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EXECUTIVE SUMMARY
POLICY QUESTION
What are the Federal and State policy solutions to the barriers for youth re-enrolling
into Medicaid once they have left care?
RECOMMENDATIONS
I recommend three solutions that the Children’s Bureau should consider to address
the barriers of Medicaid re-enrollment for youth aging out of foster care.
The Children’s Bureau should:
• Support states in making the transitions onto Medicaid after foster care a seamless
process.
• Encourage restructuring of the independent living programs.
• Study the possibility of a change in institutional mechanisms.
IDENTIFIED ISSUES
Nationally about 30,000 of the half million youth in state custody will age out of
care this year . Youth aging out of care are at greater risk of unemployment, homelessness,
dropping out of school, and unplanned parenthood . These transition age youth report
more health problems and mental health diagnoses, than their peers who have not been
in the child welfare system . Unfortunately many recently emancipated young adults
do not have health insurance; this makes swift and appropriate interventions much
harder to achieve.
I have identified four barriers to youth re-enrolling into Medicaid once they have
left care. First, there is a lack of knowledge at the service delivery level, for
both Medicaid enrollment staff as well as independent living coordinators. This is
likely due to high turnover amongst staff in both divisions. Second, for youth that
have aged out of care there is a lack of knowledge of the Medicaid option. There is
variability in how independent living programs are delivered and some states and counties
may not have a set curriculum for teaching transition age youth about their benefits.
Third, once youth have left foster care they have shown a strong desire to disassociate
with “the system”. Lastly, youth who have aged out of foster care lack healthy adult
connections. These are adults that many transition age youth can turn to help them
understand their insurance or how to make a doctor’s appointment. Former foster youth
often do not have a parent or other supportive adult they can turn to for help.
CRITERIA I use the following criteria to analyze my
solutions:
• Minimize costs for key stakeholders.
• Create collaborations among stakeholders.
• Assist states in their preparation for providing health insurance for all youth
that age out of care until age 26.
POLICY SOLUTIONS The five policy solutions I evaluate
are:
1. Support states in making the transition onto Medicaid after foster care a seamless
process.
2. Encourage restructuring of the independent living programs.
3. Study the possibility of a change in institutional mechanisms.
4. Support collaborations with service providers outside of DSS.
5. Encourage states to develop websites that clearly communicate eligibility benefits
for stakeholders.
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