FOR IMMEDIATE RELEASE
February 1, 2000
Contact Janet Basu, UCSF, 415-476-2557
Contact: Katrina Brown, AMCHP, 202-775-0436

States Should Take Advantage of Opportunity to Expand Health Coverage for Adolescents, According to Report

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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.

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