Children’s Bureau/ACYF/ACF/HHS

800.394.3366 | Email: info@childwelfare.gov | https://www.childwelfare.gov

ISSUE BRIEF

May 2015

Health-Care Coverage for 

Youth in Foster Care—

and After

WHAT’S INSIDE

Health-care needs of 

children and youth 

in foster care

Medicaid coverage—

who is eligible and how?

Other health-care 

coverage (non-Medicaid)

Coverage benefits

Improving health-care 

coverage for children 

and youth in foster care

References

Acknowledgment 

and disclaimer

Health care is a basic necessity for all children 

and youth. Children and youth who enter foster 

care because of abuse or neglect often have 

significant health-care needs. Changes in 

the nation’s health-care laws have increased 

access to and affordability of health care for 

some of our most vulnerable children and 

youth—those involved with child welfare. This 

issue brief reviews the eligibility pathways for 

children and youth in foster care to receive 

Medicaid or other health-care coverage and 

looks at some of the newer benefits now 

mandated through the Patient Protection and 

Affordable Care Act (ACA), especially those 

for older youth in or formerly in foster care. 
Health-Care Coverage for Youth in Foster Care—and After https://www.childwelfare.gov

2

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Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/health-care-foster.

This brief provides a general overview; States differ with 

regard to health-care benefits and how they administer 

many of the benefits. For specifics in your State, visit 

https://www.healthcare.gov/medicaid-chip/eligibility. In 

addition to State examples of what works for Medicaid 

and non-Medicaid coverage for children and youth in 

foster care, this brief also provides resources to help youth 

and young adults understand their health-care options 

and resources for agencies on health-care access for 

children, youth, and families involved with child welfare. 

Health-Care Needs of Children 

and Youth in Foster Care

Children and youth placed in foster care because of 

abuse or neglect often enter care with significant health 

challenges. Health issues may be related to poverty and 

other at-risk conditions such as parental substance abuse 

or mental illness. The actual abuse or neglect (including 

medical neglect) can also be a contributing factor to poor 

health, as can the disruption caused by removal from the 

home and placement in foster care. A government study 

that compared children receiving Medicaid who were in 

foster care with those not in care found that the children 

in foster care had much higher rates of developmental 

disorders, certain medical disorders (e.g., vision disorders, 

teeth and jaw disorders), and a number of behavioral 

disorders, including attention deficit and adjustment 

disorders (Center for Mental Health Services and Center 

for Substance Abuse Treatment, 2013). This same study 

showed that youth aged 12 through 17 in foster care had 

three times as many behavioral/mental health diagnoses 

and were more than twice as likely to require inpatient 

care of any kind compared to youth not in foster care. 

The risk factors associated with poor health in children 

in foster care can also contribute to long-term and even 

lifetime problems. Studies such as the Adverse Childhood 

Experiences (ACEs) study from the U.S. Centers on 

Disease Control and Prevention show that, as the number 

of ACEs (e.g., abuse, neglect, parental substance abuse, 

witnessing domestic violence) increases, the risk increases 

for adulthood heart disease, suicide, HIV, and other 

conditions that can lead to early death (Anda, 2007). 

ACEs are also associated with such factors as relationship 

stability and job performance in adulthood. Thus, quality 

health care for children and youth in foster care addresses 

many childhood conditions and also may set the stage 

for a healthier, happier, and more successful adulthood.

Medicaid Coverage—Who 

Is Eligible and How?

Medicaid, as authorized by title XIX of the Social 

Security Act, is a program funded jointly by Federal 

and State governments to provide health-care 

coverage to low-income citizens who meet certain 

additional criteria. States determine their own 

eligibility criteria within broad Federal guidelines. 

While States are not permitted to use Federal child 

welfare funds to pay for Medicaid, they do receive 

some reimbursement from Medicaid to help defray the 

costs of covering children in foster care (Baumrucker, 

Fernandes-Alcantara, Stoltzfus, & Fernandez, 2012). 

The majority of children and youth in foster 

care are eligible for Medicaid, and this section 

outlines how children and youth in foster care 

meet those eligibility requirements.

Title IV-E and Foster Care

The most common eligibility pathway to Medicaid 

for children and youth in foster care is through title 

IV-E eligibility. Title IV-E of the Social Security Act 

provides funding to support safe and stable out-ofhome care for children who are removed from their 

homes. Title IV-E does not provide Medicaid, but 

children and youth in foster care who receive title 

IV-E payments are categorically eligible for Medicaid 

in every State. This group includes the following:

Children and youth who receive title IV-E foster 

care maintenance payments. This is the category 

that covers most children and youth in foster care. If 

title IV-E payments are being received, the children 

or youth are eligible for Medicaid in their State of 

residence. A youth on whose behalf title IV-E foster 
Health-Care Coverage for Youth in Foster Care—and After https://www.childwelfare.gov

3

care maintenance payments are made is categorically 

eligible for Medicaid in the State of residence, including 

a youth up to age 21. A youth aged 18 through 20 is 

eligible for Medicaid (if IV-E payments are received 

for such a youth) whether or not the title IV-E agency 

in the State of residence has taken the option to 

provide extended IV-E assistance (ACF, 2010).

Children and youth who receive title IV-E 

guardianship assistance program (GAP) payments.

Children and youth who receive title IV-E guardianship 

assistance payments are eligible for Medicaid in their 

State of residence. A youth on whose behalf title 

IV-E guardianship assistance payments are made 

is categorically eligible for Medicaid in the State of 

residence, including a youth up to age 21. Such a youth 

is eligible for Medicaid (if IV-E GAP payments are 

received for such a youth) whether or not the title IV-E 

agency in the State of residence has taken the option 

to provide extended IV-E assistance (ACF, 2010).

Children and youth subject to a title IV-E adoption 

assistance agreement. Children and youth covered by 

title IV-E adoption assistance agreements are eligible 

for Medicaid. Generally, title IV-E adoption assistance 

agreements are available for children or youth who are 

deemed to have “special needs” as defined by the title 

IV-E agency, and they are children for whom adoption 

might not be feasible without the adoption assistance 

agreement. (See Child Welfare Information Gateway’s 

“Special Needs” Adoption: What Does It Mean? at https://

www.childwelfare.gov/pubs/factsheets/specialneeds/.) A 

youth who is subject to a title IV-E adoption assistance 

agreement is categorically eligible for Medicaid in the 

State of residence, including a youth up to age 21. Such 

a youth is eligible for Medicaid (if the IV-E assistance 

agreement is in effect for such a youth) whether or not the 

title IV-E agency in the State of residence has taken the 

option to provide extended IV-E assistance (ACF, 2010).

