In My Eyes: Limitations of the Affordable Care Act for Foster Youth

Dustin Haley
Dustin Haley

Today’s guest blog post is written by Dustin Haley, a CCAI 2013 intern, University of Texas undergraduate student, and former foster youth.

As the Affordable Care Act (ACA) is rolled out, many former foster youth will have increased availability for medical coverage.  Starting in 2014, youth who aged out of foster care will be eligible to remain on Medicaid until age 26, a huge win for child welfare advocates and former foster youth.

Youth in college will now have the peace of mind of always having their health insurance covered, and will not have to choose between books and medical care.  Former foster youth who are working part time will also be able to support themselves without having the unnecessary burden of healthcare costs. However, limitations to the ACA will negatively impact many of the former foster youth. As a former foster youth myself, I am all too familiar with these restrictions but it wasn’t until I started interning with CCAI that I learned I could advocate to change this policy.

First Focus, a bipartisan advocacy organization, recently took a look at this regulation, in addition to the rest of the ACA as it applies to foster youth.  They found that as it stands now, coverage will only be guaranteed to those who remain in the state where they resided when they were 18.  This is a huge issue for foster youth around the nation, as they often travel to different states for extended periods for school, jobs, or internships.  Many also move to be closer to support systems, whether they are close friends or extended family.  First Focus points out that restrictions on residency only apply to foster youth, not to adopted children nor to youth raised in a traditional family.

During CCAI’s summer Foster Youth Internship (FYI) Program, foster youth from around the nation come to DC work on Capitol Hill.  Most all of them come from different states and thus are not eligible to receive Medicaid in DC.  Since I’ve started interning at CCAI, I’ve learned about one of last summer’s interns, who ended up needing medical treatment, but experienced difficulties because he was not in his “home” state.

I contacted Josh to learn more about his experience and he explained how he had just returned from a trip to Ecuador when he started as an FYI participant last summer.  Soon thereafter, Josh started to experience serious stomach issues stemming from possible parasites contracted while abroad.  He went to a quick-service clinic in DC and had to pay full cost for treatment.  Unfortunately, the practitioners in the clinics are not specialists and could not figure out what he had contracted.  Seeing a specialist in DC would have cost Josh too much money out of pocket and was thus forced to fly back to Tennessee.  He was able to get the proper treatment from a specialist there and he soon recovered.

I too have run into the same struggles as Josh since being out of my home state—Texas—and completing my internship in DC this semester.  I recently injured my knee, but due to the limitations on Medicaid, I was not able to seek out treatment.  Had I seen a doctor, they would have surely ordered X-Rays and possibly an MRI.   Without insurance, these bills quickly add up.  My struggles, along with the struggles of all foster youth, should not be lost on child welfare advocates.

The Center for Medicaid and Medicare Services recently opened up to debate the section of the Affordable Care Act regarding former foster youth.   Organizations have been able to submit comments, many of which proposed medical coverage for former foster youth irrespective of the state they resided in when they were 18.   I, for one, hope to see change that eventually leads to greater benefits to the youth.

Family Protects Against Negative Stress

Image Source: The New York Times

Jacob and Noah Muthler are two brothers from Roaring Spring, Pennsylvania who personify a phenomenon that this weekend’s New York Times Magazine addressed– why can some children take stress in stride while others crumble?

The article highlights the increasing stress that children face, especially because of standardized testing. “The pressure to do well on achievement tests for college is filtering its way down to lower grades, so that even third graders feel as if they are on trial.”

As a test approaches, Noah panics. According to his mother, “he was crying in my arms the night before the test, saying: ‘I’m not ready, Mom. They didn’t teach us everything that will be on the test.’ ” The night before the examination, Noah couldn’t sleep; the only way he would go back to bed is if his mother lay with him.

His brother, Jacob, however seems un-phased by the stress; in fact, he is so unnerved by taking the standardized test that his mother started to worry that he didn’t care about his performance.

It turns out, reactions to stress are partially genetic.  An enzyme responsible for removing dopamine from the brain can affect a person’s ability to cope with stress. Stress floods your brain with dopamine and how quickly the enzyme is able to rid your brain of the excess dopamine determines a child’s natural ability to handle stress. Jacob and Noah prove that even in a family of brothers, the speed of this enzyme can be drastically different.

Still, for those with a slow moving enzyme, all is not lost. Researchers have shown that stress does not always have to be a bad thing.  Jeremy Jamieson, an assistant professor of social psychology at the University of Rochester, believes that people’s negative labeling of stress is the detriment – not the stress itself.

Jamieson believes that if stress is harnessed and viewed as a motivating factor, it can actually improve performance. Jamieson cites the performance of athletes and that the stress they feel before a game fuels their competitive edge.

Maybe Jamieson is on to something; however, for many children this positive outlook on stress is not natural and will need to be coached. For kids like Noah that coach is his mom. She is the one who tells him that the test is no big deal; she reframes it as an opportunity to display his intelligence and acumen, both of which he has proven at school as a student in the gifted and talented program.  And for those times when that perspective isn’t enough to calm him, it’s Noah’s mom who rubs his back and lays with him so he’ll fall back asleep.

