On March 28th, the Arizona Health Care Cost Containment System (AHCCCS) submitted a letter to CMS Administrator Chiquita Brooks-LaSure. Within the letter was an application for Arizona’s Former Foster Youth Annual Automatic Renewal demonstration waiver proposal, which is part of AHCCCS’s effort to reform and modernize Medicaid. The demonstration would amend Arizona’s current 1115 waiver.
AHCCCS Public Information Officer Heidi Capriotti confirmed with State of Reform that CMS received the request on April 11th, with the request having been posted for the federal public comment period on the federal register the following day. The public comment period closes on May 12th.
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“Once the public comment period ends, there is no set time frame for the 1115 negotiations, but they generally take 12-18 months before approval,” Capriotti told State of Reform.
While the state offers transitional medical care for individuals between the ages of 18-26 who are leaving the foster care system, if the waiver amendment were to be approved by CMS, it would require AHCCCS to automatically renew the eligibility of individuals who were in the state’s Department of Child Safety (DCS) when the individuals reached 18 years of age without requiring extra information from them until they reach 26 years.
If former foster youth notify AHCCCS that they moved out of state, provide information that indicates they may qualify for a different eligibility category, voluntarily withdraw their enrollment, or are deceased, then the automatic renewal would not take place.
“In combination with Arizona’s approved 1115 waiver programing, this amendment will help address the higher risk of multiple chronic health conditions and health-related social needs experienced by the foster youth and former foster youth including but not limited to an increased prevalence of physical and behavioral health needs and higher rates of homelessness,” stated AHCCCS’s letter to CMS.
Youth who have experienced the foster care system oftentimes also experience trauma or disruptive events prior to transitioning to adulthood. Some of these lived experiences include abuse, neglect, numerous foster home placements, disruptions in education, and the loss of relationships, which can lead to mental illness, substance use, and emotional and social development.
According to Youth.gov, 25% of 19-year-old former foster care youth reported higher rates of health issues in comparison to non-foster youth, such as hospitalization, accident, injury, and the use of narcotics. One third of former foster youth had mental health challenges, including depression, dysthymia, PTSD, social phobia, alcohol use disorder, and substance use disorder.
By the time foster youth age out of the system with limited connections and support, they may have an increased risk for unstable housing and experiencing homelessness. According to Youth.gov, over one-fifth of foster care youth experience homelessness for at least one day within one year of emancipation.
AHCCCS states that the rates of homelessness among American Indian youth are significantly greater: 43% of young American Indian adults experience homelessness between the ages of 19 to 21. For low-income adults living with chronic health conditions, AHCCCS believes easier access to Medicaid is a vital driver of heath and health-related outcomes.
The amendment proposal was submitted in alignment with House Bill 2622, which the state’s legislature passed in 2022. The bill allows AHCCCS to automatically renew the eligibility of individuals who were in DCS care at the time of turning 18 years, without requiring additional information until the person reaches 26 years.
If approved, the waiver amendment would be in place for five years and would promote the continuity of care and simplify administrative work. During the tribal consultation and public notice processes, which ended on Feb. 27th, AHCCCS engaged with 220 stakeholders, including the state’s Medicaid Advisory Committee, community members who participated in public forums, and tribal representatives.