Children of a minor parent or youth over age 18 in 

foster care. If a youth in foster care whose costs are 

covered by title IV-E foster care maintenance payments 

is or becomes a parent, that youth’s child is categorically 

eligible for Medicaid as a title IV-E child in the State where 

they live. This continues to hold true regardless of whether 

or not the title IV-E agency in that State has elected to 

extend foster care assistance to youth age 18 and older. 

If the State has placement and care responsibility for 

both the parent and the child, title IV-E eligibility must be 

determined individually for each, and title IV-E payments 

determine Medicaid eligibility (Children’s Bureau, n.d.).

The above information on title IV-E categorical 

eligibility for Medicaid is detailed in a Program 

Instruction published in 2010 by the Children’s Bureau, 

Administration for Children and Families, U.S. Department 

of Health and Human Services, which can be found at 

http://www.acf.hhs.gov/sites/default/files/cb/pi1011.pdf.

Other Ways Children in Foster Care 

May Qualify for Medicaid

For children and youth in foster care who are not 

eligible under title IV-E, there are other ways that 

they may be eligible to receive Medicaid.

Mandatory Medicaid eligibility for children under age 

19. States are required to provide Medicaid coverage

for children under age 19 whose household income is 

no more than 133 percent of the Federal poverty line 

(FPL) or a higher income limit established by the State 

for the child’s age group (under age 1, aged 1 through 

5, or aged 6 through 18). Often, for a child placed out 

of home in foster care (especially if the parents do not 

intend to claim the child as a tax dependent for the 

current tax year), only the child’s income is considered for 

Medicaid eligibility. Therefore, most children under age 

19 in foster care who do not qualify for the Medicaid IV-E 

eligibility do qualify for this other mandatory eligibility 

group. Many States cover children under age 19 to a 

higher income limit under the Children’s Health Insurance 

Program (CHIP; see below for more information).

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/health-care-foster.
Health-Care Coverage for Youth in Foster Care—and After https://www.childwelfare.gov

4

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/health-care-foster.

Medicaid eligibility for the adult group. States have 

the option to cover the “adult group” added by the 

ACA for nonpregnant individuals aged 19 through 64 

whose household income is no more than 133 percent of 

the FPL. Currently, 28 States cover this eligibility group. 

Because youth in foster care aged 19 or older often are 

considered for Medicaid eligibility as a household of one 

person, their income is usually within the limit for this 

group, if covered by their State of residence (see http://

www.medicaid.gov/medicaid-chip-program-information/

by-population/adults/non-disabled-adults.html).

Youth formerly in foster care and under age 26. The 

ACA provides a new mandated eligibility pathway for 

Medicaid, effective in 2014, for the “former foster care” 

group, which covers older youth no longer in foster care 

so they may continue to receive Medicaid until their 26th 

birthday. This coverage is similar to that of other young 

adults with no foster care connection who are able to 

remain on their parents’ health-care plans until age 26. 

Youth formerly in foster care are eligible for their State’s 

full Medicaid coverage, regardless of their income and 

regardless of whether the State where they live opted or 

declined to expand Medicaid coverage under the “adult 

group.” This provision applies to individuals under age 

26 who were both enrolled in Medicaid and in foster care 

under the responsibility of the State or Tribe where they 

currently live upon attaining either age 18 or such higher 

age as the State or Tribe has elected for termination of 

Federal foster care assistance under title IV-E. States 

have the option to cover youth who were in foster care 

and/or enrolled in Medicaid in another State than where 

they currently live, but they are not required to do so. To 

date, 12 States have opted to cover eligible youth from 

other States (Houshyar, 2014). For more information, 

see the Medicaid website at http://www.medicaid.gov/

State-Resource-Center/Downloads/Medicaid-and-CHIPFAQs-Coverage-of-Former-Foster-Care-Children.pdf.

Youth who age out of foster care in States that 

offer the Chafee option. The Chafee Foster Care 

Independence Act of 1999 provides services and supports 

to help youth aging out of foster care make a successful 

transition to adulthood and independence. Chafee 

funds may also cover youth who are adopted or enter a 

guardianship after their 16th birthday. The Chafee Act 

authorizes States to provide Medicaid to certain youth 

who age out of foster care. States receive grants to 

fund Chafee services, and States also have the option 

to determine eligibility under Medicaid for this group 

of “independent foster care adolescents” up to age 19, 

20, or 21. Currently, 30 States have elected to cover this 

Medicaid group for older youth who were in foster care 

at age 18 and are not eligible for the mandatory Medicaid 

groups such as the former foster care group. Twenty-six of 

these States do not apply an income limit for this group.
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The ACA’s Coverage for Mandatory Former Foster Care Group 

Versus the Chafee Option—What’s the Difference?

There is some overlap between the coverage mandated by the ACA for the former foster care group of 

older youth and young adults and the Medicaid coverage that some States provide through the Chafee 

option for older youth who have left foster care. A Medicaid factsheet that includes frequently asked 

questions on this topic makes the following points about differences in these Medicaid eligibility groups 

(Centers for Medicare and Medicaid Services [CMS], 2013; see http://www.medicaid.gov/State-ResourceCenter/Downloads/Medicaid-and-CHIP-FAQs-Coverage-of-Former-Foster-Care-Children.pdf):

Chafee Optional Medicaid Group for Independent Foster Care Adolescents 

 Youth receiving IV-E foster care or, at the State’s option (as elected by all 30 of the States), were in State- or 

Tribal-funded care, are eligible.

 Youth must have been in foster care at age 18.

 Young adults with an income above a certain level are not eligible, if the State has an income test for this 

group (as only 4 out of 30 States do).

 Young adults are not required to have been in foster care in the same State where they are seeking coverage, 

unless the State imposes such a requirement (which 2 of the 30 States have).

 Chafee coverage goes up to age 19, 20, or 21 at State option.

ACA Mandatory Medicaid Coverage for Former Foster Care Group 

 Young adults who were receiving IV-E foster care or State- or Tribal-funded foster care and were enrolled in 

Medicaid at age 18 or when they aged out of care are eligible.

 There is no income requirement.

