Health Reform WK-EDGE ACA can provide coverage for homeless youth
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Tuesday, April 26, 2016

ACA can provide coverage for homeless youth

By Bryant Storm, J.D.

Homeless youth and other young people who are at risk of becoming homeless are likely to be eligible for health care coverage under the Patient Protection and Affordable Act (ACA) (P.L. 111-148), according to an HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) fact sheet. The fact sheet explains that through the ACA’s marketplaces and expansion of Medicaid, many homeless and other low-income young people can obtain health coverage to prevent and treat health issues such as sexually transmitted infections and mental health and substance use disorders (ASPE Fact SheetMarch 22, 2016).

Eligibility. The ASPE explains that eligibility for coverage through Medicaid and marketplaces depend on several factors, including income, citizenship, immigration status, and state of residence. The fact sheet clarifies that the state of residence is the state where a young person is living, which is not necessarily the state where their parents reside. Homeless youth and youth at risk of becoming homeless are likely eligible for Medicaid in the state they reside, if they:

  • are under age 19, and earn less than 133 percent of the Federal Poverty Level (FPL) annually;
  • are over 19 years of age, and earn less than 133 percent of the FPL annually, and live in a state that has expanded Medicaid to adults;
  • are under age 26, have aged out of the foster care system in the state, and were enrolled in Medicaid in that state while in foster care;
  • are pregnant or parenting; or
  • have a disability.

Youth who are not eligible for Medicaid but have incomes between 100 and 400 percent of the FPL may be eligible for financial assistance to purchase health care coverage through the ACA’s marketplaces. Additionally, young people under age 26 and still connected to their parents can stay on their parents insurance.

Coverage. In the case of plans purchased through a marketplace, the ACA mandates that those plans offer “essential health benefits,” including primary care and specialist visits, diagnostic tests, hospital visits, surgical procedures, mental health and substance use disorder treatment, prescription drugs, preventive and wellness services (including reproductive health services), and rehabilitative services. Coverage under state Medicaid programs differs and is outlined by each state’s Medicaid or Children’s Health Insurance Program (CHIP) state plan. However, Medicaid benefits for individuals under age 21 are required to be comprehensive. The fact sheet also recommends that individuals without health coverage looking to obtain health care services visit a local health center.

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