How Advocates Can Set Older Youth Up for a Healthy Transition to Adulthood

As CASA volunteers, we all want to see the youth we serve grow into their happiest, healthiest selves. But the fact is, youth who experience foster care often have specialized medical and mental healthcare needs. These youth are already dealing with so much, and the healthcare system is complicated, intimidating and difficult to navigate. It’s crucial for CASA volunteers to understand it so that they can work with youth and caregivers to ensure they’re getting the healthcare they need and deserve. To help with this, Texas CASA has created an in-depth Health Advocacy Guide that will be released in the coming weeks.

Today, we’re focusing on health advocacy specifically for older youth who are getting ready to transition out of foster care—how CASA volunteers can empower them to become their own best advocate for their physical and mental health, connect them with support and services, and set them up for a healthy adulthood.

You can make a lasting difference during this critical moment in their lives! Read on to learn how.

First, CASA volunteers should understand the basics of STAR Health, Texas’ Medicaid program for youth in foster care.

Texas administers its state Medicaid program through a managed care system, meaning the state contracts with private health insurance companies to provide services. The state is currently contracted with Superior HealthPlan to manage healthcare for youth in foster care via the STAR Health program. Medicaid contracts are renewed periodically, so this could change over time.

Generally, the state will only cover services for youth that are offered by a doctor or provider who contracts with STAR Health. In addition, doctors in the STAR Health network are specially trained to work with youth who’ve experienced abuse or neglect, and are often trauma informed. For these reasons, it’s important for CASA volunteers to be familiar with how to find an appropriate provider and to understand what services are covered.

All youth enrolled in STAR Health are generally entitled to any medically necessary service, and remain covered until their 21st birthday. For a high-level list of covered benefits, physical health and mental health services, see the STAR Health Member Handbook (starting at page 17).

It’s important to note that we’re only scratching the surface of STAR Health and the services and support it covers in this guide. We recommend you bookmark and read through the full Member Handbook so that you can refer to it when needed.

Older youth should know they have the right to request a hearing to become their own medical consenter.

What is a medical consenter? A medical consenter is the person whom a court has authorized to consent to medical care for a child in state conservatorship. Youth who are 16 or older may become their own medical consenter, meaning they can make decisions about their own healthcare, if a judge signs an order allowing them to do so.

The Department of Family and Protective Services (DFPS) must inform youth of their right to request a hearing to determine whether they can consent to (in other words, make the decisions about) their own medical care. DFPS also provides training on informed consent and provision of medical care as part of the Preparation for Adult Living (PAL) program. If a youth has an attorney ad litem, the attorney is also required to advise them of this right.

Make sure the young person you serve knows they have the right to become their own medical consenter and have a voice in their own care! If you are uncertain about who the medical consenter currently is, ask your supervisor or the youth’s caseworker, or ask to see the 2085-B Designation of Medical Consenter form. Be aware that CASA cannot and does not ever serve as the medical consenter.

Help make sure youth keep their health coverage when they transition out of foster care.

Under federal law, young people who age out of foster care are guaranteed Medicaid coverage until they turn 26. In practice, however, many youth lose their healthcare because of a simple oversight: not updating their address with HHSC.

  • It’s critical that youth renew their Medicaid coverage annually by updating their address with HHSC anytime they move. Check with youth to make sure they have done this, or help them do it.
  • Youth who age out at 18 can either stay on STAR Health with the same managed care organization they had while in foster care (Superior HealthPlan), or opt into a new Medicaid plan.
  • When a young adult turns 21, they are no longer eligible for STAR Health. They must select a new Medicaid plan and managed care organization if they would like to remain insured.
  • It’s especially important that young adults 18 and older have both of their Medicaid insurance cards (one from HHSC and one from Superior HealthPlan) prior to their last day in foster care. If needed, help their caregiver obtain replacement cards by calling 211 or visiting 211texas.org. They can also call Superior Member Services at 1-866-912-6283.

STAR Health also provides Transition Specialists that can be assigned to youth anytime between age 15 and their 21st birthday. Transition Specialist have no relation to DFPS PAL workers—they have a more direct focus on navigating healthcare. They can help educate and prepare youth for turning 21, transitioning off of STAR Health and enrolling in a new health plan that meets their needs. They can also refer youth to services. You can obtain a Transition Specialist for the youth you serve by calling 1-866-912-6283.

Make sure youth know their rights and understand their options when it comes to reproductive and sexual health.