 Young adults are eligible only in the State in which they aged out of foster care, although some States 

(currently, 12 States) are opting to cover young adults who were in foster care and/or Medicaid in other States.

 Coverage is provided until the young adult’s 26th birthday.

For young adults who meet eligibility requirements under both Chafee and the 

ACA groups, the ACA requirements supersede Chafee option.

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Other pathways to Medicaid eligibility. Within a broad 

range of Federal guidelines, States may offer other ways 

for children and youth in foster care to be eligible for 

Medicaid if they do not meet the criteria outlined above. 

These pathways are not specifically targeted for children 

in child welfare, and some are “optional pathways” (in 

contrast to the federally mandated pathways) available 

only in some States. The other pathways to eligibility 

include the following (Baumrucker et al., 2012):

 As noted above, the Federal Government requires 

all States to provide Medicaid coverage to children 

in families with incomes at or below 133 percent of 

the FPL or a higher income limit established by the 

State. Pregnant women are covered with this same 

income requirement. States are also required to cover 

parents and other caretaker relatives of dependent 

children (through which individuals aged 19 or older 

may be covered) and certain children with severe 

disabilities who are receiving Supplemental Security 

Income (SSI) from the Social Security Administration 

(see http://www.medicaid.gov/medicaid-chipprogram-information/by-population/pregnant-women/

pregnant-women.html). 

 In some States, youth who are 19–20 years old may 

qualify for Medicaid under the Ribicoff pathway of 

optional reasonable classifications of children under 

42 CFR 435.222. Each State makes its own decision 

about this eligibility and defines the income and 

other qualifications. Twenty States cover, under this 

provision, certain children in State- or Tribal-funded 

foster care who do not qualify for the mandatory 

Medicaid eligibility groups (especially those aged 19 

or 20). Ten of those States do not apply an income limit 

for this group.

 A child or youth adopted from foster care and covered 

by an adoption assistance agreement funded solely 

by the State or Tribe (not IV-E) may be eligible for 

either Medicaid or a program with benefits equal to 

Medicaid if he or she is a child “who the State has 

determined cannot be placed with an adoptive parent 

or parents without medical assistance because such 

child has special needs for medical, mental health, or 

rehabilitative care” (Social Security Act 471(a)(21) at 

http://www.ssa.gov/OP_Home/ssact/title04/0471.htm). 

Every State but one has elected to cover the optional 

Medicaid eligibility group for children with State- or 

Tribal-funded adoption assistance agreements in 

effect who are under age 18, 19, 20, or 21. All but 

three States either do not have an income test for this 

Medicaid group or base eligibility on whether the child 

was Medicaid-eligible at the time of the adoption.

Other Health-Care Coverage 

(Non-Medicaid)

While the great majority of children and youth 

in foster care are eligible for Medicaid, those 

who are not may be eligible for other subsidized 

programs or other health-care coverage. Children 

not in foster care but whose families are involved 

with child welfare may also be eligible for other 

kinds of government-sponsored coverage.

The Children’s Health Insurance 

Program (CHIP)

Like Medicaid, CHIP is a State-administered program 

jointly funded by the State and the Federal Government. 

CHIP provides free or low-cost health-care coverage 

to children (through age 18) whose families earn too 

much to qualify for Medicaid. In most States, this 

means that children in families with incomes above 

133 percent FPL and up to 250 percent of the FPL or 

higher might qualify for CHIP. The Federal Government 

provides a website, Insure Kids Now, that describes 

both Medicaid and CHIP eligibility and benefits, 

as well as a map of all the States with links to each 

State’s specific Medicaid and CHIP information (visit 

http://www.insurekidsnow.gov/state/index.html). 

Private and Marketplace 

Health-Care Coverage

The ACA has made private health-care coverage more 

attainable by more people and has removed some 

restrictions—such as denial of coverage for preexisting 

conditions and dollar limits on essential benefits—

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7

that kept citizens from purchasing health insurance. 

Health insurance purchased through an employer or 

through a marketplace health exchange may be the 

answer to coverage for some children and youth in 

adoption assistance agreements, for some young 

adults who have aged out of foster care but do not 

meet eligibility requirements for the Chafee option 

or for Medicaid, and for some families receiving child 

welfare services who are not eligible for Medicaid.

Young adults who age out of care without 

Medicaid. Young adults who do not meet the eligibility 

requirements for the Chafee option (or are not living 

in a State that provides it) or for other Medicaid 

groups can purchase private health-care insurance 

through their employer, if employed, or through the 

marketplace. Those with lower incomes and larger 

households may qualify for plans at a reduced cost. The 

website HealthCare.gov provides a chart that shows 

qualifying income and household size for Medicaid 

and for reduced-cost private health plans: https://www.

healthcare.gov/qualifying-for-lower-costs-chart/.

Families receiving child welfare services. While 

there is no special health-care coverage for families 

with child welfare involvement, the ACA provides 

new opportunities for lower-to-middle income and 

other families who may not have had reliable health 

insurance in the past. Tax credits and subsidies are 

also available to help make insurance more affordable 

for families. To explore the options for coverage made 

available by the ACA, visit the Federal Government’s 

health-care website at https://www.healthcare.gov. 

Coverage Benefits

Children need a broad spectrum of health-care coverage 

that includes both preventive and treatment services. 

Screening services are essential for the prevention and 

early detection of health issues. Children who enter 

foster care may have an even greater need for the 

benefits that full health-care coverage can offer. This 

section discusses the general benefits that Medicaid and 

other health-care insurers offer to children and youth in 

foster care or those who have aged out of foster care.

Medicaid Benefits

State Medicaid programs offer an array of services, 

including mandatory services such as physician, 

inpatient hospital, and lab and x-ray services, as well 

as optional services such as dental services, physical 

therapy, and clinic services. As such, State Medicaid 

programs differ from State to State. The Medicaid 

website lists both the mandatory and optional services 

at http://www.medicaid.gov/medicaid-chip-programinformation/by-topics/benefits/medicaid-benefits.html.

In general, the services for children and youth 

in foster care 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). The EPSDT benefit is a 

mandatory service under the Federal Medicaid program 

and defined at section 1905(r) of the Social Security Act. 

