The Affordable Care Act includes language that requires states to provide Medicaid coverage to youth who were in foster care in their state before aging out of the child welfare system. However, most states have interpreted the law differently for youth who move to their state after aging out, determining that automatic Medicaid coverage is an option, not a requirement. Varying state policies have created barriers to health care access for this already vulnerable population, as has the lack of a coordinated process to inform these young people of their continued access to health care via Medicaid and to ensure that they are enrolled. This policy brief describes the health needs of those who have transitioned from foster care, the hurdles they must clear to obtain access to care, and changes in policy and practice that would make investments in the welfare of these young people and the future of our nation a reality. A list of references and notes is included.