Healthcare access among youth with disabilities leaving foster care: Exploring barriers in the Deep South

Youth leaving foster care face significant challenges accessing healthcare due to frequent placement changes, fluctuating health insurance eligibility, and inconsistent adult guidance during the transition into adulthood. Concerns over health care access are intensified among youth leaving care because of the significant prevalence of behavioral and medical disabilities. Studies exploring specific psychosocial (e.g., stigma) and structural (e.g., systemic bias/racism) barriers to healthcare access within racially diverse, urban, and rural communities are crucial to improving health equity. Set against a backdrop of long-standing concerns over health access in the Deep South, this exploratory study provides a foundational understanding of barriers to healthcare access for youth leaving care with disabilities in a Southeastern state. Ten in-depth semi-structured focus groups were conducted across three locations in Alabama with distinct stakeholder populations, including youth leaving care with diagnosed disabilities (n=12), caregivers of youth (n=29), and child welfare professionals serving youth (n=37). Themes illustrate several factors challenging healthcare access for youth leaving care with disabilities, including (1) mistrust of healthcare, (2) concerns over cost, (3) insufficient learning opportunities, (4) conflicting and ineffective healthcare guidance, and (5) child welfare policies and practices limiting access to care. Given the limited literature describing challenges to healthcare access among youth with disabilities leaving care in the Deep South, this study contributes valuable insights to inform the development and implementation of regionally tailored strategies to promote healthcare access among this population.