Health Insurance (Medicaid) and Other Public Benefits

Healthcare
Medicaid While You are Still in Foster Care
Former Foster Care Children’s (FFCC) Medicaid Program
Healthcare Plans Available to Aged Out Foster Youth
Immigrants and Foster Youth Health Insurance
Applying for Health Insurance (Medicaid) for Aged Out Texas Foster Youth
Big Problems with Medicaid Applications
Renewing Your Health Insurance
Important Reminders
Medical Records
Dental Coverage
Finding a Doctor
Other Health Options
Penalty for not Having Health Insurance
Health Insurance for Your Children
Food Stamps (SNAP Food Benefits)
Temporary Assistance for Needy Families (TANF)
Social Security and SSI Benefits
Other Social Services Resources

Health Care

After you leave foster care, you will be responsible for the costs of your medical care. Things like seeing a doctor, paying for a prescription, and getting emergency room care are very expensive. If you don’t have health insurance after you leave foster care, it will be very difficult to pay for medical care. Those who don’t have health insurance often are unable to get medical care because they don’t have the ability to pay for it. Fortunately, most aged out foster youth between the ages of 18 to 26 qualify for a special free health insurance program for aged foster youth. As you prepare to turn 18 and make the transition out of foster care, you should be sure you become familiar with the health insurance for former foster youth. This health insurance is often called Medicaid. The state of Texas provides Medicaid health insurance to several categories of low income people, and one category is aged out foster youth.

Health Insurance (Medicaid) for Aged Out Texas Foster Youth

Health insurance is complicated for everyone. In this Guide we are including some information that should help you understand what to expect as an aged out foster youth. We have more detailed and regularly updated information at www.texasfosteryouth.org.

Medicaid While You are Still in Foster Care

If you are 18 and older and stay in extended foster care, including supervised independent living, or return to foster care, you are covered by Texas’ foster youth health insurance, which is often called Star Health or Medicaid. Your CPS caseworker should take care of making sure you are on the insurance. However, since you are an adult, it will be up to you to schedule doctor appointments, make your medical decisions, and address questions about your insurance with the health insurance company and doctor.

As you sort out health insurance options and issues be sure to get help from an adult who knows something about health insurance choices and issues. Your Aftercare case manager or PAL worker are good people to contact for help. You can also contact the Texas Foster Youth Justice Project toll free at (877)313-3688 if you need guidance about how to apply or legal assistance if you are denied the foster youth health insurance.

Former Foster Care Children’s (FFCC) Medicaid Program

The Former Foster Care Children’s (FFCC) Program is a type of free Medicaid insurance that most aged out foster youth are covered by.

You can get the FFCC Medicaid Insurance if:

• You are under the age of 26—coverage goes until the end of the month of your 26th birthday.
• You were in the conservatorship of Texas’ CPS on your 18th birthday.(Conservatorship means that there is a court order saying Texas’ CPS is in charge of you).
• You were receiving foster youth Medicaid when you turned
• You are a US citizen or, if you are under the age of 21 and not a citizen, you are a legal permanent resident (green card holder) or other specified immigrant category (see Immigrants and Foster Youth Health Insurance in this section for more details).
• You currently live in Texas.

If you are under the age of 21 and do not qualify for the FFCC program because you were not receiving Medicaid when you turned 18, you may qualify for the Medicaid for Transitioning Foster Care Youth (MTFCY) Program. The most common reason someone was not receiving Medicaid when they turned 18 is because they were in prison or jail.

The rules for MTFCY are:

• You are under the age of 21—coverage goes until the end of the month of your 21st birthday.
• You were in the conservatorship of Texas’ CPS on your 18th birthday. (Conservatorship means that there is a court order saying Texas’ CPS is in charge of you—CPS can still be your conservator even if you are incarcerated).
• You are a US citizen or you are a legal permanent resident (green card holder) or other specified immigrant category (see Immigrants and Foster Youth Health Insurance in this section for more details). 
• You do not have adequate health coverage.
• You have household income at or below 400% of the Federal Poverty Level (in 2019, this was $49,960 per year for a household of one).”
• You currently live in Texas.

