This article first appeared in January 2001.

Cheyenne Worthen lives in a neat, rambling house in Seattle that she shares with other young men and women who have one thing in common: they've been homeless. The house, a "transitional living center," is operated with state funds by a nonprofit organization. It is designed to be a safe haven for 18- to 22-year-olds who have run out of options, a population in which former foster children like Cheyenne seem to be well represented.

Each year in this country, about 20,000 adolescents leave the foster care system on their 18th birthdays, after having spent months or years as dependent wards of the state. Like most young people barely out of the nest, they are not entirely ready to be on their own. Children who have been in foster care often lack the kind of familial cushion that most young people take for granted: a place to call home; help with school or housing; simple parental solicitude. Being young, they may not even realize that they're missing another important piece in their support system: extended health coverage.

Keeping Kids Healthy, State by State

Recently, states have given some new options to these young people, thanks to the Chafee Foster Care Independence Act, signed into law by President Clinton in late 1999. The act is named in honor of the late Senator John H. Chafee, who championed the legislation until his sudden and unexpected death shortly before its passage. In an effort to address the many needs of young people transitioning out of foster care, the Chafee legislation doubled federal funding available for services to young people formerly in foster care.

The law helps with the troublesome issue of providing health care coverage: states now have the option of extending Medicaid health benefits to young men and women, aged 18 to 21, who have "aged out" of the foster care system. Yet, as of January 2001, only four states had allocated matching funds under the Medicaid option to provide health coverage to this group. (Fifteen states are already providing some kind of health coverage to former foster children though other programs.) The remaining states, including Washington, where Cheyenne lives, have yet to enact policies to provide the matching funds for Medicaid coverage.

High Costs of Care

For Cheyenne, that policy decision has been costly: she owes about $1,000 for medical care she received shortly after leaving the foster care system. More importantly, while Cheyenne now seems to have the upper hand in her continuing struggle against drugs, she wants very much to get into a residential drug treatment program. But she has been told that unless she can demonstrate an ability to pay, she cannot even win a spot on the waiting list.

Thirty to 40 percent of children entering foster care have urgent physical health problems, ranging from delayed growth, HIV infection and malnutrition to toothaches and the lack of eyeglasses. Many children entering care simply have not had regular medical check-ups and have chronic illnesses that have gone unrecognized and untreated. Eighty percent of foster children suffer from emotional or behavioral problems, the inexorable wounds of the abandonment and the uncertainty that mark their early lives. These health problems don't disappear when foster children emancipate; indeed, some worsen with the pressures and complexities of independence.

Forgotten Children

The Congressional Budget Office estimated in 1998 that there were 65,000 18- to 21-year-olds who had aged out of foster care, young men and women trying to make their way in the world. Most of them, like Cheyenne, have no health insurance. Factor in high unemployment (56 percent) among young men and women who've left foster care, homelessness (25 percent, at least once), and a precipitous school drop-out rate (46 percent) and a picture begins to emerge of a group of young Americans living at the margins of the nation's prosperity.

They hold in common childhood histories of great hardship, and the determination to endure, whatever that takes. In the process of surviving, they have jettisoned parts of themselves over the side—their feelings, family ties, even, at times, hope. As young adults, they are just beginning to appraise the cost of the journey and to make choices about who they want to be, and what to reclaim, as they begin to discern the shape of the world, on their own.

Finding Home, Sweet Home

Cheyenne, 21, is back in transitional housing after a summer spent living in parks with friends, a lost season from which she is only now beginning to emerge. She'd been doing pretty well—living at the house, holding down a job—when a romance she'd pinned her hopes on went sour, and she became severely depressed. "I started doing drugs again. They made me feel happy, at least for awhile," she says. Cheyenne has a quick, open smile and almond eyes, like a cat's, one blue and one green.

Cheyenne is back "home" now and working with a counselor, but she believes the more intensive support of a residential program would make a big difference. "I was cut off from Medicaid at 19," she says, after several years in state custody, in foster care and in a state psychiatric hospital. She developed a bleeding ulcer after leaving care and had no way to pay for medical services. "I don't want to use the system. I don't want to live on disability, like my parents have done. But I did need help when I was sick with the ulcer and do need some help right now."

The Road to Independence

Cheyenne managed to graduate from high school, with special honors, in 1998. She is an avid reader and keeps a journal. "It's therapy for me," she says of the journal writing. At her graduation she was asked to give a speech. "I just talked about how I got from my childhood in Idaho, all the craziness at home, to where I was then, when I finished school," she says. "My message was: you can do it too." (Read more excerpts from Cheyenne's journal.)

The road from childhood to independence has not been smooth. For as long as Cheyenne can remember, her father drank, and when he was drunk, he terrorized his family. "He hurt my mother many times, and my brothers and myself," she recalls. Finally, when she was 15 she left home after he'd put a gun to her head and threatened to kill her. She moved in with an aunt and when that didn't work out, she drifted between friends and relatives. "I really don't feel like I have a home," she says, "not a place where I feel I belong."

At 17 she was diagnosed with mononucleosis and left school to recover. But there were deeper troubles: she became suicidal and was admitted to a state psychiatric hospital where she made an attempt on her life. "I just felt so alone," she says. But it was at the hospital that she met a nurse who helped her face a secret she'd been keeping, even from herself. Cheyenne realized that she was a lesbian. "I didn't date, I'd been isolating myself. I just closed off that whole part of my life. And finally she helped me see what was true about my life and to accept myself."

A Different Kind of Family

Two women became her foster mothers when she was released from the hospital. "They clothed me, comforted me; they came to my graduation, took me to the doctor and to my counseling sessions," she says of her experience in foster care. The state extended medical benefits to her while she completed her studies, until she was 19. "Then I was out on the streets and without (medical) coupons," she explains. That's when she developed an ulcer and quickly ran up about $1,000 in hospital bills for treatment. "I basically ran out on the bill. I have no idea how I'll pay it," she explains.

Cheyenne remains fond of her foster parents, "I can talk to them like friends," but she is 21 now and has to make her own choices. Though she saw her birth parents recently and felt good about the visit, they are unable to offer much help.

As a former foster child, Cheyenne is part of a relatively small subgroup of the 42 million Americans who have no health insurance. Now, however, they actually having something working in their favor: Congress declared their case worthy and opened the nation's pocketbook to cover a significant portion of the cost of health coverage, if states opt to provide the matching funds to ensure their care.

For Cheyenne in Seattle, the question of whether Washington should adopt the "Medicaid option" offered in the Chafee legislation is far removed from her immediate concerns. For now, she's trying to focus on keeping a part-time job she recently landed, and getting into drug treatment. "I need to learn to love myself, and take care of me, and work on getting well now," she says.

Kathryn Hunt is a writer and filmmaker. She is the director of Take This Heart, a PBS documentary that chronicles the lives of three boys in foster care. The research and writing of On My Own was funded by the Casey Family Programs.