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Children in the child welfare system

Medicaid is an important source of coverage for children and youth involved in the child welfare system. Children and youth receiving Title IV-E assistance, including foster care, guardianship assistance, and adoption assistance, are automatically eligible for Medicaid. Those who are not eligible for Title IV-E services (for example, children who do not meet the Title IV-E income standard but who are receiving in-home services) are not automatically eligible for Medicaid, but may be eligible through another pathway, such as the low-income or disability pathways.

The Patient Protection and Affordable Care Act (P.L. 111-148, as amended) required states to continue providing Medicaid coverage to youth under age 26 aging out of foster care (either Title IV-E or non-Title IV-E) who were receiving Medicaid, with the option of covering youth who have aged out in other states. The Support for Patients and Communities Act (P.L. 115-271) updated this provision, requiring that states cover youth who aged out of foster care in other states, beginning January 2023.

States also may cover former foster care children up to age 21 without requiring that they had prior Medicaid enrollment or were in foster care in the same state in which the youth currently resides (known as the Chafee option).

For more, see The Intersection of Medicaid and Child Welfare.

TABLE 1. Child Welfare-Related Eligibility Pathways for Children

Eligibility group Federal statutory and regulatory requirements State plan options
Children and youth involved in the child welfare system Children receiving Title IV-E child welfare foster care or adoption assistance payments

  • States must cover children in Title IV-E foster care, kinship guardianship assistance, or adoption assistance programs.

Children aging out of foster care

  • States must cover youth up to age 26 who received Medicaid and have aged out of foster care regardless of their income.
Children receiving (non-IV-E) state adoption assistance

  • States have the option to cover children that are in a state adoption assistance program who do not meet the Title IV-E income standard but were eligible for or enrolled in Medicaid prior to adoption and have a special medical need.

Chafee option (independent foster care adolescents)

  • States have the option to cover youth who were formerly in foster care up to age 21 at a state-determined income threshold (including no income threshold).
Source: MACPAC, 2017, Federal Requirements and State Options: Eligibility.