MTFCY ends when you turn 21 and you will no longer qualify for any aged out foster youth Medicaid program.

Health Care Plans Available to Aged Out Foster Youth

Once you have qualified for either the Former Foster Care Children’s (FFCC) Medicaid Program or the Medicaid for Transitioning Foster Care Youth (MTFCY) Program, you will then get a health care plan with another name. Health insurance is confusing!

STAR Health—This health care plan covers both aged out foster youth between the ages of 18 and 20 as well as current foster youth (which includes youth in extended foster care). Coverage ends the month of your 21st birthday and is provided through the Superior HealthPlan Network.

STAR Health coverage is the same no matter where you live in Texas; this means that if you move within Texas, your same health insurance plan will go with you. You can find more information about STAR Health at: dfps. state.tx.us/Child_Protection/Medical_Services/ and at www.fostercaretx.com. You can choose to switch from STAR Health to another health care plan called, very confusingly, STAR. Some young adults find there are limited providers available under STAR Health that serve young adults and request to change to STAR.

STAR—This health care plan covers aged out foster youth between the ages of 21 and 25. Coverage will go through until the end of the month of your 26th birthday. Depending on what county you live in, there are also different STAR insurance plans to choose from, such as Blue Cross Blue Shield, and Sendero. If you move to a new county in Texas, you may have to change plans depending on what options are available in your county. You can find more information about STAR and what plans are available in your county at: hhs.texas.gov/ services/health/medicaid-chip/programs/star-medicaid-managed-care-program.

When you are deciding what STAR plan to pick or if you decide to switch from STAR Health to STAR, you should carefully review the providers on each plan. Be sure to check if your doctor takes that plan and if there are providers and services near where you live. You should also see what extra services, also called “value- added” services, are offered by the plan.

Immigrants and Foster Youth Health Insurance

What if I am not a citizen?

If you are a lawful permanent resident (have a green card) or have a certain other specific immigration status, you can get the aged out foster youth insurance until your 21st birthday. But after you turn 21, you may not able to continue getting the aged out foster youth insurance. You can only qualify for it if you have been a lawful permanent resident for at least 5 years and you or your parents have 40 quarters of work history with the Social Security Administration or meet some other very limited requirements. If you become a U.S. citizen, you can qualify for the aged out foster youth health insurance even after you turn 21.

What if I am undocumented?

Undocumented aged foster youth are not eligible for the Medicaid programs for aged out foster youth. However, CPS is required to help foster youth try to obtain legal immigration status before they age out of foster care. If this has NOT been taken care of for you yet, you need IMMEDIATE help, before you leave foster care.

Immigration law is complicated and even more complicated when it comes to aged out foster youth health insurance! If you are not a citizen, you should contact the Texas Foster Youth Justice Project for more guidance about your eligibility for the insurance. You should also see the Special Immigrant Juvenile Status, Green Card and Becoming a U.S. Citizen section, starting on page 83, for other important information about being a non-citizen.

Applying for Health Insurance (Medicaid)

You should receive information about health insurance while you are still in foster care from your CPS caseworkers, Preparation for Adult Living (PAL) staff, PAL Life Skills training, Aging Out Seminars and other conferences. One of  the most important things you should do before you leave foster care is make sure your CPS caseworker and PAL worker have the address you will be moving to or receiving mail at after you leave foster care. You should give them plenty of notice of when you plan to leave so that they have time to complete the paperwork. A few weeks after you leave care, be sure to call 2-1-1 and ask to speak to a foster youth specialist about your Medicaid to make sure it is active and they have a current address for you.

If you have already left foster care, you can apply for FFCC on your own, but keep in mind that having a PAL or Aftercare worker help you with the application is a great idea! The best way to apply for aged out foster youth health insurance/Medicaid is to do it online at www.YourTexasBenefits.com. Click on “Apply for benefits” and either create an account or log in to your existing account. You should write down your login information and keep it safe! When the application asks you to pick the program you want to apply for, make sure you select that you are a “Person who (1) is age 25 or younger, and (2) was age 18 or older when they were in foster care.” Once you finish filling out the application, you can submit it electronically.

