Behind the first wave of pain came fear.

It wasn’t just the agony of a shattered pelvis that terrified Jimmy Dion as he lay in the street that day last December.

It was having no insurance.

A driver had cut him off, and he’d swerved to miss her, but his handlebar caught in the wheel well of a truck.  And then he was underneath, the truck dragging him and Dion screaming and onlookers screaming and then the truck stopping and people running toward where he lay tangled in the wreckage of his bicycle.

That December accident could have been yet another calamity in a life scarred by unfair struggles: taken from his drug-addled parents as a toddler, 16 foster homes by his 11^th birthday, an occasional assurance that he had potential, but more often official reminders that “my chances of making it were slim to none.”

And on the day of the accident, Dion had just turned 23, well past the age limit on the Medi-Cal health insurance that California extends to most youths who become wards of the state. A community college student, he couldn’t afford private coverage. An application for interim insurance provided through the Los Angeles County Department of Health Services was in limbo.

And now, lying in the street, he couldn’t move his legs. He had no idea how he was going to pay for the ambulance ride and hospitalization awaiting him.

“Even under the truck, you know, you’re thinking, ‘I don’t have insurance! What’s gonna happen?’” Dion recalled.

“And then you wake up from (surgery) and you’re still thinking, ‘What’s gonna happen? What’s gonna happen?’”

This time, Dion got a break.  A provision of the Patient Protection and Affordable Care Act extends Medi-Cal coverage to former foster youths until they turn 26. Since the insurance also is retroactive for claims occurring up to three months prior to the date of coverage, Medi-Cal also will cover Dion’s treatment for his injuries, said Taylor Dudley, a staff attorney at the Los Angeles-based Alliance for Children’s Rights who is working with Dion to resolve payment questions.

Before the ACA became law, California extended Medi-Cal coverage for former foster children until their 21st birthdays. In Los Angeles County, that deadline meant some 1,500 former foster youth lost their health coverage each year, Dudley said. Statewide estimates set the number at up to 5,000 youths a year.

Now, the ACA guarantees access to health care services for former foster youth until age 26, just like other young people who can stay on their parents’ private insurance plans until that age.

That kind of support can be important even for young people from stable families. For foster youth, it’s crucial, advocates say.

Dion had the good fortune to find a stable foster home when he was 11, and still lives with his foster father, Jim Vironda.

But Vironda, who said he’s offered shelter to more than 30 children in the past 35 years, said many foster youth get caught in public assistance bureaucracies that provide little guidance on how to get the help they need. He thinks one big benefit in the change to Medi-Cal coverage under the ACA is that the young people won’t have to renew their applications for aid every year. The former foster youth will have “uninterrupted eligibility,” with no requirement for annual registration.

“Until now, every little issue that came up, they’d have to make sure the paper work was right. Because they’re young, they don’t think of this, because they’re young, they really don’t want to stand in line,” Vironda said.

“Jimmy got himself more severely injured than most of them, but at this age, these kids are falling off skateboards or they get into a brawl and get hit in the mouth. These things happen to them all the time, and they really need medical coverage. So this Affordable Care Act is a godsend.”

Many also carry psychological injuries that may require ongoing treatment, said Rusty Selix, executive director of the California Council of Community Mental Health Agencies.

“Former foster youth are the highest risk for incarceration and homelessness of any members of society. The system is not doing a good job, and they have more problems than anybody, and that includes mental health problems and drug problems and everything else,” he said.

“[Extended access to Medi-Cal] is incredibly important. They’re probably going to be the hardest group to enroll, because they’re so disconnected from things and don’t know to take advantage of rights that they have. It is a population that, without that [access to insurance], it was almost impossible to give them the help they need. Now, the funding is there, and it’s just a matter of linking them to the services.”