What the Times article did not address the issue of children who may not have the appropriate support structures, including those in foster and congregate care and individuals who spend their entire childhood in institutions. Harvard University’s Center on the Developing Child has concluded that in regards to stress, when “buffering relationships are unavailable to the child, the result can be damaged, weakened systems and brain architecture, with lifelong repercussions.”

Some of our most vulnerable children – those living outside of family care who do not have a parent to coach them through stress – are the same children who likely have so much more to worry about: Will I ever be adopted? If I change foster care placements, will I have to change schools as well? Who will help me with my homework? Where are my siblings living and when can I see them again?

Fortunately for Noah, his mom found a solution to rid him of his stress. He will opt out of the Pennsylvania System of School Assessment “using a broad religious and ethical exemption.” Since finding out that he won’t be taking the test, Noah has performed better in school and now looks forward to class.

But for those kids who don’t have a parent to depend on, most of them will be forced to internalize their stress without the benefit of having mom or dad to rub their back and tell them that everything will be okay.

The stress that Noah experiences from standardized testing is legitimate and powerful; no one can dispute that.  But this article neglects to address how those stress-prone children like Noah fare when don’t have an established support system like his.

And  having a safe, loving, permanent family should not be something that any child should ever have to stress about.

Educational Assistance for Foster Youth

Former CCAI Foster Youth Intern, Jeremy Long, responds to the recent USA Today article addressing the growing number of colleges and universities providing support for America’s foster youth. To read the full article click here:

Our little friend Jiminy Cricket once said “when you wish upon a star, makes no difference who you are, anything your heart desires, will come true.” Take a second and visualize something you once wished upon a star for. Maybe you wished for something as big as finding the cure for cancer or as simple as getting an A in a class. Whatever the wish, it was something you strongly desired to have in life. If your wish came true, great, if not, that’s fine to, but the point is that you had even the slightest hope it could come to be.

Now imagine a world in which wishes and dreams feel out of your reach. A world where the odds always seem stacked against you and you almost never get to experience what it is like to have a dream come true. This is the world in which too many of the half a million youth currently in U.S. foster care live.  Like most of us, they have wished upon a star. However, they don’t have the luxury of wishing to be the Laker’s new star forward. Their dreams are to be placed in a quality foster home where the parents treat them like their own, to have someone to celebrate their life’s accomplishments with, and not having to worry about where they will lay their head or fill their stomachs that night.

There is one dream that many youth, both in and out of foster care, share which is the opportunity to go to college and achieve graduation. A recent study published by Casey Family Programs found that only 3-7% of the 70% who plan to attend college actually graduate with a bachelor’s degree. That would mean out of nearly 500,000 youth, 350,000 have plans to attend college but only 11,000 are actually graduating with a degree. What is happening to the other 339,000 youth who wanted so desperately to obtain a higher education?

I remember my first day of college. I was terrified, scared of what was going to happen after my mom and my best friend left me to fend for myself in a sea full of party hungry teenagers hoping they spend their parents’ money wisely on an extremely expensive education. Yes, I was in foster care, but my story is very unique compared to most foster care alumnae. I was placed in a foster home that gave me the mom to celebrate with when goals were accomplished, someone who would make sure my stomach was full and my head was well rested. I had someone who made sure she did everything in her power to make me a part of that 3-7% of youth who graduated with a degree. I had the dream of graduating college and she made me believe that dream was possible. And because of her support, I went on to college and I graduated. Currently, I sit as the youth engagement coordinator for Mile High United Way’s youth success initiative.

As I said, I was one of the lucky ones. A large percentage of former foster youth are attending college after “aging out” of foster care, meaning they have no family, no system who is responsible for them. At 18, they are alone making decisions that will have lifelong consequences. Many are first generation college students so they also suffer from the fear that this is a dream that is beyond someone like them. Finally, since they are most often on their own financially, these youth have to work their way through college.  Add the stress, the work, the pressures and questions that college brings to the life of any young person and you can see why so many fail to finish.

USA Today’s article “Programs Help Foster Youth Achieve College Success” describes the work that programs like Guardian Scholars are doing to better support youth along their path to graduation. All too often we see youth on the right track to success, but the lack of support both emotionally and financially derails any chance they had of getting ahead and no human being should ever be denied the ability to obtain happiness and self-worth.  In the words of a current scholar from UCLA’s program, Guardian Scholar programs provide youth “a community that I can always rely on.” I think the most important word in that statement is always. Always being able to rely on the community, always being able to say that one has friends and family he can call on in a time of need, stress, or hardship.  There is incredible power in always being able to say one always has that.

And what articles like the one in USA Today show is this. It is ALWAYS possible for each and every youth in care to achieve their dreams. They just need a Jiminy Cricket or Gepetto to guide them towards making them reality.