Another way to apply for the Medicaid is to print and mail your application; you will need to fill out one of the following forms:

• H1205 if you just want to apply for aged out foster youth Medicaid, or
• H1010 if you want to apply for both Medicaid and SNAP (food stamps). But we recommend you apply for aged out foster youth Medicaid with form H1205 and then apply for SNAP once you have been approved for Medicaid so your Medicaid application won’t be denied because of all the extra paperwork you have to provide to show you are eligible for SNAP.

You can get these forms by calling 2-1-1, going to your closest Texas Benefits Office (find offices online at www.yourtexasbenefits.com) or downloading and printing the form at www.yourtexasbenefits.com. You should mark “Yes” to the question, “Were you in foster care at age 18 or older?” You will have to mail your application to Health and Human Services or take it to the closest Texas Benefits Office. You can find more detailed information about how to apply at www.texasfosteryouth.org.

Medical Records

Once you turn 18, you are the person responsible for making decisions about your medical care. You can even be responsible for this starting at the age of 16 if you ask the court to give you the right to make health care decisions and the court gives it to you. You’ll need good information about your medical history. Before you leave foster care, make sure that you have copies of your medical records which you are supposed to be given by your caseworker. The Health Passport should have information about all the providers you have seen, prescribed medications and limited information about the services you received while in foster care. If you want a complete medical record from a specific doctor or facility, you have to contact that office. You should also ask for records from your CPS file that include your past and present treatment information and any records with information about health issues in your birth family.

How to Call 2-1-1 and Get Help from Medicaid

Many aged out foster youth have experienced problems with the Medicaid program ending their benefits and telling them that they are not eligible for Medicaid. The notices Medicaid sends out are very confusing. They also have problems getting into their YoutTexasBenefits.com accounts because of special security items in place for foster children. To get help from the right people at Medicaid, follow these steps:

1. Call 2-1-1 or (877)541-7905 between 8 m.–6 p.m. Central Standard Time Monday–Friday.
2. Select your language (English is 1).
3. Select 2 (State Benefit Programs).
4. Select 1 (Help with SNAP…Medicaid).
5. Select 1 to enter your Social Security Number and date of birth (two digit month, two digit date, four digit year- example, 01021993), or select 2 to enter your case number. (If  you only know the Social Security number and date of birth, enter 2 when it asks you to enter the case number).
6. Select Option 4 (Another Question not already listed).
7. Select Option 4 (Question Not Listed).
8. Wait for a live person—and say “I NEED TO TALK TO A  FOSTER  YOUTH  SPECIALIST.”  Keep asking to speak to the SPECIAL FOSTER YOUTH MEDICAID STAFF. Ask for a supervisor to assist if necessary.
9.  You should reach someone who can assist with your problem. If you don’t get help, you can find more information about who can help you by contacting the Texas Foster Youth Justice Project at (877)313-3688.

Renewing Your Health Insurance

Once you have FFCC Medicaid (or MTFCY), you will have to renew it every twelve months. The Health and Human Services Commission (HHSC) will mail you a renewal letter 3 to 4 months before your benefits are set to end each year. The letter will be mailed to the address they have on file for you. This is why it is so important to keep your address updated! The envelope will say “Time Sensitive,” and you only have 10 days to respond. If you have moved, you may be asked to provide documentation of your new address. If HHSC does not get a response from you by end of your 11th month of coverage, your health insurance benefits will end! So respond as soon as possible so you don’t lose your Medicaid. You do not want to get sick or hurt and show up to the doctor’s office or emergency room only to find out you do not have health insurance. Health care is very expensive if you don’t have insurance.

You can renew your Medicaid by:

• Checking and submitting your renewal at www.YourTcom;
• Calling 2-1-1 or (877)541-7905; or
• Completing the forms on the renewal letter and returning it by mail or

If you know your Medicaid is expiring in two months or less and you haven’t gotten a renewal letter yet, you can still go online or call 2-1-1 to renew it. Be sure to check that your address is up to date at this time.

