States should take advantage of opportunity to expand health coverage for adolescents, according to

By Bonz Otsuki on January 01, 2000

States should take full advantage of the nationwide state Children’s Health
Insurance Program to improve the health of millions of low-income and at-risk
adolescents, according to a new report released by the Association of Maternal
and Child Health Programs (AMCHP); the National Adolescent Health Information
Center (NAHIC) at the University of California, San Francisco (UCSF), and the
Policy Information and Analysis Center for Middle Childhood and Adolescence
(the Policy Center), also at UCSF.

The report was reviewed in Washington, DC at a February 1 briefing for Capitol
Hill health policy experts. State and federal health professionals who have
initiated successful strategies in several states to improve care for
adolescents joined the study’s authors to urge recognition that a special focus
is needed to meet the health needs of this age group.

The report, Adolescents and the State Children’s Health Insurance Program
(SCHIP): Healthy Options for Meeting the Needs of Adolescents, analyzes
strategies tested in 12 states to use the SCHIP program to improve health care.
SCHIP provides federal funding that enables states to expand health insurance
coverage for low-income children from birth to age 18. It extends coverage to
children and adolescents whose families cannot afford private health insurance,
including working families and those trying to get off welfare.

“SCHIP represents an unprecedented opportunity for states to expand health
insurance for children of all ages, but particularly the under-served
population of adolescents,” said Claire Brindis, DrPH, co-author of the report
and UCSF professor of pediatrics and health policy in the Division of
Adolescent Medicine and the Institute for Health Policy Studies.

In a 1999 study, Brindis and colleagues found that one in seven youth between
the ages of 10 and 18 are uninsured. Even as teens have been added to public
insurance programs, the number and proportion of adolescents covered by private
insurance has declined. In a study of the demographics of adolescent health, 
Brindis found that teens are increasing as a percentage of the overall
population for the first time in 20 years. It is estimated that the number of
young people ages 10-19 will increase by 13 percent between 1995 and 2005. In
California, the most populous state, teen numbers will rise by 34 percent.

“Adolescents have unique needs - they are neither big children nor little
adults,” said Catherine Hess, executive director of AMCHP. “Our report
documents how the states are beginning to tailor their new or expanded health
insurance programs to address their special needs. There is much more we could
be doing though, and this report also provides some pointers.”

Brindis and Hess welcomed the renewed national interest in covering more of the
uninsured and called for bipartisan support to help more youth and families.
One example is President Clinton’s proposal, announced January 19, to offer
insurance as well to the parents of children covered by SCHIP and Medicaid, and
to include young adults through age 20. “More than 4 million children aged 10
to 17 are not insured,” Brindis said. “Coverage is even lower in the 18 to 20
group, and among families with young parents. These are the children and young
adults least likely to get regular health care or to get the preventive care
and counseling that saves lives and protects them from illness and injury.”

## Key findings of the report:

In Adolescents and the State Children’s Health Insurance Program (SCHIP):
Healthy Options for Meeting the Needs of Adolescents, the authors found:

* Adolescents have pressing health care needs that often are not fully
addressed by Medicaid, SCHIP or even private health plans, state health
officials report. These include reproductive health care and information, oral
health care, and mental health services, such as violence prevention and
treatment for substance abuse.
* States can take advantage of the expansion of health programs under SCHIP to
target adolescents for improved health care.
* A major challenge is to assure that health providers are adequately
reimbursed for providing the services that teenagers need, including preventive
care. Many medical providers are inadequately trained to recognize adolescent
health problems, whose origins may be primarily psychosocial instead of
physical. The report recommends that adolescent health specialists,
school-linked health centers and other adolescent safety net caregivers should
be included in provider networks. Education programs should let teens and
parents know how they can gain access to health providers of their own.
* Adolescents are the group least likely to be insured. SCHIP and Medicaid
enrollment strategies for qualified adolescents have been shown to succeed when
they use outreach materials targeted to teens and their parents. Some
successful programs enlist young people as counselors to encourage their peers
to take an active role in their own health care. Simplified application and
enrollment procedures are crucial for this age group.
* Confidentiality is a top priority when health providers address the high-risk
behaviors that cause the highest rates of illness and death among adolescents -
such as substance abuse and violence. States should establish procedures to
assure confidentiality for adolescent health care; to work with health plans
and providers to increase awareness of each state’s confidentiality laws; and
to educate adolescents about the confidentiality protections available to them.
* Additional provisions should be made to give appropriate care to adolescents
with special needs, and to at-risk youth such as those in homeless and runaway
shelters.
* Professional guidelines for quality care, and measures to evaluate care
programs, should pay specific attention to adolescents and their unique needs.
* States should work to develop linkages among all the health and community
programs that serve adolescents.

## States’ innovative approaches to teen health:

The report describes several programs developed in the states to offer health
care to adolescents via Medicaid and SCHIP. Some examples:

* ALABAMA: Peer Outreach. In Escambia County, Alabama, a pediatrician enlisted
seven of her adolescent patients for SCHIP outreach efforts targeting teens in
their county. The young counselors were trained to help identify other
adolescents and their families in need of health insurance. Their efforts were
highly effective: in one local hospital, the percentage of children and youth
coming in without insurance dropped from 25 percent to 11 percent.

* CALIFORNIA: The California Primary Care Association (CPCA) launched It’s
Important! - a TV, radio, and print ad campaign aimed at enrolling Latinos in
Medicaid and in the state’s Healthy Families program.

* COLORADO: A local non-profit health organization based in Denver, Rocky
Mountain Youth MNC, Inc, is conducting outreach efforts to enroll at-risk youth
to the Child Health Plan Plus (CHP+) program, Colorado’s non-Medicaid SCHIP
program. The organization conducts outreach to runaway and homeless youth who
live at Urban Peak, a Denver-based shelter.