Former foster care youth can now qualify for Medicaid coverage until they turn 26 years old under the Affordable Care Act. This new requirement applies to individuals aged 18 to 26 who received Medicaid coverage in a federal or state-funded foster care category on or after their 18th birthday. These former foster care youth do not have to meet any income or resource guidelines in order to qualify for Medicaid.
Here is what former foster care youth or individuals currently in foster care and their advocates need to know:
Individuals aging out of foster care after January 1, 2014: Current foster care youth who turn 18 and age out of the foster care system now or in upcoming years should automatically transfer to this new category with no break in coverage. The County Children and Youth Agency will send discharge paperwork to the County Assistance Office (CAO) which will act as an application and the Medicaid caseworker will change the Medicaid category from a federal or state foster care category to the new category for former foster care youth. The person leaving foster care should not have to take any action to have their Medicaid continue.
Individuals who aged out of foster care before January 1, 2014: Those who are under age 26, and who aged out of the foster care system between 2007 and 2013, will need to apply for Medicaid to obtain coverage under this new category. They should use the PA 600HC application and answer the questions for persons under age 26 at the bottom of page 2. Those individuals who received previous foster care and Medicaid benefits in Pennsylvania will not need to prove this because the CAO caseworker will be able to verify this in their system. Anyone who previously received foster care and Medicaid from another state will need to provide proof they received those benefits when applying for Medicaid in Pennsylvania.
Individuals can apply any of the following ways:
Online, go to www.compass.state.pa.us;
Over the phone, call 1-866-550-4355 (between 8am and 5pm);
Through the mail, use the PA 600 HC; or
In person, visit the local County Assistance office
Former foster care youth should receive the full Medicaid benefit package. Those aged 18 through 20 continue to qualify for benefits under Early Periodic Screening, Diagnosis, and Treatment (EPSDT) which allows them to receive all medically necessary health care services, including behavioral health rehabilitation services (also called wraparound), shift nursing, home health aide services and unlimited prescription coverage. Once they turn 21, these individuals will receive the full package of Medicaid benefits for adults including certain behavioral health services and prescription drug coverage with limits.
Former foster care youth who are experiencing problems with Medicaid eligibility can call PHLP’s Helpline (1-800-274-3258) for advice and assistance.