Proof of Address—Medicaid often wants some proof that you live in Texas. If you don’t have any leases or bills or other documents that show your current mailing address, who can have someone who is familiar with your situation complete a form that says you live in Texas. You can find a form, a Medicaid Residency Verification Letter, that they can use at www.texasfosteryouth.org/legal-resources-for–youth/medical- issues-health-insurance/.

There is a Your Texas Benefit Mobile app available. This is a great way to upload documents Medicaid needs, change your address, and check the status of your benefits. Visit www.yourtexasbenefits.com to get the app. If you have trouble accessing your account, call 2-1-1 and ask for a foster youth specialist.

IMPORTANT REMINDERS

• Always keep your address up to date with The easiest way to do this is online at www.YourTexasBenefits.com and clicking on Report a Change under Case facts, by calling 2-1-1 or (877)541-7905 or using the Your Texas Benefits mobile app. Failing to keep your address up to date may result in your benefits being cut off. Besides not getting renewal letters, if any mail is returned to the agency, they will cut off your insurance.
• If you move a lot and cannot keep your address up to date, you should talk to a trusted adult about accepting mail for y Most Aftercare Caseworkers will do this for you. You could also ask a relative, mentor, or CASA worker. Don’t use your friend’s apartment address as often the post office won’t deliver mail to someone not on the lease.
• You can find more detailed, regularly updated information about health insurance and Medicaid at texasfosteryouth.org. You can also contact the Texas Foster Youth Justice Project toll free at (877)313-3688 with questions or for legal assistance in getting your health insurance.

What if I move outside of Texas?

If you aged out of care in Texas and move to another state, you cannot get Texas FFCC or MTFCY. A few states will provide FFCC Medicaid to foster youth who live in the state but did not age out in the same state. You should check to see if your new state has coverage. Ask your Texas PAL Worker to help you, or contact the Texas Foster Youth Justice Project toll free at (877)313-3688 to get your state coordinator’s contact information.

If you ever move back to Texas and meet the eligibility requirements, you can apply for aged out foster youth Medicaid again.

What if I was placed out of state while I was in Texas foster care? What if I was placed in a Texas foster care placement by CPS in another state?

Sometimes when a child is placed into foster care in their home state, they are later placed in a foster home or with a relative in another state under a set of rules called the Interstate Compact on the Placement of Children (ICPC). If you now live in Texas and you were placed inside of Texas under the ICPC or you entered foster case in Texas and you were placed in another state, you can qualify for the FFCC program until you turn 21. Contact the State PAL office at (512)438- 5442 or the Foster Youth  Justice  Project toll free at (877 )313-3688 to see if you are considered an ICPC youth.

What if I was in foster care in another state and move to Texas?

Texas does not provide aged out foster youth Medicaid to someone who aged out in another state, unless you were under the conservatorship of Texas’ CPS when you aged out of care and were placed in the other state under the Interstate Compact on the Placement of Children (ICPC).

Dental Coverage

Medicaid only provides dental services to those 20 years old and under. If you have dental issues, it is very important to get them taken care of before your 21st birthday. Some dental issues may take several months to fix, so get started early! Dental insurance through Medicaid covers check-ups, fillings, crowns, and emergency dental services. Dental insurance can even cover braces and other orthodontic treatments that are “medically necessary.” You should talk to your dentist about the services you think you need and ask to be referred to a specialist, if necessary.

After you turn 21, you will only get dental coverage if you choose a STAR plan with a “Value Added Service” covering dental work. Keep in mind that the dental work it covers is very limited.

You can find more information about dental coverage at www.texasfosteryouth.org.

Finding a Doctor

You will have two different medical cards—your Medicaid identification card, and the card for the provider of your health care plan. If you are under 21 and enrolled in STAR Health, the name of your provider is Superior HealthPlan. If you are enrolled in STAR, the name of your provider of your health care plan will be different depending on where you live and which plan you choose.

The back of your cards will have important phone numbers that you can call for help. They may also have a website where you can go to search for a doctor or find out other information.