EPSDT is the Medicaid program’s comprehensive and 

preventive benefit for children and youth under the age 

of 21, enrolled in Medicaid. EPSDT includes the following:

 Screening services, including: 

○ Comprehensive health and developmental history

(including assessment of both physical and mental

health development)

○ A comprehensive unclothed physical

○ Appropriate immunizations

○ Laboratory tests (including blood lead level

assessment)

○ Health education (including anticipatory guidance)

 Vision services (including diagnosis and treatment for 

defects in vision, including eyeglasses) 

 Dental services (which, at a minimum, include relief 

of pain and infections, restoration of teeth, and 

maintenance of dental health) 

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 Hearing services (which, at a minimum, include 

diagnosis and treatment for defects in hearing, 

including hearing aids) 

 Any other medically necessary health care, diagnostic 

services, or treatment coverable under section 1905(a) 

of the Act 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. 

Note: States determine the individual medical necessity 

criteria within their State for the services listed above.

Detailed descriptions of the EPSDT services listed above 

can be found on the Centers for Medicare and Medicaid 

Services (CMS) Medicaid website at http://www.medicaid.

gov/Medicaid-CHIP-Program-Information/By-Topics/

Benefits/Early-and-Periodic-Screening-Diagnostic-andTreatment.html. The goal of EPSDT services is to identify 

and treat children and adolescents’ health problems 

as early as possible (CMS, 2014). States must establish 

a schedule for medical, dental, vision, and hearing 

screenings and must ensure that enrolled children 

and their families are notified about the availability of 

screenings. Additional information on EPSDT services 

and requirements may be found in the EPSDT Guide for 

States, released in June 2014. See http://www.medicaid.

gov/medicaid-chip-program-information/by-topics/

benefits/downloads/epsdt_coverage_guide.pdf. 

Mental/behavioral health services and trauma 

services. The child welfare field has put emphasis on the 

identification and treatment of trauma in children and 

youth in foster care. As with other mental and behavioral 

health issues, trauma responds best to early diagnosis 

and individualized treatment. These kinds of services are 

covered under the Medicaid EPSDT benefit (see above). 

These services may include screening, therapy and/

or counseling, medication, substance abuse treatment, 

and, for some children, inpatient services. On March 

27, 2013, CMS issued additional information through a 

CMS Informational Bulletin regarding the coverage of 

Mental Health and Substance Use Disorder Screening 

under the EPSDT benefit (see http://www.medicaid.gov/

federal-policy-guidance/downloads/CIB-03-27-2013.pdf).

Additionally, in July 2013, the Administration for Children 

and Families (ACF), CMS, and the Substance Abuse 

and Mental Health Services Administration (SAMHSA) 

sent out a joint letter to State Directors on the topic of 

trauma. The letter provides background information on 

trauma experienced by children in foster care, discusses 

treatment and services for trauma, and outlines funding 

for services (see http://www.medicaid.gov/FederalPolicy-Guidance/Downloads/SMD-13-07-11.pdf). 

Home- and community-based services. Some healthcare services that might have previously been provided 

in an institutional setting may now be provided in the 

home of a child or youth or in a community-based 

setting. The joint letter from ACF, CMS, and SAMHSA 

(2013) covers the topic of providing and funding homeand community-based services for the treatment of 

behavioral health issues, including trauma, for children 

in foster care. The letter notes that health-care coverage 

in the Medicaid State Plan can extend beyond the 

Medicaid EPSDT services; this extended coverage is 

granted in section 1915 of the Social Security Act (http://

www.ssa.gov/OP_Home/ssact/title19/1915.htm):

“[Section 1915(i)] permits States to provide a full 

array of home and community-based services 

to individuals whether or not they qualify for an 

institutional level of care, as long as they have 

significant need. This can include individuals 

with mental health or substance use disorders 

[...] A State can also use section 1915(c) homeand community-based services waiver programs 

to cover similar services and serve individuals 

with significant needs who meet institutional 

level of care criteria. Examples of services and 

supports beyond those covered under Medicaid’s 

EPSDT services may include psychosocial 

rehabilitation, respite care, transition services, 

and social skill development.” (ACF et al., 2013)

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Waiver programs vary by State, but States can combine 

services available under a waiver with EPSDT services 

to provide comprehensive or “wraparound approach” 

care for children and youth with disabilities who might 

otherwise require institutionalization (CMS, 2014). 

Benefits of Home- and 

Community-Based Services

In 2013, the CMS joined with SAMHSA to 

distribute an informational bulletin on covering 

the costs of behavioral health services for 

children and youth with significant mental 

health conditions who are treated with homeand community-based services, rather than 

in residential settings. The bulletin points to 

two demonstration programs that illustrate 

the benefits of early treatment and care that is 

community-based, coordinated among agencies 

(wraparound approach), addresses trauma, and 

involves peer services, among other things. 

The bulletin also describes how Medicaid 

coverage can be used to cover the costs of 

these intensive home- and community-based 

services and how these services may result in 

better outcomes for children and families.

The bulletin, Coverage of Behavioral Health 

Services for Children, Youth, and Young Adults 

With Significant Mental Health Conditions is 

available at http://www.medicaid.gov/federalpolicy-guidance/downloads/CIB-05-07-2013.pdf. 

Psychotropic medications. The child welfare field has 

become increasingly concerned with the high numbers 

of children and youth in foster care who take prescribed 

psychotropic medications. A number of studies have 

shown that psychotropic drugs are prescribed for 

children and youth in foster care at a higher rate than 

for other children, and the combinations of drugs and 

the young ages at which the drugs are sometimes 

administered do not always follow best practices (e.g., 

Government Accountability Office [GAO], 2011).

In response, the Child and Family Services Improvement 

and Innovation Act of 2011 required States to establish 

protocols for the appropriate use and monitoring of 

psychotropic medications with children and youth in 

foster care (Information Gateway, 2012). To help States 

develop these protocols, the Children’s Bureau issued 

an Information Memorandum in 2012 to promote “the 

Safe, Appropriate, and Effective Use of Psychotropic 

Medication for Children in Foster Care” (see http://www.

acf.hhs.gov/sites/default/files/cb/im1203.pdf). In addition, 

the Children’s Bureau published a booklet to help youth 

in foster care better understand these medications and 

alternatives to them: Making Healthy Choices: A Guide 

on Psychotropic Medications for Youth in Foster Care, 

which is available—in both English and Spanish—on the 

Child Welfare Information Gateway website at https://

www.childwelfare.gov/pubs/makinghealthychoices/

(English) and https://www.childwelfare.gov/

pubs/makinghealthychoices-sp/ (Spanish).

