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2004 - Medicaid Coverage for Former Foster Care Children

 
Implementation Status 
Statutory Text 

Summary

As revised by sections 10201(a)(1) and 10201(a)(3) of the Senate Manager’s Amendment, beginning January 1, 2014, states must cover under their respective Medicaid programs individuals under age 26 who were in foster care under the responsibility of the state on the date of attaining 18 years of age (or older as the state may have elected) and were enrolled in Medicaid under the state plan or a wavier thereof.  Provides states the option to provide presumptive eligibility to this population.

#Pediatrics, #Waivers

Implementation Status

 
Summary 
Statutory Text 

On January 14, 2013, CMS issued a proposed rule that addressed implementation of this provision, in addition to posting a corresponding informational bulletin on the underlying regulation.  Note that Reps. Karen Bass (D-CA) and Jim McDermott (D-WA) submitted a comment letter to HHS on the above-referenced proposed rule in which the members urged HHS to “issue a final rule that not only provides states with the option of extending Medicaid, but ensures that states provide Medicaid benefits to age 26 for all eligible former foster youth residing within the state.”

On July 5, CMS issued a final rule implementing a number of ACA Medicaid eligibility, benefit and premium and cost sharing provisions, among others related to Exchanges, while explicitly noting a focus only on those “most critical for implementation” by January 1, 2014, and thus deferring the finalization of other proposals from a January 22, 2013, proposed rule – such as Exchange eligibility appeals, proposed CHIPRA provisions, Exchange certified application counselors and coordination of SHOPs with individual market Exchanges – to future rule-making. A CMS press release is available here.  Please also see CMS’ July 5 informational bulletin regarding related IT changes – i.e., Medicaid Information Technology Architecture (MITA) Draft Eligibility and Enrollment Supplement, Version 3.0 – as a result of certain Medicaid eligibility requirements resulting from the ACA.

Also, in a related event, on July 12, 2013, SAMHSA announced two new Challenges under which it will provide up to $100,000 in collective prizes for communications-related methodologies and materials to reduce enrollee “churn,” which may stem from eligibility-related changes or other breaks in coverage that SAMHSA notes have a “disproportionate impact” on individuals with behavioral health conditions, including enrollees who are Medicaid-eligible due to a disability.  Submissions are due by August 31, 2013.

Statutory Text

 
Implementation Status 
Summary 

SEC. 2004. MEDICAID COVERAGE FOR FORMER FOSTER CARE CHILDREN. (a) IN GENERAL.—Section 1902(a)(10)(A)(i) of the Social Security Act (42 U.S.C. 1396a), as amended by section 2001(a)(1), is amended— (1) by striking ‘‘or’’ at the end of subclause (VII); (2) by adding ‘‘or’’ at the end of subclause (VIII); and (3) by inserting after subclause (VIII) the following: ‘‘(IX) [Replaced by section 10201(a)(1)] who— ‘‘(aa) are under 26 years of age; ‘‘(bb) are not described in or enrolled under any of subclauses (I) through (VII) of this clause or are described in any of such subclauses but have income that exceeds the level of income applicable under the State plan for eligibility to enroll for medical assistance under such subclause; ‘‘(cc) were in foster care under the responsibility of the State on the date of attaining 18 years of age or such higher age as the State has elected under section 475(8)(B)(iii); and ‘‘(dd) were enrolled in the State plan under this title or under a waiver of the plan while in such foster care;’’. [Section 10201(a)(2), p. 839, provides a related amendment to section 1902(a)(10) of the SSA] (b) OPTION TO PROVIDE PRESUMPTIVE ELIGIBILITY.—Section 1920(e) of such Act (42 U.S.C. 1396r–1(e)), as added by section 2001(a)(4)(B) and amended by section 2001(e)(2)(C), is amended by inserting ‘‘, clause (i)(IX),’’ after ‘‘clause (i)(VIII)’’. (c) CONFORMING AMENDMENTS.— (1) Section 1903(f)(4) of such Act (42 U.S.C. 1396b(f)(4)), as amended by section 2001(a)(5)(D), is amended by inserting ‘‘1902(a)(10)(A)(i)(IX),’’ after ‘‘1902(a)(10)(A)(i)(VIII),’’. (2) Section 1937(a)(2)(B)(viii) of such Act (42 U.S.C. 1396u–7(a)(2)(B)(viii)) is amended by inserting ‘‘, or the individual qualifies for medical assistance on the basis of section 1902(a)(10)(A)(i)(IX)’’ before the period. [Additional conforming amendments relating to section 1902(a)(10)(A)(i)(IX) are in section 10201(c)(1), p. 840] (d) EFFECTIVE DATE.—The amendments made by this section take effect on January 1, 2014. [As revised by section 10201(a)(3)]

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