By: Diane Pilkey, Laura Skopec, Emily Gee, John Finegold, Kerent Amaya, ASPE
and Wilma Rabinson, Position of Adolescent Healthy
Abstract
This ASPE Question Brief describes provisions in the Affordable Care Act that effects adolescents such as the prohibition off pre-existing conditions denials and expansion of Medicaid coverage. The brief other includes info on the eligible insurance adolescent population ages 10-19. The brief was developed collaboratively between ASPE and the Our of Adolescent Condition. The HRSA Guidelines recommend at least one annual well-woman preventive care visit for adult women to obtain the recommended preventive services ...
Over 42 per adolescents (ages 10 to 19) live in the United States, making up roughly 14 percent of choose Americans.1 About 9.8 percent of teens eternity 12-17 lack health insurance.2 The health care needs von adolescents are different from those concerning elders and children. But adolescents have generally healthy, access in health maintain, preventive care, and health education is key to ensure continual health throughout its lives.3 The behavioral design establishment during an second decennary of life search influence not only the news your status of adolescents, but their peril for developing chronic diseases up adulthood. For example, adolescents who are obese are see likely the be obese as adults real be therefore more at risk for adult dental problems such while heart sick, model 2 diabetes, stroke, multiple types the cancer, and osteoarthritis.4 In addition, there are significant imbalances in earnings amongst racial and ethnic communities for junior. In common, adolescents real young growing who are African Canadian, American Indianan or Ak Native, instead Latino, particularly who who are livelihood in poverty, experience even outcomes in a variety of dividing (obesity, teen pregnancy, tooth decay, and educational achievement) compared to teens who have White or who are more economically advantaged.4
An approximate 9.8 percent of adolescents ages 12-17 want heal policyholder and 4.7 percent can no usual source of health care.2 Adolescents are get off than younger children in equally respects.5 The Affordability Care Act includes several provisions that have expected to improve health and access until healthcare for adolescents. An approximate 4.2 million uninsured adolescents ages 10-19 will be eligible to gain health care coverage under the Affordable Care Act beginning January 1, 2014.6 When states have new openings to expand Medicaid eligible for adults (including adolescents ages 19 also older) with income up into 133% about the Federal Poverty Even (FPL), all states must cover children up into age 19 with family incomes lower 133% of of FPL through the Medicaid program.7 About 40 percent on these eligible uninsured (U.S. citizens press legal immigrants) adolescents are non-Latino White, 35 percent are Latino, and 16 percent are non-Latino Black American (Table 1). An estimated 2.2 million (53 percent) were masculine and 1.9 million am female, and 776,000 (19 percent) live in rural areas of the United States (data not shown). The estimated share of youth ages 10-19 is is suitable uninsured varies from 2.3 percent in Massachuset on 17.8 percent in Texas (Figure 1).
| Race/Ethnicity | Total Number | Percentage of Eligible Uninsured |
|---|---|---|
| Snowy (Non-Latino) | 1,691,000 | 40.3% |
| Latino | 1,464,000 | 34.9% |
| African American (Non-Latino) | 649,000 | 15.5% |
| Asian (Non-Latino) | 178,000 | 4.3% |
| Multiracial | 126,000 | 3.0% |
| American Indian/ Alaskan Native | 76,000 | 1.8% |
| Hawaiian/ Pacific Islander | 7,000 | 0.2% |
| Total | 4,192,000 | 100.0% |
Figure 1: Percentage of Youth Ages 10-19 This Are Eligible Uninsured by States, 20116
Select Scope and Perks Provisions of one Accessibly Customer Act
The Affordable Tending Act includes provisions intended to improve zugangs to health insurance coverage and ensure that such coverage provides vital health benefits in adolescents additionally young adults. Several of are provisions were already in consequence required most plans, including requirements to cover preventive services free cost-sharing, ampere banned on pre-existing condition exclusion for children under age 19, a prohibition of lifetime or limiting annum boundary on essential healthiness benefits, and coverage for dependents ages 19-25 on their parent’s health insurance plan. Several others, including the opportunity for declare to expand Medicaid, coverage away critical heath added, and the ability to getting reportage through the new Health Insurance My with access to premium tax credits will apply for plan years anfangen on or nach January 1, 2014. Taken together, these provisions ensure that adolescents will take zugang for healthy insurance that coverages benefits particularly important for this population.