Before you make an appointment to see a doctor, you should talk to their office and make sure they accept your insurance. Sometimes a website will say that a doctor accepts your insurance, but the doctor no longer accepts it. Be sure to give them the full name of the provider of your health care plan—listed on your provider card and documents Medicaid has sent you. Many plans have names that are very similar, so be careful.

It can sometimes be hard to find a doctor because not everyone accepts Medicaid insurance. For this reason, you should try to find a Primary Care Physician (“PCP”) and have your first visit long before you need one. That way, if you get sick or hurt, you will know immediately who to call.

If you have STAR Health, the plan’s website is www.fostercaretx.com. You can search for a doctor or click on the “Resources” link to get important phone numbers and review your member handbook. If you cannot find a doctor in your area, call STAR Health at (866)912-6293 and ask to speak to a Service Manager in the Foster Care Department.

Other Health Insurance Options

Hopefully you will be covered by the Medicaid health insurance for aged out foster youth until you turn 26 years old. However, if you are certain you do not qualify for it, or you are 26 or older, you will need to try to obtain health insurance from another source.

In Texas, Medicaid generally does not cover most adults unless you are disabled or elderly and receive SSI, are pregnant, or are receiving TANF. If you fall in one of those categories, you can apply for Medicaid— pretty much the same way you apply for the aged out foster youth Medicaid. Regularly seeing a doctor during a pregnancy is very important for the health of your baby, so if you don’t have health insurance, apply for Medicaid as soon as you know you are pregnant.

If you can’t get Medicaid, you should see if you can get health insurance through the federal government health care exchange at www.healthcare.gov. Depending on your income, you may qualify for a federal government subsidy that could pay some or most of the cost of the health insurance. You can apply online or you can go to a local site and get help applying. To find a local site, check localhelp.healthcare.gov/#/or call (800)318- 2596. You should know that if the health care exchange determines that your family income is too low, you won’t qualify for a federal government subsidy. The federal government program calls for Texas to cover low income people with Medicaid; however Texas has not expanded Medicaid and is not providing Medicaid health insurance coverage to most low income adults. If you do have insurance from the federal government health care exchange, you need to reapply every year between November 1 and December 15.

You might be able to get health insurance through your employer, but with employer insurance you often have to pay a portion of the cost. When applying for jobs, you may also want to ask about health insurance. Many large businesses offer health care plans to their employees, including part-time employees. If you work in a profession that is part of a union, then it is also likely that some medical benefits are provided. If you attend college, you may have a student health insurance plan you can buy. There are also resources, like www. texashealthoptions.com, to help you understand your medical insurance choices.

Health insurance in America is changing a lot so other options might become available. Check www. texasfosteryouth.org and www.healthcare.gov for updates. You should also try applying at www.healthcare. gov each year between November 1 and December 15 as your eligibility could change. You can also reapply at www.healthcare.gov whenever your income changes or you have a major life event like having a baby or getting married.

Health Insurance for Your Children

If you cannot afford private insurance for your children, then your children may be able to get free or low cost health insurance through Children’s Medicaid and the Children’s Health Insurance Program (CHIP). For more information visit the Health Care for Children Section of YourTexasBenefits.com or call 2-1-1 or call (877)541-7905.

Food Stamps (SNAP Food Benefits)

Under the Supplemental Nutrition Assistance Program (SNAP), also called food stamps, young adults living in Texas may be eligible to receive an electronic debit card to buy groceries. To qualify you must show financial need and meet other criteria.

If you are between the ages of 18 and 50 and you do not have a child, then expect some limits on your ability to get food stamps. You probably can’t get food stamp benefits for more than three months in a three-year period unless you work at least 20 hours a week, participate in a training program or go to school. There are some exceptions to these requirements, such as for a person who has a disability or is pregnant. It is very important that you report any change in your income every month to the program; you can be charged with fraud if you don’t.

For more information on this program, visit the “SNAP food benefits” at www.yourtexasbenefits.com, dial 2-1-1 in Texas, or visit your local Texas Health and Human Services office.

Temporary Assistance for Needy Families (TANF)

If you have children, you may be eligible for a monthly cash payment through the Temporary Assistance for Needy Families program. These payments are made to needy single and two parent families. The amount of each family’s payment depends on a few things, including income, assets and need. The maximum payment for a family of three is around $286 per month.

