I’m a New Yorker. I come from a long line of New Yorkers who know how to stretch a dollar and find a way. We are gritty, witty, and relentless. Hustle isn’t just what I do; it’s who I am and something I inherited. It’s how my family survived, and how I learned to survive too.
So at 20, working two jobs wasn’t anything special; it was expected. After earning my associate’s degree, I was bouncing between a retail job and just starting my nonprofit career, logging over 60 hours a week. I didn’t complain. I just kept moving. Because when you come up through foster care in New York, you figure out how to build something out of nothing, even if it breaks you.
One night after a shift, I checked my phone and saw a voicemail from the hospital. My grandmother — my guardian, my everything — had a stroke.
The week that followed was a daze. I’d clock out of one job, head straight to the hospital, then head off to my second job and return back to the hospital to do it all over again. I was always moving and always working, but I wasn’t feeling. There was no time for that, no room to process.
When she passed shortly after, there was no space to grieve. The bills didn’t stop. Funeral costs piled up. And to top it off, I had aged out of foster care just three weeks earlier and was about to lose my housing. Happy birthday to me. For the first time, I was completely on my own — no safety net, no backup plan; just me, my thoughts, and the weight of it all.
Dutch psychiatrist Bessel van der Kolk says, “the body keeps the score,” and mine did. I had four sciatica flare-ups, two reproductive health emergencies, and too many anxiety attacks to count. I wasn’t healing. I was just trying to survive.
The only reason I made it through was because of Medicaid, coverage extended through the Affordable Care Act for former foster youth until the age of 26. It covered the ER visits, the prescriptions, and the care I didn’t even know how to ask for. When hustle betrayed me, Medicaid helped me. It didn’t shame me for falling behind or ask me to prove I was worthy. It gave me support and dignity. When survival nearly took me out, Medicaid was the reason I made it through.
And now, that support is at risk.
Under new law, Medicaid is being reshaped into a system that demands compliance and punishes those without support. It’s a change that prioritizes bureaucracy over care. The law is expected to cut federal healthcare spending by more than $326 billion over the next 10 years, but the real cost will be paid in lives, and that can’t be measured in dollars. To keep coverage, adults must now work, be in school, or volunteer at least 80 hours a month. States will be required to verify monthly income twice a year, but they’re allowed to go further.
On paper, it sounds like accountability. But in reality, it means more paperwork and deadlines without anyone to help navigate them. For young people without internet or stable housing, a missed notice or lost form could mean losing healthcare without even knowing it. It’s survival of the fittest, a game I’ve played my whole life, and one where current and former foster youth are set up to lose.
There are exemptions for some with medical conditions, but most former foster youth don’t qualify. And with nonprofits losing funding, there is less support to help navigate all the bureaucracy and red tape. One missed call, one wrong form or address, or one moment of crisis can mean losing everything, again. Even retroactive coverage has been cut from three months to one. So when young people are in crisis — as so many of us are, because crisis has been embedded in our lives because of foster care — there’s nothing there to protect us.
I’ve worked directly with young people who didn’t even know whether they had insurance until they were in pain or in a hospital bed. I’ve supported young people who have “thugged it out” in order to make ends meet only to find out their Medicaid had lapsed. Crisis isn’t new to us; it’s part of the reality that foster care passed off to us. When a crisis hits, there’s no time to chase down paperwork. These changes don’t just create barriers. They close the doors completely for young people who had to fight and survive their whole lives.
Survival shouldn’t be the standard. No young person should have to choose between their health and their ability to survive for the week. Policy should reflect the realities of our lives, and our reality is that access to healthcare isn’t optional — it’s essential. It should not depend on a person’s ability to work, produce, or prove they’re deserving of support. Monitoring and oversight matter, but without the right support networks in place, oversight turns into scrutiny and bias. That’s why we have to invest in community-based organizations that show up for young people and help them navigate these systems and life challenges.I’m a New Yorker. I come from a long line of New Yorkers who could survive anything, but at a cost no one ever talked about. We are hardened, overburdened, and emotionally shut down. I know how to hustle, but I shouldn’t have to sacrifice my health to prove I’m trying. Foster youth should not have to earn their right to care because healthcare should never be a survival test.
