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The Affordable Care Act (ACA), enacted in March 2010 and taking full effect in January 2014, increases the number of people who have access to health insurance, simplifies insurance enrollment, and requires that benefits include substance abuse and mental health coverage, as well as medical services. All these changes, if implemented fully and carefully, would be particularly valuable for the highly vulnerable children and families in contact with the child welfare system. This paper considers the implications of the ACA on child welfare families, specifically on youth aging out of foster care, parents and guardians of children in (or at risk of entering) the child welfare system, and children already involved in the system. The authors also offer potential strategies for action by state and federal child welfare and health officials, philanthropic funders, and outside experts.