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VFA Policy Intern Blog: Stand Up for Medicaid to Protect Our Foster Youth

Stand Up for Medicaid to Protect Our Foster Youth

by Isabel Marcelletti

Published 7/14

With the passing of the American Health Care Act of 2017 in the House and the introduction of the Senate’s Better Care Reconciliation Act of 2017, Voice for Adoption (VFA) is very concerned for the future of Medicaid, the lifeline for our vulnerable foster care children. This entitlement program is authorized by Title XIX of the Social Security Act where states receive reimbursement from the Medicaid pool to help defray the health costs of children in foster care. This entitlement program is essential for providing foster youth an opportunity to heal from their past traumas and to grow as healthy individuals, body and mind.

There are multiple paths for foster care children to receive Medicaid coverage. A common way in which foster care youth receive Medicaid coverage is through qualification for Title IV-E maintenance payments. These children would be considered as special needs, where adoption would not seem to be feasible without a Title IV-E adoption assistance agreement. Additionally, states are required to provide Medicaid coverage for children (under the age of 19) whose families’ household incomes are not more than 133% of the Federal Poverty Line. When youth age out of the foster care system, from ages 19 to 26 they can be enrolled under Medicaid, which helps ensure a healthy transition to adulthood.

The benefits of Medicaid are invaluable for foster youth. In general, the services that foster care children receive include preventive, screening, diagnostic, and treatment services necessary to ensure optimal physical and behavioral health. Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) guidelines are all inclusive, entailing any treatment “to correct or ameliorate defects and physical and mental illnesses and conditions”, whether or not such services are otherwise provided in the State’s Medicaid plan under section 1905(a). This care is essential, as EPSDT stipulates that screening services, vision services, dental services, hearing services, any other medically necessary health care, and diagnostic services are guaranteed services for the youth who are enrolled under this entitlement. Additionally, Medicaid provides services, like transportation, to help a child access their necessary health care.

Undoubtedly, any tampering with the existing Medicaid system would be devastating for foster youth. The Senate measure and the House bill on health reform would phase out extra funds that the federal government has provided to states as an incentive to expand the eligibility for Medicaid. Essentially, the entire Medicaid program would be put on a budget (capped), ending its open- ended nature which allows for expansion. The fact that Medicaid would not be allowed to expand would be a devastating setback. Additionally, fellow Medicaid advocates worry that the proposed fixed growth rate for Medicaid would not account for varying patterns of health costs. If the Senate bill passes, Medicaid would be disbursed through a per-beneficiary allotment of money to states where each covered individual would be assigned a set amount which Medicaid would pay for and the rest would be on the enrollee’s dime. The alternative to that, would be Medicaid fund disbursement as an annual lump sum, a block grant, to state governments. States would be faced with serious number crunching and would have to cut certain populations from Medicaid coverage. They would have to choose to either raise more money to make up the difference in their losses, or to cut back on medical coverage for Medicaid enrollees, including the close to 500,000 foster children and youth who rely on it. The Congressional Budget Office estimates that the changes would lead to a reduction in spending on Medicaid of more than $800 billion over a decade. It is time to stand up for Medicaid now, as the proposed Congressional bills would inflict horrors onto our foster youth, whose lives depend on Medicaid coverage.