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Tuesday, March 6, 2012

Child Welfare: Health Care Needs of Children in Foster Care and Related Federal Issues


Evelyne P. Baumrucker
Analyst in Health Care Financing

Adrienne L. Fernandes-Alcantara
Specialist in Social Policy

Emilie Stoltzfus
Specialist in Social Policy

Bernadette Fernandez
Specialist in Health Care Financing


Approximately 662,000 children spend some time in foster care each year. Most enter care because they have experienced neglect or abuse by their parents. Between 35% and 60% of children entering foster care have at least one chronic or acute physical health condition that needs treatment. As many as one-half to three-fourths show behavioral or social competency problems that may warrant mental health services. Many health and mental health needs persist. A national survey of children adopted from foster care found that 54% had special health care needs and research on youth who aged out of foster care shows these young adults are more likely than their peers to report having a health condition that limits their daily activities and to participate in psychological and substance abuse counseling.

The Social Security Act addresses some of the health care needs of children in, or formerly in, foster care through provisions in the titles pertaining to child welfare (Titles IV-B and IV-E) and to the Medicaid program (Title XIX). Under child welfare law, state child welfare agencies are required to have a written plan for each child in foster care that includes, among other items, the child’s regularly reviewed and updated health-related records. In addition, state child welfare agencies, in cooperation with state Medicaid agencies, must develop a strategy that addresses the health care needs of each child in foster care. Upon aging out of foster care, youth must receive from the state child welfare agency a copy of their health record and information about health insurance options and designating other individuals to make health care decisions on their behalf if they are unable to do so on their own.

States are not permitted to use federal child welfare program funds to pay medical expenses of children in care or those who left foster care due to their age or placement in a new permanent family. However, states can (and do) receive reimbursement through Medicaid to pay a part of the medical expenses, including well-child visits and other benefits, for many of these children and youth. Most children in foster care are eligible for Medicaid under mandatory eligibility pathways, meaning that states must provide coverage because these children meet low-income and other eligibility criteria. Children in foster care who are not eligible under mandatory pathways generally qualify for Medicaid because the state has implemented one or more optional eligibility categories allowing coverage. Further, some children who leave foster care for legal guardianship remain eligible for Medicaid on a mandatory basis, as do most children with statedefined “special needs” who leave foster care for adoption. The income and resources of the child’s guardian or adoptive parent are not considered under this eligibility pathway. Separately, youth who age out of foster care may be eligible for Medicaid through one of the mandatory eligibility pathways that are available to adults generally. States also have the option of providing Medicaid to youth up to the age of 21 if they aged out of foster care. However, the Patient Protection and Affordable Care Act (ACA, P.L. 111-148, as amended), requires that beginning on January 1, 2014, states must provide Medicaid to young people under the age of 26 who aged out. Unlike most other Medicaid pathways, coverage must be provided without regard to the income and assets of these young people. This new pathway parallels another requirement in ACA that generally directs health insurance companies to continue to provide coverage to children up to age 26 who are enrolled in their parents’ health care plans.

ACA made additional changes to assist adults in obtaining private health insurance, and young adults leaving foster care may benefit from these changes. ACA may also include new opportunities for providing health insurance to child welfare-involved children and their families, such as those children in foster care who are vulnerable to losing Medicaid upon returning home.



Date of Report: February 27, 2012
Number of Pages: 56
Order Number: R42378
Price: $29.95

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