Adolescent Health Services Missing Opportunities (2009) / Chapter Skim
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6 Health Insurance Coverage and Access to Adolescent Health Services
6 Health Insurance Coverage and Access to Adolescent Health Services
Pages 265-292
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From page 265... ...
• As is true for all Americans, medically uninsured adolescents are less likely to have a regular source of primary care and use medical and dental care less often compared with those who have insurance. • The majority of medically uninsured adolescents aged 10–18 are eligible for public coverage but not yet enrolled.
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From page 266... ...
The discussion addresses limitations of the current financing system for adolescent health services with respect to both the lack of health insurance coverage and shortcomings of the coverage for adolescents who are insured. LACK OF HEALTH INSURANCE COVERAGE As is true for all Americans, adolescents who are medically uninsured often receive care late in the development of a health problem or not at all.
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From page 267... ...
Those with multiple risk factors can suffer quite severe limitations in access to care. Thus, 16.1 percent of uninsured adolescents aged 10–18 who reported fair or poor health status failed to get medical care because of cost in 2004–2005, compared with 5.3 percent of their counterparts covered by public insurance (tabulations based on data from the U.S.
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From page 268... ...
Error Percent Std. Error Failed to get needed medical care 2.6 0.3 1.1 0.1 13.3 0.8 because of cost Delayed getting medical care because 4.1 0.4 2.4 0.2 17.2 0.9 of cost Failed to get needed prescription drugs 4.3 0.5 2.1 0.2 11.2 1.1 because of cost No usual source of care 6.6 0.6 3.6 0.3 41.3 1.8 No physician visit in the past year 14.4 0.8 11.8 0.5 40.6 1.9 aIncludes Medicaid, State Children's Health Insurance Program, and other state coverage.
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From page 269... ...
. More than 4 million individuals aged 10–18 have no health insurance coverage whatsoever, according to recent census data (tabulations based on data from the 2005 Current Population Survey)
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From page 270... ...
NOTE: FPL = federal poverty level. Figure 6-1 SOURCE: Tabulations based on data from the 2005 Annual Social and Economic Supplement to the Current Population Survey.
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From page 271... ...
who are full-time students are much less likely to lack insurance coverage than those in the same age group who are part-time students or are not students (tabulations from the 2005 Current Population Survey)
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From page 272... ...
• is true for all Americans, medically uninsured adolescents are As less likely to have a regular source of primary care and use medi cal and dental care less often compared with those who have insurance. Eligibility for Coverage for Adolescents Although those aged 19–24 lie outside the age range covered in this report, it is striking to note that eligibility for public coverage is lower for this group than for those aged 18 and under (Brindis, Morreale, and English, 2003; Cohen Ross, Cox, and Marks, 2007; Fox, Limb, and McManus, 2007b)
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From page 273... ...
As indicated above, young adults are much less likely than adolescents aged 18 and under to qualify for both public and private coverage. Addressing the Problem of Medically Uninsured Adolescents Many poor adolescents, particularly those between the ages of 10 and 18, are medically uninsured despite being eligible for Medicaid or SCHIP coverage.
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From page 274... ...
. The bulk of the remaining low-income uninsured adolescents aged 10–18 who do not qualify for Medicaid or SCHIP coverage are legal immigrants who are ineligible for coverage because they have not been in the country for more than 5 years; are undocumented immigrants and qualify only for emergency Medicaid, which is very limited in scope; live in the nine states that have income thresholds below 200 percent of the federal poverty level; or do not live in selected California counties or states that have targeted insurance coverage initiatives with state or local funds.
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From page 275... ...
In addition, very few uninsured in these age groups with incomes between 100 and 200 percent of the federal poverty level are eligible for Medicaid/SCHIP coverage. Therefore, substantially reducing uninsurance among those aged 19–24 will require more than increasing participation in existing Medicaid and SCHIP programs.
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From page 276... ...
SHORTCOMINGS OF EXISTING COVERAGE Having health insurance coverage does not ensure adolescents' access to the health services they need. Following an overview of existing health insurance coverage for adolescents, this section reviews four particular shortcomings of the coverage provided: inadequate coverage of preventive, sexual and reproductive health, mental health and substance abuse treatment, and dental services; access problems related to high cost sharing or lack of provider participation; lack of incentives to invest in preventive and chronic care services; and limited confidentiality policies for adolescents receiving health services.
