Foster Youth Provision Survives in House Healthcare Bill

The Affordable Care Act (ACA) provided presumptive Medicaid eligibility until age 26 for any youth aging out of the foster care system.

The House’s newly unveiled healthcare bill, the American Health Care Act (AHCA), will not repeal that provision. The AHCA does plenty to downsize Medicaid; its caps the entitlement and phases out the ACA expansion of it. But no portion of the bill’s text appears to repeal the new mandatory eligibility categories established by ACA, including the mandatory coverage for youths who have aged out of foster care.

The bill does tinker with ACA expansions to what is known as “presumptive eligibility” (PE) which refers to a group that states can choose to prove access Medicaid services for at a hospital even if they have not enrolled in the program.

Presumptive eligibility used to apply only to pregnant women and children; ACA expanded the universe to include, among others, aged out foster youths up to 26.

What does this all mean? If you age out of foster youth, it is mandatory that the state enroll you in Medicaid if that is what you want. But it is on you to enroll; it isn’t done automatically.

Under PE, though, a former foster youth who had yet to enroll could receive Medicaid services at a hospital anyway. And presumably, the incident would lead to coordination of services and enrollment going forward in Medicaid.

Youth Services Insider is still working to confirm exactly what the fate of PE for the aging out group is. Here is the relevant section in the House bill:

“In section 1920(e) (42 U.S.C. 1396r–1(e)),

by striking ‘‘under clause (i)(VIII), clause (i)(IX), or

clause (ii)(XX) of subsection (a)(10)(A)’’ and insert-

ing ‘‘under clause (i)(VIII) or clause (ii)(XX) of sec-

tion 1902(a)(10)(A) before January 1, 2020, section

1902(a)(10)(A)(i)(IX),’’.

That is Congressional sanskrit to 99.99 percent of the world, but the key term in it is clause (i)(IX); that is the aged-out foster youth provision. And what appears to happen as a result of this language is: PE for clause i(VIII) and clause ii(XX), both regarding people of certain income levels, is phased out on January 1, 2020.

But the placement of clause (i)(IX) after the 2020 specification leads us to conclude that PE for former foster youths is protected.

Zach Hunter, communications director for the House Committee on Energy and Commerce, confirmed YSI‘s interpretation of this phrasing.

“You understand correctly,” Hunter said.

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