandate. Senator Bob Casey will be offering an amendment that would clarify Congress’s intent with regards to states’ obligation to extend Medicaid coverage to former foster youth. This amendment clarifies that the intent of the original provision in the ACA was to ensure that all former foster youth who were enrolled in Medicaid when they aged out can maintain that coverage until they turn 26. While the amendment is not germane and will be pulled, it is an important statement and affirms Congress’ commitment to and support for young people aging out of foster care.

As background, signed into law on March 23, 2010, the ACA makes notable improvements to Medicaid and the Children’s Health Insurance Program (CHIP) and ensures that millions of Americans have access to affordable health coverage through insurance exchanges. Among the ACA provisions that took effect in 2014 were several new requirements that are critical for foster children and other vulnerable youth. Most notably, the law expands Medicaid coverage to former foster children up to age 26. To qualify, individuals must be under the responsibility of the state when they turn 18 (or older, if the state’s federal foster care assistance under title IV-E continues beyond that age), and to enroll in or maintain Medicaid eligibility, they must have been enrolled in Medicaid while in foster care and not yet reached the age of 26.

In early 2013, CMS issued a number of documents to clarify how states should implement the new provision. On January 22, 2013, CMS issued a proposed rule in the Federal Register, which clarified CMS’s interpretation that a youth is only eligible for Medicaid coverage in the same state in which he or she was in foster care at age 18 and enrolled in Medicaid. While CMS gave states the option to cover youth under this group who were in foster care and Medicaid in any state at the relevant point in time, it did not require that they do so. On July 15, 2013 CMS published the final rule, clarifying several outstanding issues but did not revisit the state option.

Given the clear Congressional intent for states to provide Medicaid coverage for all youth aging out of foster care up to age 26, advocates have urged CMS to reconsider its interpretation of the law. CMS has responded that it cannot interpret the statute as such. This amendment reaffirms Congress’ intent and commitment to ensuring health coverage for all young people aging out of foster care irrespective of where they aged out of care.

We appreciate Senator Casey’s leadership in introducing the amendment and applaud his continued efforts to ensure better outcomes for children and youth in foster care and those who have aged out of care.