Governor Mike Parson signed House Bill 397 and Senate Bill 514 on Thursday. Both bills fixed an oversight in the Affordable Care Act related to youth formerly in foster care. One of the most popular provisions of the Affordable Care Act is the ability for children to stay on their parents' health insurance until they turn 26.

“I want the same things for children who’ve been in foster care that I want for my own children,”  Senator David Sater (R-Cassville) said. “My kids wouldn’t lose coverage; older youth who’ve experienced abuse and neglect shouldn’t lose coverage, either.”

The ACA allows children that aged out of the foster care system at 18 to remain on Medicaid until they are 26 years old. However, the language passed in the ACA only required a state to provide Medicaid to that individual if they aged out of that specific foster system. Currently, if a youth aged out of Illinois’s foster system but moved to Missouri to work, they are not allowed to maintain their public insurance in Missouri.

“I am very glad that we were able to close this loophole and allow the out of state foster care children the opportunity for healthcare coverage,” Representative David Wood (R-Versailles) said. “There are a lot of challenges facing youth aging out of foster care and having healthcare coverage takes some of the issues away.”

Research has shown that access to health care for youth previously in foster care is important because they are more likely to have health complications. Ensuring these youth remain insured helps the broader community by keeping them out of crisis that could lead to emergency room visits or hospitalizations.

“We are thankful for the legislature’s work to ensure that youth exiting foster care who may have needed to move from another state are not excluded from the same benefit provided to those who remain in Missouri,” said Craig Stevenson, director of policy and advocacy at Kids Win Missouri.

In the fall of 2018, Congress passed and President Trump signed into law a federal fix to this provision within the ACA, but it will not take effect until Jan. 1, 2023. These former foster youth in Missouri will be able to access Medicaid beginning Aug. 28, 2019, when the bill takes effect, according to the nonprofit Kids Win Missouri, whose mission is to further child well-being. 

The child protection bill, HB 397, Gov. Parson signed into law includes “Nathan’s Law” to protect and strengthen the safety of young children receiving care and education in unlicensed, in-home child care providers. The law will also go into effect on Aug. 28.

“For over a decade, families of children who have died in unlicensed care have urged the general assembly to take action by fixing the lax laws to prevent future tragedies,” Senator Jill Schupp (D-St. Louis) said. “Finally, after the tireless and persistent work of so many, the loophole has been closed and more accountability standards for providers are in place. I am thankful to all who have helped make this legislation protecting our vulnerable young children, law in the State of Missouri.”

Current law in Missouri allows an unlicensed, in-home child care provider to care for four or fewer unrelated children in addition to an unlimited number of related children up to the third degree. Beginning Aug. 28, these providers may care for a total of six children, and no more than three under the age of two. 

 “Since November, at least two infant fatalities occurred in Missouri when unlicensed in-home providers were attempting to care for more children than allowed by law,” Stevenson said. “Our state’s infants will be safer under this new law. We are grateful for Sen. Schupp’s work to bring stakeholders from across the state together to create a workable solution.”

The legislation also increases the criminal penalties for those who violate the child care licensure statutes and creates a civil penalty enforceable by the Department of Health and Senior Services, while ensuring adequate due process protections for providers who are operating in good faith.

“This change in law lowers child-to-adult ratios, which are proven to ensure that young children get enough one-on-one attention from an adult who is available to care for each child’s unique needs,” Robin Phillips, CEO of Child Care Aware® of Missouri said. “These individualized relationships help infants, toddlers, and preschoolers thrive in their development as well as reduce stress and feelings of being overwhelmed for both the child and the adult.”