When doctors diagnosed Carla Vance with Hodgkin’s Lymphoma two years ago, the then 16-year-old had been in the Los Angeles County foster care system for seven years.
Vance sought treatment for her cancer, including chemotherapy, surgeries, and a regimen of medication. As with all foster youth, Medi-Cal covered the teenager’s health care needs. Now more than two years after her initial diagnosis, the Pomona native’s cancer is in remission.
Because of the Former Foster Care Children (FFCC) program, Vance may still access Medi-Cal through the age of 21, even though she is emancipated and living independently. However, the extended Medi-Cal that provides Vance and many like her with continued medical coverage into adulthood falls well short of the provision in the 2010 Patient Protection and Affordable Care Act that allows young adults to stay on their parent’s health insurance up to the age of 26 beginning in 2010.
Vance, now 18, does not know what to expect when she turns 21.
“Not really,” said Vance, sitting in a McDonald’s in her hometown of Pomona, off Interstate 10 approximately a half hour east of downtown Los Angeles. “I don’t know what I’m going to do in all honesty.”
However, many younger foster youth may have brighter prospects. The health care reform law also requires states to provide Medicaid to foster youth up until the age of 26. The provision does not take effect until 2014; only applies to youth in the system at that time; and, like the entire health reform law, is in the hands of the United States Supreme Court, which plans to rule on the legality of the ACA next week.
In addition to utilizing Medi-Cal up to the age of 21, foster youth may enter the newly-established Extended Foster Care program. The EFC program began in January and is applicable to foster youth turning 18 in 2012 and provides them with additional support as they enter adulthood.
Dr. Charles Sophy, the Medical Director for the County of Los Angeles Department of Children and Family Services, sees the EFC as a welcomed improvement over sending a foster youth out into the world once they emancipate.
“A lot of kids just were not successful because they were not stable enough to be mastering the skills to be able to navigate the world,” said Dr. Sophy, speaking from his fifth-floor office in the DCFS headquarters in Los Angeles.
Dr. Sophy, who has worked at DCFS for 10 years, cites a number of ailments that impact foster youth. He stresses the importance of continued medical coverage to provide screenings and physicals for foster youth to address issues such as diabetes, obesity, hypertension and other long-term ailments that can have an impact later in life.
Dr. Sophy also notes the mental health issues faced by those who were victims of abuse or separated from their families at a young age. Some are treated for anxiety and depression and are in need of therapy or medication. Avoiding a service disruption in coverage for these young adults is critical.
“There’s a huge set up and fallout if we don’t keep these children connected or young adults connected to their services,” Sophy said.
For Theresa Wilson, it’s been an uphill climb ever since birth. With her parents struggling with drug abuse, Wilson’s aunt and uncle raised her. But that’s just the beginning. Wilson was born with sickle cell disease, and entered the sickle cell program at Long Beach Memorial Medical Center. What Medi-Cal didn’t cover, the state-run California Children’s Services picked up the rest.
More recently, Wilson has been diagnosed with Graves’ Disease, which affects the thyroid.
“I may have it bad, but some people have it worse,” said Wilson, 17, who graduated from high school in June. “I’m just humble that I’m still alive. I’m able to move forward.”
Wilson turns 18 in August, and will take advantage of Extended Foster Care in addition to continued Medi-Cal and CCS benefits through the age of 21. She intends to continue her education at Cal State University Channel Islands, looking forward to the serene setting. She plans to study biology and chemistry with a goal of becoming a forensic scientist.
While Wilson has a few years before considering her life after 21, she reflected on the coverage she’s received up to now.
“I would have passed away a long time ago,” she said of where’d she be without the state’s help. “I wouldn’t be alive.”
According to a 2010 report from the Public Policy Institute of California, there are approximately 60,000 children in foster care in the state. Also according to the PPIC report, in 2008-2009, approximately 4,500 foster youth 18 and older aged out of the system.
While foster youth turning 18 in 2012 may stay on Medi-Cal until they are 21, and those turning 18 in 2014 can stay on until they are 26 if the ACA is upheld, there are a few options for those falling through the cracks. Tony Cava, spokesperson for California’s Department of Health Care Services, suggested that some youth who age out may qualify for the Low Income Health Program. The LIHP is a bridge that prepares the state for national health care reform.
Jeff Gibbs, Assistant Regional Administrator, Medical Case Management Services for DCFS, works with approximately 600 medically fragile foster youth in Los Angeles. He suggested that some foster youth may qualify for Medi-Cal following emancipation if they meet low income thresholds. Dr. Sophy added that some youth may qualify for a Medi-Cal as adults because of disability.
Vance entered the foster system at the age of 9. She first lived with a foster family, then with another foster family, then with her uncle and aunt, then with another foster home, and then back with her uncle and aunt at the age of 13. After her cancer diagnosis, Vance moved into a medical fragile foster home, designed and staffed specifically for those with serious health challenges. That’s where she stayed until she emancipated at 18.
Vance didn’t qualify for EFC because she turned 18 before January 2012 and emancipated, but she receives support from the Independent Living Program. She recently finished her first year at Cal Poly Pomona, where she’s studying political science but might switch to a business degree, and tutors part-time at a local high school. In addition to IPL, she continues to receive Medi-Cal coverage.
But it’s after she turns 21 that Vance isn’t sure what will happen, and those questions go beyond how she might afford insurance if she doesn’t have employment in a little more than two years. She doesn’t know how to navigate the intimidating process of getting health insurance.
“I don’t know what I’m going to do exactly,” Vance said. “I don’t know how to go about the insurance thing. I don’t know what I’m suppose to do.”
“I don’t know how that’s going to happen if I do get diagnosed again,” she added. “I don’t want to think about it really, but I have to because I have to be prepared for what’s going to happen.”
With the Supreme Court due to make a ruling on health care reform by the end of the month, there’s a chance that the entire law may be thrown out, including mandating coverage for young adults – foster and non-foster – to age 26.
Dr. Sophy would rather see coverage for foster youth extended to 26, allowing young adults to focus on college or careers instead of worrying about medical bills and disruptions in coverage.
“A 21-year-old is not always a 21-year-old,” he said.