You may be eligible for a one-time $1,000 cash payment through the One-time TANF (or OT-TANF) program. OT-TANF helps families that meet certain crisis criteria. In order to get this payment, families must meet the TANF guidelines and can’t already be receiving any TANF benefits. Once you receive this one-time payment, you are not eligible to receive TANF payments for the next 12 months.

For more information on TANF, visit www.hhsc.state.tx.us, visit www.yourtexasbenefits.com, dial 2-1-1 in Texas, or visit your local Texas Health and Human Services office.

Social Security and SSI Benefits

There are different types of Social Security and SSI Benefits. Those who are under 18, or who are under 19 and in high school full time, can receive social security benefits based on their parent’s social security earnings if their parent is disabled, retired or deceased; this is called Retirement, Survivors, and Disability Insurance (RSDI) benefits. Even if your parent’s rights were terminated you can receive these benefits. While you are in foster care, these benefits go to the Texas Department of Family and Protective Services to pay for your foster care. In the unlikely event that the benefits are more than the cost of your foster care, or the Department receives benefits while you have run away from foster care, the Department is supposed to put the funds in a special account and use them for additional expenses you have or, when you leave foster care after you turn 18, release them to you or the Social Security Administration. If you get Social Security RSDI benefits and you have a disability, you can apply to continue to receive RSDI after you turn 18. You will need to show you are disabled and you must be unmarried. If you receive RSDI and get married, you will lose the benefits.

SSI stands for Supplemental Security Income. It is for disabled or elderly people, with limited income and resources; disabled children can receive it as well. While you are in foster care, if you receive SSI benefits your money goes to the Texas Department of Family Services to pay for your foster care or the benefits might be suspended. If you receive SSI, when you turn 18, you may be notified by the Social Security Administration that you would need to prove to them again that you are disabled; it is important that you provide the needed documentation of your disability and attend any evaluation appointments they schedule for you. If you have disabilities and don’t already receive SSI, you should ask your caseworker about applying for SSI well before you leave care. Often, it can take a long time, even years, to establish with the Social Security Administration that someone is disabled, although some disabilities can be more easily established. Your caseworker should have a DFPS SSI coordinator assist with preparing the application and taking the necessary steps to obtain SSI and/or RSDI. If you receive RSDI but the amount of the benefit is low, you should qualify to get some additional SSI benefits and the SSI specialist should assist with that. The maximum about of SSI benefits in 2019 is $771.

Be sure to get a copy of documentation from the Social Security Administration that shows what benefits you receive. Your caseworker should request this from the SSI coordinator. Often there is confusion and incorrect information about whether a foster youth gets Social Security benefits and what type they get, so demand a written document from the Social Security office. Applying for these benefits can be complicated, particularly providing the necessary documentation to establish that you have a disability. If you are denied benefits, be sure to appeal on-time; you can keep appealing until you have a hearing with an Administrative Law Judge. If you are applying for SSI after you leave foster care, be sure to get help from your Aftercare case manager or another caring adult throughout the application process.

Your school records and evaluations related to special education can be very important to helping establish your disability. You should request them within four years of leaving school or the school may not have them anymore. (See page 34 for more information about IEP Plans and Special Education.)

If you stay in foster care after you turn 18, you will need to sign over your RSDI or SSI benefits. If your benefits exceed the cost of your care, the money will be put in a personal account for you to use for expenses.

For more information about Social Security and SSI benefits visit www.socialsecurity.gov.

Other Social Services Resources

On the www.211texas.org website, you can find programs in your area that can help with your needs, including health care, food, housing, rental assistance, utility bill assistance, counseling and child care. You can also get this information by dialing 2-1-1 on any phone in Texas. Another helpful website is www.auntbertha.com.

YourTexasBenefits.com offers online access to Texas Health and Human Services benefits including Medicaid, Food Stamps (SNAP), Temporary Assistance for Needy Families (TANF) and Children’s Health Insurance. You can also dial 2-1-1 on any phone in Texas to get this information.