Access to Contraception: Despite a common misconception, youth do not need consent from anyone, including their caregiver or foster parent, to obtain contraception. Youth also have the right to say no to being placed on contraception, if they do not want it.

Federal law protects confidential access to family planning services, which includes the contraceptive method of choice for individuals of childbearing age enrolled in a state’s Medicaid program (including minors). Additionally, DFPS policy states that caseworkers cannot attempt to prohibit a youth from seeking contraceptive services.

Ensure the youth you serve knows they have the right to consent to covered contraception, without obtaining anyone’s permission. Make sure they also know that their confidentiality around the decision to use contraception is protected by federal law.

OB/GYN Care: Youth do not need a referral to see an OB/GYN. However, the OB/GYN must be in network with STAR Health. If a youth wishes to remain with their current or previous OB/GYN, but they are out of network, exceptions can be made—but Superior HealthPlan must develop a single case agreement with the doctor.

If a youth is pregnant, there are programs and support available, both for the youth and the baby.

Regardless of their age, youth who are pregnant in foster care can be the official medical consenter to all hospital medical or surgical treatment related to their pregnancy—with the exception of abortion. They can also consent to all medical care for their newborn child unless DFPS has conservatorship of the newborn.

Start Smart for Your Baby: Start Smart for Your Baby is a program covered by STAR Health offered to youth who are pregnant or new mothers. To enroll, youth must notify STAR Health about their pregnancy by submitting the Notification of Pregnancy (NOP) form or by calling Superior HealthPlan member services at 1-866-912-6283. For youth who are pregnant with special needs, START Smart offers Care Managers who can provide specialized support.

Helping through Intervention & Prevention (HIP): HIP is another voluntary, free program that offers educational opportunities for young parents through home visits, as well as financial support for the basic needs of the child. Youth who are pregnant in foster care, or have recently given birth and are parenting a child that is up to 2 years old, qualify for HIP. This includes youth who are single teen fathers, and those who have aged out, are receiving Preparation for Adult Living and/or are in the extended care program.

Volunteers can refer youth with their consent to HIP by emailing [email]HIP@dfps.state.tx.us[/email]. Please include the youth’s name, date of birth, current address, phone number, gender, the baby’s name, and the baby’s date of birth or due date.

Health Coverage for a Newborn: If the young person who is pregnant is enrolled with STAR Health, the baby will be automatically enrolled upon birth. However, the youth must take the following steps before or immediately following the birth:

  1. Prior to the newborn’s delivery, consult with STAR Health about selecting a pediatrician.
  2. Contact the Department of State Health Services (DSHS) about the birth of the baby as soon as possible to ensure the baby’s Medicaid enrollment is processed more quickly.
  3. Contact STAR Health (by calling member services at 1-866-912-6283) to notify them of the birth. Superior HealthPlan should be made aware by the hospital, but it is important to follow up with them.
  4. If the adolescent who is pregnant is in foster care, contact the DFPS caseworker after the baby is born. The baby does not need a Social Security Number to be signed up.

If the youth you’re advocating for identifies as LGBTQ, connect them with relevant services and support.

Given the heightened risks many LGBTQ young people face in foster care, it is vital that they feel comfortable discussing their healthcare needs and know the options available to them. As their advocate, make sure you communicate that you are affirming of their identity, respectful of their experiences and willing to learn. In addition, it’s important to have the youth’s consent before disclosing their sexual orientation or gender identity to anyone.

STAR Health offers resources for both LGBTQ youth and their caregivers to ensure their medical needs are appropriately addressed, including books with educational information about what other LGBTQ youth have experienced, resource guides, HIV information and more. Superior HealthPlan has also compiled a resource guide that lists organizations by city that may offer support and services for LGBTQ youth. It’s also important to get LGBTQ youth connected with a Transition Specialist, as they can assist with connecting them to more services.

Help young people take ownership of their healthcare with the My Health Pays® Rewards Program.

This program is designed to incentivize young adults 18-21, still enrolled in STAR Health, to take control of their own healthcare by offering cash rewards for continuing regular check-ups. Young adults can earn up to $125 annually!

CASA volunteers, thank you for your commitment to the physical and mental health of the youth you serve. The critical conversations you have with them today will ensure a healthier tomorrow—and help give them the best possible chance of a happy, supported and successful adulthood. Be on the lookout for Texas CASA’s Health Advocacy Guide, coming soon!

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