Two years after passage, Indiana’s Medicaid program helps youth become productive adults

Aug 16, 2018 | Health & Well-Being, Policy & Practice

Your 18th birthday is a celebrated milestone for any teenager.  For many kids turning 18, their adventures after high school are beginning with support from their families back home. One form of support comes from the passage of the Affordable Care Act in 2010. The law allows 18-year-olds to remain on their parent’s health insurance plans until they turn 26. That’s one less worry for youth, even if health insurance isn’t something most young adults think about much, if at all.

For foster youth, however, turning 18 means they are now legal adults and not supported by the same plan that provided coverage for them up until that point. At the age of 18 years and 1 second, you’re on your own. 

“Everyone else can stay on insurance until age 26,” Brent Kent, Executive Director of Foster Success said. “That’s the nearly universal bi-partisan part of the ACA everyone can get behind. It’s even in every Republican bill that came before and after it.”

After the passage of the ACA, foster youth who turn 18 while in state care have the ability, if their state acts, to add them to Medicaid. It works differently in each state, but in Indiana the process required foster youth to know they needed to apply for Medicaid. Most 17-year-olds, however, never gave insurance much of a thought. “They didn’t know they were eligible, or they’d get signed up on an alternative income-based insurance plan. Often because someone advising them didn’t know, either,” says Kent.

“We tried addressing this by hosting movie nights, pizza parties, or any other social event we could think of just to get foster youth in a room with Medicaid plan providers,” says Kent. Providers like MHS, Anthem, and Caresource would enroll foster youth in Medicaid on-the-spot, but Indiana law required them to renew annually. Those renewals were handled in the mail, and applications were often returned by mail. For a transient group like foster kids who rarely have an address for long, most lost touch and many didn’t understand the renewal process.

With the burden of proof on kids to renew their insurance, and no one working to educate them or even caseworkers about their care, Foster Success approached the legislature in 2017. “We thought since their eligibility is based on a permanent requirement – turning 18 while in foster care – why not require the Department of Child Services to enroll them before their 18th birthday provide them Medicaid access automatically until age 26?” Despite some legislative hurdles and bureaucratic wrangling, the bill passed. SEA 497 granted foster youth who turn 18 while in the State’s care the same parity as 18-year-olds with a parent’s insurance plan.

Foster Success’ work with SEA 497 wasn’t about seeking special benefits. “We wanted to bring parity between youth in foster care and youth with families with sustained medical coverage,” Kent says. “We also know from our research that kids who aged out of foster care were not accessing medical treatment. And many of them have a slew of issues, including 40% with some form of PTSD.”

The whole process is smoother now than it was right after enactment. “One youth,” Kent recalls, “called us to say he was insured, but their carrier was telling them they were ineligible. Here’s a kid with enough knowledge to know they should be insured, had the social capital to call an insurance carrier to navigate the phone tree and org chart and speak to someone who told them they weren’t eligible. All because they had a job.” The situation was eventually corrected to reinstate coverage, but not without considerable time and advocacy.

Another youth with a form of throat cancer benefited from SEA 497’s passage. Thousands of foster youth have and will continue to get Medicaid coverage that will help them continue to become productive adults. For those starting their young adult lives, they can do so without ruinous financial strain from medical bills.

“I’ve never worked on a piece of public policy with such a profound and measurable impact in such a short time as this,” says Kent. A year after SEA 497, the number of foster youth enrolled in Medicaid increased by 72%. 

“Now we get to work on improving access to that care and ensuring enrollment happens with the best coverage possible. We can focus on pregnancy prevention, mental health, telemedicine — all things you can’t do until after you get insurance. All things we’re looking at now as part of a ‘healthcare strategy 2.0’, “says Kent.

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