The cost of prescribed psychotropic drugs, as well as 

other prescribed medications for children and youth in 

foster care, is generally covered as a medical benefit by 

Medicaid.

Reproductive and sexual health services. For a variety 

of reasons, teens in—or formerly in—foster care are more 

likely to become teenage parents than their counterparts 

not in foster care (Friedman, 2013). Therefore, easy access 

to reproductive health services is crucial for these teens. 

While Medicaid benefits vary by State, family planning 

services are a mandatory benefit under the Federal 

Medicaid program. Services are required to be provided 

to eligible individuals of child-bearing age (including 

minors who can be considered to be sexually active) 

(section 1905(a)(4)(c) of the Social Security Act). Family 

planning services are defined by each State and must 

be consistent with overall State policy and regulation 

regarding the provision of family planning services. 

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While each State may determine specific services and 

supplies that will be covered under its Medicaid State 

plan, any definition must include services to prevent or 

delay pregnancy and be sufficient in amount, duration, 

and scope to reasonably achieve the purpose of the 

benefit. Examples of covered services are counseling 

services and patient education, examination and 

treatment by medical professionals, laboratory tests, 

and pharmaceutical supplies and devices. The services 

must be available to men as well as women and to 

individuals under age 21 eligible for EPSDT services. 

Health homes. Through the optional health homes 

Medicaid State plan benefit, the ACA expanded 

treatment options for individuals with chronic medical 

conditions who are covered by Medicaid. States may 

opt to use a health home model in order to coordinate 

comprehensive physical and behavioral health care 

(including treatment for mental health and substance 

use disorders) and to provide linkages to long-term 

services and supports and social services for eligible 

persons. Health homes are responsible for operating 

under a “whole-person” philosophy, caring for both 

clinical and nonclinical needs. The focus of this 

coverage is a coordinated team-based approach to 

care with strong support in the community to improve 

health outcomes and quality of life for individuals with 

chronic conditions. This option may apply to youth in 

or formerly in foster care with serious and persistent 

mental illness/serious emotional disturbance or certain 

chronic conditions who live in States that have opted 

to design health homes. More information is available 

on the CMS site (http://www.medicaid.gov/MedicaidCHIP-Program-Information/By-Topics/Long-TermServices-and-Supports/Integrating-Care/Health-Homes/

Health-Homes.html) and on the Health Home Information 

Resource Center site (http://www.medicaid.gov/stateresource-center/medicaid-state-technical-assistance/

health-homes-technical-assistance/health-homeinformation-resource-center.html). States that opt to 

establish health homes through Medicaid are required 

to submit a State plan amendment to CMS for approval. 

Other services covered by Medicaid. Besides direct 

health services, Medicaid includes services that help a 

child or youth access necessary care. One example is 

coverage of transportation services for the child and 

family to a practitioner’s office. While not a 1905(a) 

coverable service, language translation services at 

a medical appointment are often another service 

available to beneficiaries. Although interpreter services 

are not classified as mandatory 1905(a) services, all 

providers who receive Federal funds from the U.S. 

Department of Health and Human Services for the 

provision of Medicaid services are obligated, under Title 

VI of the Civil Rights Act, to make language services 

available to those with limited English proficiency. As 

a result, many States elect to reimburse for translation 

services. For more information, CMS published a 

guide to help States and others understand what 

is covered under Medicaid for children: EPSDT: A 

Guide for States: Coverage in the Medicaid Benefit 

for Children and Adolescents (http://www.medicaid.

gov/Medicaid-CHIP-Program-Information/By-Topics/

Benefits/Downloads/EPSDT_Coverage_Guide.pdf).

Health Coverage for American 

Indians and Alaska Natives

The ACA expanded the range of health-care 

options for American Indians in federally 

recognized Tribes and for Alaska Native 

Claims Settlement Act (ANCSA) Corporation 

shareholders, as well as for some others of 

Indian descent. For American Indian children 

and youth in foster care, these benefits may be 

in addition to any already available because of 

the child’s foster care status. Visit the Federal 

Government’s Health Care website for more 

information about these special protections 

and benefits https://www.healthcare.gov/

american-indians-alaska-natives/coverage/. 

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Health-Care Coverage for Youth in Foster Care—and After https://www.childwelfare.gov

11

Private and Marketplace Insurance Benefits

For the few children and youth in (or formerly in) foster 

care who do not qualify for Medicaid, coverage through 

the Health Insurance Marketplace or private health 

insurance also covers a variety of preventive, screening, 

and treatment services for medical and behavioral healthcare issues. The ACA requires that Marketplace plans 

cover 10 categories of essential health benefits (see 

https://www.healthcare.gov/blog/10-health-care-benefitscovered-in-the-health-insurance-marketplace/). Some 

private health-care plans available through employers 

are exempt from providing some of these services 

(Federal Register, Vol. 78, 12834; also see https://www.

healthcare.gov/coverage/what-marketplace-plans-cover). 

Preventive services. Most health insurers must provide 

specific preventive services for children (and adults) 

at no cost. Some of these services include screenings 

for autism, vision, hearing, developmental issues, and 

obesity; immunizations for childhood diseases and other 

diseases such as measles and hepatitis; and screenings 

and examinations as indicated for adolescents and 

teens, such as alcohol and drug use assessments, 

depression screenings, HIV screenings, and sexually 

transmitted infection counseling and screening. The full 

list of mandatory prevention services is available on the 

Federal Government’s Health Care website at https://

www.healthcare.gov/preventive-care-benefits/children/.

Medical benefits. The ACA requires that Marketplace 

plans cover such medical services as pediatric care, 

outpatient care, hospitalization, necessary surgeries, 

laboratory services, prescription medications, maternity 

and newborn care, and rehabilitative services. Other 

health insurance plans are also required to include 

specific benefits, although “grandfathered” and 

self-insured plans may have some exemptions. 

See https://www.healthcare.gov/coverage/whatmarketplace-plans-cover/ (scroll down).

Mental/behavioral health-care benefits. Coverage for 

behavioral and mental health care, including substance 

abuse treatment services, is part of the essential services 

mandated by the ACA for Marketplace plans. Specifically, 

the ACA requires that substance use disorder screening, 

brief intervention, and treatment be offered in all health 

plans. The ACA also helps beneficiaries by expanding 

the 2008 Mental Health Parity and Addiction Equity 

Act to cover individuals who receive insurance through 

small employers or purchase it on the individual market 

(45 CFR 156.115(a)(3)). For more information, visit the 

HealthCare.gov website at https://www.healthcare.gov/

coverage/mental-health-substance-abuse-coverage/. 

