Family acceptance has been identified as one of the strongest predictors of the mental and behavioral health outcomes of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. In fact, LGBTQ youth with accepting families are significantly less likely to attempt suicide and report experiencing depression. This chapter focuses on the role that acceptance plays in the experiences of youth in foster care. Foster care alumni were intervieded in an attempt to compare the experiences of youth with accepting foster families to those who had rejecting experiences in foster care. Foster families often experience minimal training that specifically addresses the need to create supporting and affirming environments for LGBTQ youth. Given the important role that family acceptance plays in the health and well-being of LGBTQ youth, it is critical that efforts to create a more inclusive and accepting system of care specifically address efforts to enhance foster family acceptance.