Extended Medi-Cal

Q: I understand that the Affordable Care Act will extend Medi-Cal for youth who were in foster care at age 18 to age 26. My question is: will that be EPSDT Medi-Cal (which funds the specialty foster care mental health services) or regular Medi-Cal?

A: The Affordable Care Act (ACA), passed by Congress in 2011, extended eligibility for Medi-Cal for individuals under age 26 who were in foster care at age 18 and receiving Medicaid, effective January 1, 2014. According to the ACA, youth will be eligible for this extension regardless of whether or not they were federally-eligible for foster care. Additionally, it specifies that there is no income or resource test for this group.

However, eligibility for services funded by EPSDT (Early and Periodic Screening, Diagnosis and Treatment) continue to end at age 21. At age 21, youth would no longer be eligible for the specialty mental health services provided through EPSDT. They would, however, remain eligible for these services between age 18 and 21, regardless of whether or not they are in extended foster care, as long as they are otherwise eligible for Medicaid.

A question still under consideration by the federal Administration is whether or not youth must continue to reside in the state where they were in foster care to be eligible for Medi-Cal to age 26. This requirement was included in the draft regulation. In February 2013, a coalition of stakeholders requested that this restriction be removed.
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Proposed Rule: Medicaid, Children’s Health Insurance Programs, and Exchanges; Proposed Rules for Extending Medicaid to Age 26 for Eligible Former Foster Children (Fed. Reg. Vol. 78, No. 14, 1/22/13)

7 thoughts on “Extended Medi-Cal

  1. Jean Vilmenay says:

    Do we know if this will also include youth who are not AB 12 eligible, but were in Foster Care at 18 and are currently under the age of 26???

    • John Burton Foundation says:

      Yes, this will include these youth. The ACA extension of Medicaid (Medi-Cal in California) to age 26 is completely independent of California’s extension of foster care or eligibility for AB 12.

  2. Ella says:

    This is great news! Thank you to those who work hard to make the lives of our foster and former foster youth so much better and dignified. I have questions about the ACA extension of Medical to age 26, My former foster youth will be turning 21 next month and therefore his medical will end. Q. When does it really end? the day he turns 21, the first day of the month he turns 21? Can he apply to emergency medical since he doesn’t work and is a full time student(DSPS)?

    I have helped him schedule an “exit physical”, had his eyes checked with the optometrist (glasses adjusted, etc.) and his last dental cleaning is completed.

    How do we go about re-instating his medical on January 1, 2014?

    Thanks for your

    • John Burton Foundation says:

      I wish I could give you more details about this at the moment. I know that the CA legislature is working on an effort to implement the provision as early as July 1. We at JBF will research what details are known about the administrative process and include that as a Question of the Week. Or, yoou can always call Amy or Simone at 415-693-13222. 🙂

  3. Susan Paradise says:

    Would there be a way to advocate for extending EPSDT services for the former foster youth aged 21-25?

    • John Burton Foundation says:

      I think this is an interesting idea. There is more and more evidence that parents are providing increasing levels of support to their adult children, up until the early 30s. If this is happening in in-tact families, it certainly raises the question as to whether the child welfare system should be doing more for the most vulnerable children.

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