The Affordable Care Act Increased Medicaid Coverage Among Former Foster Youth

By Bonnie Tse

September 3, 2021

The Affordable Care Act increased Medicaid coverage for former foster youth, with stronger effects from Medicaid expansion to low-income adults than from the Medicaid age-based extension.
photo of Angelica Meinhofer

Angélica Meinhofer was one of the three recipients who received CHERISH pilot grant funding in 2019.

In a new study published in Health Affairs, Lindsey Bullinger, an assistant professor in the School of Public Policy at Georgia Tech, and Angélica Meinhofer, a CHERISH Research Affiliate and an assistant professor in the Department of Population Health Sciences at Weill Cornell Medicine, suggest that the Affordable Care Act (ACA) has not only increased Medicaid coverage for youths formerly in foster care but can also be modified to enroll more of this population.

Youths aging out of the foster care system face heightened challenges to becoming independent adults. They have a greater risk for physical, mental, and behavioral disorders, homelessness, substance use, and unemployment compared to youths who are not in foster care. Before the ACA was passed, maintaining their Medicaid eligibility also depended on their age and whether they resided in a state that adopted the Chafee Foster Care Independence Act, a federal legislation that funds programs and resources for youth who have left the foster care system. Subsequently, the ACA Medicaid expansions to low-income adults, which allow states to adopt at their discretion, and the mandatory ACA provisions that extended Medicaid eligibility for former foster youths nationwide became pivotal in giving this population access to affordable healthcare.

Using longitudinal data from the 2011 to 2018 National Youth in Transition Database, Meinhofer and Bullinger found that the ACA provisions that expanded Medicaid eligibility to low-income adults saw a 13 to 14% increase in Medicaid coverage among youths formerly in foster care, while the ACA provision that extended Medicaid eligibility up to age 26 for former foster youths saw a 5% increase in coverage. Given the modest treatment effects associated with the ACA Medicaid age extension for former foster youths relative to the ACA state Medicaid expansions for low-income adults, Meinhofer and Bullinger recommend revising Medicaid enrollment, recertification, outreach, and eligibility determination processes associated with the ACA Medicaid age extension to further increase Medicaid coverage among former foster youth. This will be especially beneficial in states where Medicaid eligibility for low-income adults has not been expanded.