Chapter 5

Community Resources
Chapter 5 - Community Resources
Health Insurance Coverage

The majority of youth currently in the foster care system are eligible for and enrolled in Medicaid. This coverage continues while youth in care attend college. As of January 2014, the Affordable Care Act (ACA) has provided this pathway to Medicaid coverage for youth who exited foster care at age 18 or older, and were enrolled in Medicaid at the time of discharge. Medicaid coverage under this category lasts until the young person becomes 26 years old. Youth are eligible for this coverage regardless of their income.

Health insurance through the Medicaid program can be a great cost saver for college students already struggling to make ends meet. Eligible youth also avoid the time consuming, often stressful process of shopping for insurance and gain the peace of mind of having reliable coverage while they attend school.  In most cases, individuals eligible for Medicaid receive care through a Health Management Organization (HMO), which contracts with service providers at the county level. Because some HMOs may only serve certain areas of the state, and youth may travel outside their home county to attend college, determining the right HMO for a youth is an essential college preparation task.  Below is additional information to help you assist students with a foster care background in securing the appropriate coverage.

Medicaid Coverage
For Students Currently in Foster Care (under 21 years of age)

Students in foster care may either have straight Medicaid or be enrolled in Medicaid via a managed care plan. Students with straight Medicaid, can typically access health care services anywhere within the state. Students who have managed care plans should check with their HMO prior to moving out of county for college. If the HMO provider does not provide services in the county where the student will be attending school, the student should call the NYS Medicaid Enrollment Hotline (800) 505-5678 and request information regarding available HMOs in the county where their college is located. Going away to college is considered a “qualifying event” and therefore young people are eligible to change their managed care plan. Please note that Medicaid is not subject to an open enrolment period.

Dental, Vision, and Behavioral Health services are covered under Medicaid, but students need to check with their health plans to confirm how to access services. Behavioral health treatment includes counseling and other therapeutic services that address mental health issues and substance abuse. All students should verify coverage and options with their insurance provider before seeking health care outside of their counties of origin.

For Students No Longer in Foster Care (discharged on or after 18th birthday, or aged out of care)

Students who were in foster care at age 18 or older and were enrolled in Medicaid at the point of discharge from the system should be eligible for and enrolled in Medicaid under the “Former Foster Care” category. If a youth was not enrolled in Medicaid at the time of aging out, or lost coverage due to an error, they should apply at their local county assistance office as soon as possible – as they may be eligible for Medicaid. Former foster youth in New York may enroll in Medicaid without providing documentation of their previous foster care status to the county. Counties will conduct the status verification work and inform youth when their eligibility has been determined.

For Students No Longer in Foster Care (discharged prior to 18th birthday)

Students without health insurance who left foster care before turning age 18 may be eligible for Medicaid or coverage through the state’s health insurance exchange. Students can find more information and apply for insurance by visiting the NY State of Health Marketplace.  Students that do not qualify for Medicaid may be eligible to purchase an insurance plan through the marketplace, and will be directed to the list of eligible plans based on income and county of residence.

HMO Selection for Students Enrolled in Medicaid

Students who are enrolled in Medicaid in NYS need to determine how they prefer to access health care services while they are in college. This is important because HMOs authorized to serve Medicaid patients may only cover certain geographic areas (sometimes it is organized by county or region). The following information will guide you in advising youth seeking to enroll in an HMO that matches their eligibility, desired location of services, and specific needs.

  • Students planning to attend college where they currently live (aka their “home” county) can keep their existing HMOs and health care providers. 
  • Students planning to attend college in a part of NYS other than their “home” county, and who choose to return to home to receive services, can keep their existing HMOs and health care providers. 
  • Students planning to attend college in a part of NYS other than their “home” county, and who choose to receive services close to campus (rather than at home), may need to switch HMOs to access health providers in this location.

 

Directory of NYS Managed Care Organizations Providing Medicaid (by county)
NYS Medicaid Choice Hotline (800) 505-5678
Directory of NYS Local Departments of Social Services

Residency Considerations
  • NYS youth who are attending out-of-state schools, but wish to continue accessing health and behavioral care in their “home” state, should maintain their New York-based Medicaid coverage. However, it is important these students understand that they will only be able to access care (other than in emergency medical situations) from Medicaid providers in New York State.
  • Students who go out of state to attend college have the option to officially change their “home or state of residency.” In this scenario, these students will need to seek coverage options through their school, or through the health insurance marketplace in their new state of residency. 
  • Currently, 10 states provide Medicaid coverage under the “Former Foster Youth” category to young adults who were previously in foster care, but in a different state’s child welfare system. In 2023, pursuant to the SUPPORT Act (P.L. 115-271), all states will have to provide this coverage regardless of the student’s home state and current residency. Until this new law goes into effect, only youth with a foster care background attending colleges in the following states will be eligible for Medicaid outside of their states of origin:
    • California
    • Delaware
    • Kentucky
    • Massachusetts
    • New Mexico
    • Pennsylvania
    • South Dakota
    • Utah
    • Virginia
    • Wisconsin

If you are assisting youth with a foster care background who are planning to leave NYS to attend a college located outside the 10 states listed above, they will need to consider how they will access medical coverage, which can be through their school, place of employment, or they may be eligible to obtain coverage through the state-based health marketplace.

Overview of Medicaid Programs by State