What Rules Apply to Former Foster Children and Medicaid?

Eligibility Team
Researcher & Writer
February 12, 2016

There are several rules that apply to former foster care children in regards to their Medicaid eligibility. Essentially, most children that were in the foster care program and either aged out or were adopted out will be eligible for Medicaid.

The first set of rules applies to children that aged out of the foster-care system. The Affordable Care Act added former foster care children as a special group under mandatory eligibility. Section 2004 of the Act makes it mandatory for states to cover former foster care children until they turn 26 years old. In order to be part of this eligibility group, the child would have to have been enrolled in Medicaid and still be an active part of the foster care program until the age specified by the state for aging out.

Former foster care children that are eligible for this designation are covered regardless of what state they reside in. This means they are covered even if the state they live in is not the state they were in the foster care program.

Are There Any Income Requirements to be Eligible?

There are no income eligibility requirements for this group. Their designation as former foster care children covers their eligibility. There is also no asset test, and individual states cannot choose to initial income or asset eligibility requirements.

There are situations when former foster care children are not automatically covered by this eligibility group. These are primarily individuals that left the foster care program before aging out. Note that most children age out at age 18. However, the state dictates when a child “ages out” of the program. Aging out of the foster care program happens between the ages of 18 and 21 depending on the state.

Former foster care children as an eligibility group went into effect on January 1, 2014. The program covers all former foster care children that fit the eligibility requirements, regardless of this date. 

For example, if an individual aged out of foster care at age 18 many years ago and is now 24 years old, that individual will automatically be covered under the former foster care child eligibility. A former foster care child can apply for Medicaid and be approved up to age 26.

Former foster care children eligibility covers individuals that were in the care of relatives, as long as their relatives were registered as an official foster care home. If a child is adopted, there is still a chance the child will remain eligible for Medicaid after being adopted. Children who are eligible for Title IV-E adoption assistance are automatically eligible for Medicaid coverage.

Steps to Receiving This Assistance

There are two steps to receiving Title IV-E adoption assistance. The first step is meeting all three of the following criteria that determine whether or not a child is considered a special needs child.

  • It is legally determined that the child cannot and will not be returned to the birth parents.
  • Some factors make it difficult to find the child a family to adopt. These factors are determined by the state, but typically include factors such as age, sibling groups, medical conditions, and ethnic background.
  • The state has been proven unable to find the child a family without adoption assistance.

Once a child meets these three requirements, there are six categories under which the child can be eligible for Title IV-E. It is possible the child will be eligible for more than one category, but only one is needed.

  • If the child was removed from the home either by the court or voluntary placement due to a lack of parental support
  • A child is in foster care for 60 consecutive months or more.
  • The child is eligible for SSI.
  • The child’s parent is a minor currently in the foster care system
  • If the child was eligible for Title IV-E during an earlier adoption that fell through or their adoptive parents passed away.
  • The age of the child at the time of adoption was a determining factor. However, it is now being phased out. Starting in 2018, all foster care children that meet the special needs requirements above will also be eligible for Title IV-E adoption assistance.

Title IV-E adoption assistance provides financial assistance to cover the adoption costs as well as medical assistance for the child in the form of Medicaid coverage. Some states allow adoptive parents to hold their assistance for a later day. For example, a child may be eligible for Medicaid, but the adoptive parents don’t need it because they have family insurance through their place of employment. If, in the future, that insurance is no longer available, the adoptive parents can get Medicaid coverage for the adopted child based on their eligibility at the time of their adoption. 

Eligibility Team
Written by
Eligibility Team
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