Maternal, Infant, and Early Childhood 

Home Visiting Programs

The U.S. Health Resources and Services Administration 

(HRSA) houses the Title V Maternal and Child Health 

Program. While not technically a medical health program, 

the title V block grant funds many services that are crucial 

to the healthy development of vulnerable infants and 

children. Since 2010, title V has funded States for programs 

that provide home visits by health, social service, and 

child development professionals to vulnerable families 

and children. Pregnant women and families with children 

who are newborn to 5 years old can volunteer for the 

programs and qualify based on certain at-risk factors 

such as low income, teen parenthood, a history of child 

abuse or neglect, or living in an at-risk community. The 

programs are administered by States but locally managed 

and are modeled on evidence-based programs that have 

shown positive results for vulnerable families. Trained 

visitors provide guidance and advice designed to promote 

positive parenting, reduce child abuse and neglect, and 

ensure that children are healthy and ready for school. 

For details, visit the HRSA webpage on these programs 

at http://mchb.hrsa.gov/programs/homevisiting/. 

To learn more about the effectiveness of homevisiting programs, visit HHS’s website at http://

homvee.acf.hhs.gov/Default.aspx. 

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Health-Care Coverage for Youth in Foster Care—and After https://www.childwelfare.gov

12

Improving Health-Care Coverage for 

Children and Youth in Foster Care

Changing health-care coverage presents new options 

for some children and youth in foster care, as well as for 

those who age out of foster care. However, identifying 

those who are eligible, communicating the changed 

benefits to them, and ensuring that they receive optimal 

health-care coverage remains a challenge. States and 

jurisdictions also need to consider the different funding 

streams and how they can be used to achieve the best 

coverage for this population. This section discusses some 

ways that States and jurisdictions have addressed some 

of these issues, and it provides links to tools for helping 

to inform youth and families about health-care options.

State Examples of What Works

In order to meet Federal requirements and to provide 

optimal care for children and families receiving 

child welfare services, State and Tribal child welfare 

programs have developed a number of programs 

and systems related to health-care services.

Coordination and documentation of health-care 

services. As a condition of their title IV-B funding, 

States and Tribes are required to submit a plan for how 

they will provide oversight of health-care services for 

children and youth in foster care, including how they 

will ensure coordination with Medicaid and health-care 

professionals (ACF, 2010). In addition, the Social Security 

Act’s section 475(1)(C) requires children’s case plans to 

document their immunizations, health-care providers, 

and any relevant medical or behavioral conditions 

and treatments (http://www.ssa.gov/OP_Home/ssact/

title04/0475.htm). The following are examples of how 

some States are meeting these requirements:

 In Arizona, CPS and Medicaid systems are set up to 

share data, and data are transferred nightly between 

systems (Golonka, 2010). Arizona also developed 

practice protocols for Medicaid providers regarding 

the health-care needs and benefits of children in child 

welfare (Pires & Stroul, 2013).

 Both Michigan and New Jersey place health experts 

onsite in child welfare agencies to help determine 

eligibility and coordinate care for children. Michigan 

places both health liaison officers and mental health 

clinicians in county child welfare offices, while New 

Jersey has Child Health Units staffed by nurses in its 

child welfare offices (Pires & Stroul, 2013).

 Texas is one of a number of States that have 

established “health passports” for children and 

youth in foster care. Health passports provide a way 

for health records and information to follow a child 

through different placements. In Texas, a child’s 

electronic health passport is available to authorized 

providers and medical stakeholders, including 

caseworkers. While it does not substitute for complete 

electronic medical records, the health passport can 

give a good indication of conditions and treatments. 

Visit the Texas health passport website at http://www.

fostercaretx.com/health-passport/ to learn more. 

 Massachusetts provides a program called Special 

KidsYSpecial Care for children in foster care who 

have complex medical needs. Through the program, 

a pediatric nurse practitioner works with the foster 

parents, social workers, and physicians to develop an 

individualized health plan, coordinates the care, and 

makes home visits. For more information, see http://

www.mass.gov/eohhs/docs/dcf/health-med-services/

summary-of-program.pdf. 

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Health-Care Coverage for Youth in Foster Care—and After https://www.childwelfare.gov

13

Providing health-care coverage for young adults. 

The new coverage mandated by the ACA for young 

adults up to age 26 who have aged out of foster care 

ensures that most youth leaving foster care with no 

permanent family remain eligible for health care for a 

number of years. However, challenges remain, especially 

with identifying and enrolling eligible young adults. 

States providing the Chafee option have identified 

some best practices to ensure that youth retain their 

Medicaid coverage, and these practices may help 

States in identifying and enrolling young adults in 

ACA-mandated Medicaid after they have left foster 

care. In a report commissioned by HHS’s Office of 

the Assistant Secretary for Planning and Evaluation, 

Pergamit et al. (2012) identified the following strategies:

 Collaboration between the child welfare and Medicaid 

systems

 Coordinated data systems that, ideally, would 

automatically notify Medicaid when a young adult was 

aging out of foster care

 Ongoing training for child welfare and Medicaid 

administrators

 Educating youth about how to enroll and recertify in 

their State, and ensuring young adults are informed 

about their potential eligibility

The report also notes that States will need to make 

decisions about whether they want the enrollment 

and annual recertification to be as simple as possible 

(requiring no or minimal youth involvement) or 

whether it is better to use a life skills approach 

that requires youth to be proactive and educated 

about their benefits and obligations in order to 

obtain those benefits (Pergamit et al., 2012). 

States and advocacy groups have taken a variety of steps 

to identify and notify eligible young adults about the 

ACA health-care option. For instance, in Florida, a youth 

leadership group whose members are or were in foster 

care has been using social media to tweet about the 

new eligibility for Medicaid (Vestal, 2014). The Juvenile 

Law Center (JLC) publishes a list of State resources 

and policies on this topic and updates the list as new 

brochures, factsheets, and webpages become available. 

Visit the JLC website for more information at http://jlc.

org/coveredtil26PA/applyingotherstates#stateinfo.

American Academy of Pediatrics’ Bright Futures 

Program

Many States look to the American Academy of Pediatrics’ 

Bright Futures website for guidance on developing 

their statewide frequency and service schedules. 

