Health Insurance Discontinuities Among Adolescents Leaving Foster Care

Raghavan, Ramesh; Shi, Peichang; Aarons, Gregory A.; Roesch, Scott C.; McMillen, J. Curtis

doi:10.1016/j.jadohealth.2008.08.008

« Previous Next »Journal of Adolescent Health
Volume 44, Issue 1 , Pages 41-47, January 2009

Health Insurance Discontinuities Among Adolescents Leaving Foster Care

Ramesh Raghavan, M.D., Ph.D.
- George Warren Brown School of Social Work, Washington University, in St. Louis, St. Louis, Missouri
- Department of Psychiatry, School of Medicine, Washington University in St. Louis, St. Louis, Missouri
- Address correspondence to: Ramesh Raghavan, M.D., Ph.D., Washington University in St. Louis, George Warren Brown School of Social Work, Campus Box 1196, One Brookings Drive, St. Louis, MO 63130.
Peichang Shi, M.S.
- George Warren Brown School of Social Work, Washington University, in St. Louis, St. Louis, Missouri
Gregory A. Aarons, Ph.D.
- Child and Adolescent Services Research Center, Rady Children's Hospital, San Diego, California
- Department of Psychiatry, University of California–San Diego, San Diego, California
Scott C. Roesch, Ph.D.
- Department of Psychology, San Diego State University, San Diego, California
J. Curtis McMillen, Ph.D.
- George Warren Brown School of Social Work, Washington University, in St. Louis, St. Louis, Missouri

Received 19 February 2008; accepted 10 August 2008. published online 06 November 2008.

Abstract

Purpose

To determine whether adolescents who lose Medicaid entitlements when they leave foster care are subsequently able to secure employer-sponsored or student health insurance coverage.

Methods

This was a 2-year follow-up study of a cohort of 404 adolescents leaving foster care in eight counties in a midwestern state. We conducted survival analysis to study predictors of time to first insurance loss, and logistic regression analysis to determine factors associated with insurance reacquisition, among these youth.

Results

A total of 206 adolescents (51%) left foster care during follow up, of whom 138 (67%) lost health insurance coverage within a mean of 3 months of leaving foster care. Those who regained coverage (34; 17% of those leaving foster care) did so after a mean period of 8 months spent without insurance. Hazard of insurance loss was lower for employed adolescents (HR=.5; 95% CI=.4–.7; p < .0001), but only half of all adolescents leaving foster care reported being able to secure employment. Student health insurance did not reduce hazard of insurance loss. Boys had significantly lower odds of regaining insurance compared with girls (OR=.2, SE=.5, p=.003).

Conclusions

Most youth leaving the child welfare system seem unable to transition to other forms of health insurance coverage. Even those that do acquire coverage, do so after an inordinate period of time. Enacting existing extensions of Medicaid coverage until age 21 for foster care youth is necessary to provide the resources to address the considerable health and mental health needs among these youth.

Keywords: Child welfare, Medicaid, Health insurance, Foster care