At 17 years old, Daryl Chatman is more interested in football than he is in health insurance.
The high school athlete turns 18 this summer. His foster parents Brenda and Kent Davis worry about what might happen if he’s injured on the football field. They want to adopt him before his next birthday so he can get on their insurance.
“He’s going to be a part of our family forever no matter what, whether its adoption or not,” says Brenda Davis. “I would really like to make sure he's covered.”
Health insurance is far from the minds of most older teens and young adults. And for most, it doesn’t need to be. Under the Affordable Care Act, young adults can stay on their parents’ insurance until their 26th birthday. Kids aging out of foster care can also stay on Medicaid.
But having coverage is not the same thing as accessing health care, and without parents to guide them through the health care system, former foster kids can get lost.
There is scant support in navigating the health care system for the more than 20,000 kids who age out of foster care each year, says Debrah Rosen who manages strategic partnerships at Hillside, a non-profit that works for child welfare in Rochester, New York. But like all young people, they need parental guidance.
“I didn't think about [health coverage] when I was seventeen either. I panicked when I needed to go to the doctor. I panicked directly to the phone call to my mom,” she recalls.
Hillside provides specialized services and training for kids that age out of the system in Monroe County in Western New York.
One first step for kids who age out is to sign up with Medicaid.
“You can't just assume that it's going to happen through the miraculous volition of a nineteen year old who would much rather be doing something else,” says Rosen. “It needs to be somebody's job and that job description needs to be informed by the real needs and circumstances of young people.”
A new idea in New York, may be the solution. As part of the state’s Medicaid redesign, patients will soon be connected with care managers, people who oversee their health care.
This could be crucial for former foster kids. Not only do many of them lack stable family relationships, but kids who’ve been through the system are more like to suffer from mental health concerns—about a quarter of them have post-traumatic stress disorder. And they’re also likely to have other chronic medical conditions.
“We know that people with co-occurring medical conditions and mental health needs are less likely to consistently access effective care,” says Rosen.
New York’s Medicaid care managers could help solve that for foster kids. That’s not the case everywhere.
“We can assume and should assume that unless there's a very purposeful and assertive effort within a state to get the arms around that population of young people that they are trending in the same direction as any population that struggling with those issues.” says Rosen.
The Davises are raising two other teenage boys along with Daryl. They became foster parents after their biological sons were grown, in 2010. The Davises make sure to teach their boys lessons about health insurance, lessons that they learned the hard way.
“I learned about health insurance at a young age because I didn't have any when I gave birth at eighteen so we paid cash we had to pay and make payments,” recalls Brenda.
So now they take time to talk their sons through the basics of accessing health care.
“I look at health insurance, like it’s another utility. It's just one of those things that everybody needs to understand at some point when they're taking care of themselves,” says Brenda. “It's just because these kids have been dealing with adult problems all along. And I guess we want to show them adult solutions,” Brenda says.
The Davises’ older son Alex, who they adopted from foster care in 2014, deals with PTSD, anxiety and depression. Alex says his health has improved with the support of his adoptive parents, and the services they’ve helped connect him with. He’s looking forward to turning 18 soon and going to college, but not feeling quite ready for all the adult decisions he’ll have to face.
“Sooner or later, I’m going to have to figure it out. You know. That's one of the things that teenagers like to procrastinate,” he says. “They don't want to deal with the reality and they just want their parents to help them with their health insurance. ”
Brenda Davis’ focus is on making sure the three teenage boys in her care are prepared for health adulthoods--and she loves doing it. “I would say I feel like I won the foster parent lottery three times with these guys. They're just the greatest.”