A new world order was established on January 20, 2017. Promises made during a contentious election are now in the process of being fulfilled. High on the list of promises is the repeal and replacement of the Affordable Care Act (ACA). This, among many other controversial measures, has garnered much attention. Over the last month and a half, many have asked me what impact, if any, the repeal and replacement of the ACA would have on those served by Hillsides. We are now starting to get an inkling of what the future holds as this week, House Republicans released a bill to replace the ACA called the American Health Care Act. This proposed legislation is facing opposition from both Republicans and Democrats and it is hard to predict what form the bill will ultimately take. However, for an agency like Hillsides that is dependent on public funding to provide much-needed services it is clear there will be a definite impact.
The ACA provides an opportunity for states to expand their Medicaid coverage through financial incentives offered by the Federal Government. Known as Medi-Cal in California, this expansion has ensured that youth in foster care have access to medical insurance coverage until age 26. However, in the newly proposed bill, the Medicaid expansion will be curtailed starting in 2020 presumably capping the government’s Medicaid payments.
Children and youth served by foster care due to family traumas are the responsibility of the state. Because the state is the legal parent of these youth, they do not have the same opportunity as other young adults to stay on a parent’s private insurance plan until the age of 26. Although the proposed legislation maintains the provision of coverage of youth until 26, it is not clear if Medicaid is “capped” that former foster youth would also have the same coverage, since Medicaid is the funding source for this particular benefit. Providing youth formerly in foster care with Medicaid coverage until age 26 ensures parity between them and their peers, giving them one of the essential securities needed to gain independence.
Each year in California, up to 5,500 youth age out of foster care. These vulnerable youth to often lack adequate support to navigate the transition to adulthood successfully. Unlike their peers, many youth formerly in foster care do not have the emotional support of a caring adult or financial support of a family member. Ensuring continued health coverage allows these youth to access regular and preventative care and helps them to achieve self-sufficiency. Consistent access to health care is particularly important because youth in foster care have high rates of acute and chronic medical, mental health and developmental issues as a consequence of the traumas they experienced during childhood. More than 18,000 youth formerly in foster care in California currently benefit from Medi-Cal coverage until age 26. Without this coverage, many of these youth would be uninsured, resulting in an increase in emergency room visits and higher costs to youth and their communities.
Early analysis shows that expansion of defense and infrastructure spending is possible only at the sacrifice of much-needed social service funding such as Medicaid. Certainly these are complex issues that defy simple political initiatives. They are also moral issues that impact the safety and well-being of many we serve. For the nearly 600 youth we serve annually through our Youth Moving On program, an improved transportation system will be of little consequence if they lack access to desperately needed mental health services or medical care. In the great America we envision, surely one crucial service does not need to be sacrificed for the other.