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From page 277... ...
Research on state coverage policies is limited in that, with the exception of mental health, substance abuse treatment, and dental services, it does not provide information on the details of coverage. Neither does it offer a current assessment of the extent to which any of the benefits are actually authorized.
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From page 278... ...
Coverage of Adolescent-Specific Health Services Insured adolescents experience particular shortcomings in the coverage of certain health services, most notably preventive services, sexual and reproductive health services, mental health and substance abuse treatment, and dental services. Although access to services is dependent on multiple variables, such as provider availability and transportation, coverage of benefits is an essential first step to ensuring that adolescents receive the services they require.
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From page 279... ...
Private insurers Current information on the availability of coverage for annual preventive care services for privately insured adolescents is not available since large-scale surveys, such as the Kaiser/Health Research and Educational Trust (HRET) Survey and the Bureau of Labor Statistics' National Compensation Survey, ask only about well-baby visits and adult preventive care.
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From page 280... ...
Mental Health and Substance Abuse Treatment Services While the affordability of health care in general is an important issue for adolescents, the affordability of mental health and substance abuse treatment is particularly problematic. The availability of those services has long suffered from bias and stigma against persons with such disorders, which traditionally have resulted in higher patient cost sharing, lower
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From page 281... ...
SCHIP States are not federally required to cover either mental health or substance abuse treatment services under separate SCHIP programs, but all states have opted to provide SCHIP coverage for both inpatient and outpatient services. While EPSDT-like coverage or wrap-around benefits in 15 states provide comprehensive mental health and substance abuse coverage, the extent of coverage available to adolescents in the remaining states varies widely and is sometimes more restrictive for substance abuse treatment than for mental health services.
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From page 282... ...
The resulting inequities and inadequacies in health care delivery for children and families generally and adolescents in particular are extensively documented. These inequities and inadequacies are exacerbated for adolescents with mental disorders seeking care because of higher levels of patient cost sharing for such care, more limited benefits, greater demand for health care management, and bias against adolescents with mental disorders as compared with those with other disorders.
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From page 283... ...
. The MCHPRC study found that cost sharing for some types of mental health and substance abuse treatment services was required in most of the 36 separate SCHIP programs, but was usually nominal.
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From page 284... ...
Upon turning 21, dental coverage for Medicaid beneficiaries is provided by their state Medicaid plan as an optional service. Currently only 9 states provide coverage for reasonably comprehensive preventive and restorative dental services for those over age 21, while 15 states provide coverage for only emergency relief of pain and infection, and 7 have no dental Medicaid benefit of any kind for those over age 21 (Edelstein, Schneider, and Laughlin, 2007)
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From page 285... ...
. Private insurers About half of privately insured adolescents are likely to have coverage for dental services through employer-sponsored plans (The Kaiser Family Foundation and Health Research and Educational Trust, 2006; U.S.
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From page 286... ...
However, the current health care financing system, with its fragmented coverage for the nonelderly, does not offer strong incentives to invest in prevention or to treat chronic health problems adequately. Individuals rarely maintain the same insurance coverage over their life span (Herring, 2006)
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From page 287... ...
For example, the current system for financing health insurance coverage leads to under investments in disease prevention and treatment in some areas that are particularly problematic for adolescents.
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From page 288... ...
However, adolescents who have coverage experience difficulty gaining access to the services they need because of a combination of limits in benefits packages, cost-sharing requirements, lack of access to providers, and unavailability of confidential health services. These problems are particularly acute with respect to preventive, sexual and reproductive health, mental health and substance abuse treatment, and dental services.
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From page 289... ...
. Preliminary Thoughts on Restructur ing Medicaid to Promote Adolescent Health.
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From page 290... ...
. The Effect of Health Savings Accounts on Health Insurance Coverage.
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From page 291... ...
. Disparities in den tal insurance coverage and dental care among U.S.
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From page 292... ...
Rockville, MD: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health, National Institute of Mental Health.
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