CASA Deep Dive: Legislative Priorities – Healthcare Needs of Children & Youth in Foster Care

To keep you informed and inspired during the 86th Legislative Session, Texas CASA is taking the next few months to dive in to some of our key legislative priorities. Read more about our legislative priorities and our work leading up to, and during, the session.


  • Support efforts to develop better services and supports for children, parents and families dealing with substance use and abuse or mental health issues.
  • Improve services and supports for older and transitioning foster youth.


Children and youth in foster care face enormous challenges; often including lack of family support, educational deficits, inadequate or insufficient living arrangements, high medical and mental healthcare needs and lack of health insurance. Fortunately, the 86th Legislature is expected to take a broader look at how Texas can address gaps in behavioral health services this session. Given this focus, Texas CASA is excited to be working to address the healthcare needs of children in foster care this session, including those who exit foster care by being adopted or by aging out.

What are some of the gaps in services when it comes to addressing the healthcare needs of children in foster care?

Youth Currently in Foster Care
Like all children in foster care, adolescent youth who are diagnosed with a mental illness or substance use disorder are entitled to all medically necessary services covered by Medicaid. However, the Medicaid state plan excludes youth under the age of 21 from being eligible for peer support services. Medicaid coverage for peer support is currently authorized for adults, and is evidence-based, trauma-informed and cost-effective. Peer support for youth can play an important role in the recovery process, in addition to providing a sense of community.

Youth Who Age Out or Are Adopted
Children and youth in foster care often experience several placements, which can lead to inconsistent and disjointed medical and behavioral healthcare. This inconsistency also affects children who are adopted out of the foster care system, who may lose access to their medical providers while in state custody because the Medicaid provider, STAR Health, terminates a child’s health coverage on the last day of the month they were adopted. This forces adoptive parents to seek medical and behavioral healthcare through another insurance provider. It is currently not an option for adoptive parents to maintain enrollment for their adopted children in STAR Health in order to ensure that their children are able to continue utilizing the same providers and services they had before they were adopted. Having consistency in post-adopt healthcare enables qualified health providers to continue building on the service plan for the child with the help and input of adoptive parents. What’s more, providers in the STAR Health network are trauma-informed and certified to meet the specialized needs of children in foster care. This is especially important for children with mental illness who have been receiving treatment from STAR Health network providers.

Youth who age out of the foster care system also face the possibility of having inconsistent and disjointed medical and behavioral healthcare. Under federal law, youth who age out of the foster care system can receive Medicaid coverage up to age 26 through the Former Foster Care Children (FFCC) program. Texas currently provides these young adults with healthcare coverage by automatically enrolling them when they leave care. However, many young people experience a disruption in their coverage because they have difficulty annually renewing their benefits. The increasing prevalence of mental illness among this population further substantiates the need to keep these young adults insured to access critical treatment and services.

What are Texas CASA’s recommendations?

  • Direct the Health and Human Services Commission to include peer support services to adolescent youth in foster care as a covered Medicaid benefit.
  • Support adoptive parents and their children by adding STAR Health to the list of healthcare options that adoptive parents can choose from for their adopted children, giving these parents more choice and control over the medical and behavioral healthcare that their children receive.
  • Direct the Health and Human Services Commission to create a simple re-determination or auto-renewal process to maintain health coverage for youth who age out of foster care.
  • Require the Health and Human Services Commission to assume all youth who age out of foster care are Texas residents unless it is determined they are receiving benefits in another state.

Failure to provide coverage to youth formerly in foster care may actually cost more, particularly if these young people delay seeking needed medical care and find themselves in emergency rooms. Eliminating these major barriers, for both families of adopted children and youth formerly in care, would be sound investments not only in the well-being of these young people but also in the future of Texas.

What can I do to help?

Join our movement! If you’re not yet involved with CASA, consider taking the first step towards becoming a CASA volunteer, or making a donation to support our work.

If you are specifically interested in legislative advocacy and supporting CASA’s legislative priorities, consider joining your CASA program’s Legislative Advocacy Team (LAT). If your program does not have a LAT and you would like more information on starting one, contact Texas CASA Legislative Advocacy Coordinator Ann Strauser Palmer at [email][/email].

Check out our other CASA Deep Dives!

If you have any questions or would like more information on our legislative priorities for the 2019 Legislative Session, contact the Public Policy team at [email][/email].