Statewide frequency and service schedules are required 

for children receiving Medicaid services to ensure 

routine and appropriate care is being received. Bright 

Futures began in 1990, led by the Maternal and Child 

Health Bureau of the U.S. Department of Health and 

Human Services, to promote best practices in children’s 

health. The Bright Futures website offers a variety 

of resources, including toolkits on mental health for 

adolescents, at http://brightfutures.aap.org/index.html. 

With regard to reproductive health services, States 

that are following Bright Futures guidelines for 

providing EPSDT services will find a number of tools 

for screening and education on sexuality issues 

that can be used with adolescents and teens and 

to establish protocols for providing care (see http://

brightfutures.aap.org/tool_and_resource_kit.html).

Resources for Youth and Families

Health-care coverage policies are not easy to understand 

for most people. Eligibility requirements and application 

forms may exceed the understanding of young adults 

who have aged out of the foster care system and may 

not know about or understand all of their benefits and 

how to access them. Those still in foster care have the 

advantage of professional child welfare advocates in 

the form of their caseworkers and, for some, their foster 

parents. But once they transition out, these young adults 

are no longer eligible for Independent Living services 

and the advice and guidance that accompanies them. 

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Health-Care Coverage for Youth in Foster Care—and After https://www.childwelfare.gov

14

The following are some resources that may help 

older youth and young adults in or formerly in 

foster care and their families and foster families 

to better understand health-care options:

 Healthy Foster Care America (website sponsored by 

the American Academy of Pediatrics): http://www.aap.

org/en-us/advocacy-and-policy/aap-health-initiatives/

healthy-foster-care-america/Pages/default.aspx

○ Handout on transitioning out of care: http://www.

aap.org/en-us/advocacy-and-policy/aap-healthinitiatives/healthy-foster-care-america/Documents/

AgingOut%20FINAL.pdf

 Juvenile Law Center’s list of State outreach 

materials: http://jlc.org/coveredtil26PA/

applyingotherstates#stateinfo

 Making Healthy Choices: A Guide on Psychotropic 

Medications for Youth in Foster Care (Children’s 

Bureau, 2012): https://www.childwelfare.gov/pubs/

makinghealthychoices/

 Medicaid and CHIP FAQs: Coverage of Former Foster 

Care Children from the CMS: http://www.medicaid.

gov/State-Resource-Center/Downloads/Medicaid-andCHIP-FAQs-Coverage-of-Former-Foster-Care-Children.

pdf

 Medicaid and CHIP FAQs: Funding for the New Adult 

Group, Coverage of Former Foster Care Children and 

CHIP Financing from the CMS: http://medicaid.gov/

federal-policy-guidance/downloads/faq-12-27-13-fmapfoster-care-chip.pdf

 Shanice Explains the Importance of the Former Foster 

Care Provision of the Affordable Care Act (video, 2014, 

Schuyler Center for Analysis and Advocacy): http://

www.scaany.org/media/video/

What Young Adults Need to 

Do to Enroll in Medicaid

All young adults who were enrolled in Medicaid 

when they aged out of foster care are eligible 

for Medicaid until age 26. This is true even if 

there has been a gap in their coverage. They 

are eligible in the State in which they were 

enrolled when they aged out. (Some States also 

cover out-of-State young adults.) To enroll:

1. Contact your State Medicaid office. You can

find out how to contact them by typing your

State into the box at this website, https://

www.healthcare.gov/medicaid-chip/eligibility/,

or you can find your State Medicaid director

at http://www.medicaiddirectors.org.

Tell them you are a youth who aged out of foster 

care and you want to sign up for Medicaid.

. 3 Another option is to contact your 

State’s Independent Living (IL) services 

coordinator. Find your State’s IL coordinator 

on the Information Gateway resource 

list at https://www.childwelfare.gov/

organizations/?CWIGFunctionsaction=rols:main.

dspROL&rolType=Custom&RS_ID=38. 

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Health-Care Coverage for Youth in Foster Care—and After https://www.childwelfare.gov

15

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/health-care-foster.

Resources for Child Welfare Agencies

The following list is a selection of resources 

on providing health-care coverage to older 

youth in or formerly in foster care:

 The Affordable Care Act and Youth Aging Out of 

Foster Care: New Opportunities and Strategies for 

Action (Emam & Golden, 2013, State Policy Advocacy 

and Reform Center): http://childwelfaresparc.org/

wp-content/uploads/2014/07/3-The-Affordable-CareAct-and-Youth-Aging-Out-of-Foster-Care.pdf

 Child Welfare Funding Opportunities: Title IV-E 

and Medicaid (Valentine, 2012, First Focus): http://

firstfocus.org/resources/report/child-welfare-fundingopportunities-title-iv-e-and-medicaid/

 EPSDT - A Guide for States: Coverage in the Medicaid 

Benefit for Children and Adolescents (CMS, 2014): 

http://www.medicaid.gov/Medicaid-CHIP-ProgramInformation/By-Topics/Benefits/Downloads/EPSDT_

Coverage_Guide.pdf

 Making Medicaid Work for Children in Child Welfare: 

Examples From the Field (Pires & Stroul, Center for 

Health Care Strategies): http://www.chcs.org/media/

Making_Medicaid_Work.pdf

 Medicaid and Children in Foster Care (Allen & 

Hendricks, 2013, State Policy Advocacy & Reform 

Center): https://childwelfaresparc.files.wordpress.

com/2013/03/medicaid-and-children-in-foster-care.pdf

 Medicaid Outreach Toolkit (Walz & Chapman, 2013, 

State Policy Advocacy & Reform Center), a toolkit 

that provides sample social media messages, links 

to resources for youth, and strategies for reaching 

out to youth about their health-care benefits: http://

childwelfaresparc.org/wp-content/uploads/2013/09/

SPARC-Medicaid-Outreach-Toolkit.pdf

 Medicaid to 26 for Youth in Foster Care: Key Steps 

for Advocates (2013, State Policy Advocacy & Reform 

Center): http://childwelfaresparc.org/wp-content/

uploads/2013/09/Medicaid-to-26-for-Youth-in-FosterCare.pdf

 State contacts for CMS and EPSDT: http://www.

medicaid.gov/medicaid-chip-program-information/

by-topics/benefits/downloads/epsdt-contacts.pdf

 Working With Youth to Develop a Transition Plan (Child 

Welfare Information Gateway, 2013): https://www.

childwelfare.gov/pubs/transitional-plan/

References

Administration for Children and Families. (2010). Program 

Instruction ACYF-CB-PI-10-11. U.S. Department of 

Health and Human Services. Retrieved from http://

www.acf.hhs.gov/sites/default/files/cb/pi1011.pdf

Administration for Children and Families, Centers for 

Medicare and Medicaid Services, & the Substance 

Abuse and Mental Health Services Administration. 

(2013, July 11). Letter to State Directors. Retrieved 

from http://www.medicaid.gov/Federal-PolicyGuidance/Downloads/SMD-13-07-11.pdf

Anda, R. (2007). The health and social impact of 

growing up with adverse childhood experiences: 

The human and economic costs of the status quo. 

Retrieved from the Adverse Childhood Experiences 

website: http://acestudy.org/files/Review_of_ACE_

Study_with_references_summary_table_2_.pdf

Baumrucker, E., Fernandes-Alcantara, A. L., Stoltzfus, 

E., & Fernandez, B. (2012). Child welfare: Health 

care needs of children in foster care and related 

Federal issues. Washington, DC: Congressional 

Research Service. Retrieved from http://greenbook.

waysandmeans.house.gov/sites/greenbook.

waysandmeans.house.gov/files/2012/R42378_gb.pdf
Health-Care Coverage for Youth in Foster Care—and After https://www.childwelfare.gov

16

This material may be freely reproduced and distributed. However, when doing so, please credit Child Welfare Information 

Gateway. This publication is available online at https://www.childwelfare.gov/pubs/issue-briefs/health-care-foster.

Center for Mental Health Services & Center for Substance 

Abuse Treatment. (2013). Diagnoses and health care 

utilization of children who are in foster care and covered 

by Medicaid. HHS Publication No. (SMA) 13-4804. 

Rockville, MD: Center for Mental Health Services and 

Center for Substance Abuse Treatment, Substance 

Abuse and Mental Health Services Administration. 

Retrieved from http://store.samhsa.gov/product/

Diagnoses-and-Health-Care-Utilization-of-ChildrenWho-Are-in-Foster-Care-and-Covered-by-Medicaid/

SMA13-4804

Centers for Medicare and Medicaid Services. (2013, 

December). Medicaid and CHIP FAQs: Coverage of 

former foster care children. Washington, DC: U.S. 

Department of Health and Human Services. Retrieved 

from http://www.medicaid.gov/State-ResourceCenter/Downloads/Medicaid-and-CHIP-FAQsCoverage-of-Former-Foster-Care-Children.pdf

Centers for Medicare and Medicaid Services. (2014). 

EPSDT: A guide for States: Coverage in the Medicaid 

benefit for children and adolescents. Washington, 

DC: U.S. Department of Health and Human 

Services. Retrieved from http://www.medicaid.gov/

Medicaid-CHIP-Program-Information/By-Topics/

Benefits/Downloads/EPSDT_Coverage_Guide.pdf

Children’s Bureau. (n.d.). Child welfare policy manual. 

Washington, DC: U.S. Department of Health and 

Human Services. Retrieved from http://www.

acf.hhs.gov/cwpm/programs/cb/laws_policies/

laws/cwpm/policy_dsp.jsp?citID=53

Friedman, J. (2013a). Cause for concern: Unwanted 

pregnancy and childbirth among adolescents in foster 

care. Youth Law News 32(1). Retrieved from http://www.

youthlaw.org/publications/yln/2013/jan_mar_2013/

cause_for_concern_unwanted_pregnancy_and_

childbirth_among_adolescents_in_foster_care/

Golonka, S. (2010). The transition to adulthood. How 

States can support older youth in foster care. 

Washington, DC: National Governors Association. 

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sites/NGA/files/pdf/1012FOSTERCARE.PDF

Government Accountability Office. (2011). Foster children: 

HHS guidance could help States improve oversight of 

psychotropic prescriptions. GAO-12-270T. Retrieved 

from http://www.gao.gov/new.items/d12270t.pdf

Houshyar, S. (2014). Medicaid to 26 for former 

foster youth: An update on the State option and 

State efforts to ensure coverage for all young 

people irrespective of where they aged out of 

care. Washington, DC: First Focus State Policy 

Advocacy Reform Center. Retrieved from http://

childwelfaresparc.org/wp-content/uploads/2014/10/

Medicaid-to-26-for-Former-Foster-Youth7.pdf

Pergamit, M. R., McDaniel, M., Chen, V., Howell, E., 

& Hawkins, A. (2012). Providing Medicaid to youth 

formerly in foster care under the Chafee Option: 

Informing implementation of the Affordable Care 

Act. Washington, DC: Urban Institute. Prepared 

for the U.S. Department of Health and Human 

Services, Office of the Assistant Secretary for 

Planning and Evaluation. Retrieved from http://aspe.

hhs.gov/hsp/13/ChafeeMedicaidReport/rpt.pdf

Pires, S. A., & Stroul, B. A. (2013). Making Medicaid 

work for children in child welfare: Examples from 

the field. Hamilton, NJ: Center for Health Care 

Strategies. Retrieved from http://www.chcs.

org/media/Making_Medicaid_Work.pdf

Vestal, C. (2014, April 30). States enroll former foster 

youth in Medicaid. Stateline. Retrieved from the Pew 

Charitable Trust website at http://www.pewtrusts.org/

en/research-and-analysis/blogs/stateline/2014/04/30/

states-enroll-former-foster-youth-in-medicaid
Acknowledgment and Disclaimer: 

Child Welfare Information Gateway gratefully 

acknowledges the expertise of the Federal staff from 

the Center for Medicare & Medicaid Services who 

generously provided their time and knowledge in 

reviewing this paper. While every attempt has been 

made to be as complete as possible, both Federal 

and State laws change frequently, so this document 

may not be up to date on the most recent legislation. 

For the most recent information, visit the Federal 

Government websites cited throughout this document 

or contact your local Medicaid or child welfare office.

Suggested citation: 

Child Welfare Information Gateway. (2015). Healthcare coverage for youth in foster care—and after. 

Washington, DC: U.S. Department of Health 

and Human Services, Children’s Bureau.

U.S. Department of Health and Human Services 

Administration for Children and Families 

Administration on Children, Youth and Families 

Children’s Bureau

Health-Care Coverage for Youth in Foster Care—and After https://www.childwelfare.gov