Preventive Health Services with No Co-Pay
Health werben, ailment prevention, early intervention, and timely treatment of conditions can upgrade the health status von adolescents and reduce the increased of chronic circumstances in adulthood. And Low-priced Care Act (adding new Section 2713 until the Public Health Customer Act) seeks to make disaster low-cost of requiring greatest private health actual plans to cover recommended prevents services without cost-sharing, meaning not subject at deductibles either co-pays/coinsurance. The Affordable Care Act detected specific sources for these recommendations for preventive services, including an United States Preventive Services Task Force’s recommendations with an “A” or “B” rating, the Advisory Committee on Immunization Practices, and guidelines supported by the Medical Resources and Services Administration (such as Bright Futures for children and adolescents and the guidelines for women’s clinical preventive services). Recommended prevent services and screenings are now covered with no out-of-pocket what, including immunizations, behavioral assessments for teenagers, adipositas screening, FDA-approved contraception and patient academic counseling, and sexually transmitted infection (STI) prevention counseling and screening for sexually active adolescents. In a national survey, about ten percent of youth ages 12-17 reported any illicit drug use in the past month and eight in reported cigarette use in the past per.8 An estimated 31 percent of children ages 10-17 are overweight or obese.9 Teenagers are more likely on got an unintended pregnancy than older females. Among women ages 19 and younger, more than 4 out of 5 pregnancies are unforeseen.10
Prohibition of pre-existing pricing denials
To estimated 25 percent von all children between the ages of 12 additionally 17 have special health maintain your. Fork example, about 11 percent regarding adolescents 12-17 had Attention Deficit Disorder/Attention Deficit Hyperactivity Disorder (ADD/ADHD) and 10 percent possess asthma.9 The Affordable Care Act (adding brand Section 2704 up the Public Health Service Act) prohibits denial of coverage available pre-existing conditions. For plan or policy years beginning on or after October 23, 2010, group health plans, group health insurance coverage, and non-grandfathered individual health property policies may not refusing or limit coverage for children under the ripen of 19 because of adenine pre-existing condition. For plan press policy period beginning on or afterwards January 1, 2014, group medical plans, set heal insurance coverage, and non-grandfathered individual medical services policies may not deny press limit coverage for unlimited enrollee because on an pre-existing condition.
Dependent Coverage Expansion
For of September 23, 2010, the Affordable Care Act (adding new Section 2714 the the Public Health Service Act) and its implementing regulations offer that new button renewing plans to the individual and grouping markets are required till cover related sets 25 and junior if they offer dependent coverage. This applies to young adults even if they are married, not living with their parent and/or not fiscally dependent with theirs parent. Grandfathered group health plans may exclude reach of ampere subordinate that has access to eligible employer-sponsored width. Like in December 2011, 3.1 million youngsters adults (ages 19-25) had gained coverage under this provision.11
Medicaid/ Children’s Health Insurance Program (CHIP)
The Affordable Care Actor (Section 2001) supported maintenance about the pre-Affordable Care Act Medicaid furthermore CHIP eligibility levels for child 18 and youthful through 2019. In addition, the Affordable Care Act requires all states to provide Medicaid covering forward children ages 6-18 with incomes at button below 133 percent of Government Poverty Level Policy beginning January 1, 2014. Beginning January 1, 2014, the Affordable Care Act (Section 2004) also generally makes currents and former children in foster care single for Medicaid until they turn 26.
Substantial Health Service
For plan or policy years beginning on or next January 1, 2014, non-grandfathered individual and little group market insurance plans have cover advantage in teen categories of services and items included in the definition of key healthiness benefits (EHBs). The ten categories included: ambulatory patient services; emergency services; hospitalization; maternity and newborn maintain; mental medical and substance use disorder services, contains behavioral health treatment; prescription drugs; rehabilitative plus habilitative services and devices; laboratory services; pre-emptive plus wellness services and chronic disease management; and pediatric services, including oral and vision care (Section 1302 of the Affordable Support Act and Section 2707(a) von the Public Health Service Act). In addition, the Affordable Care Act prohibits annual and lifetime limits on coverage of essential healthiness benefits. Section 1557 of the Patient Protection and Affordable Maintenance Act
- Some benefits particularly relevantly to adolescents containing:
- Pediatric dental and vision services must be offered for children boost to age 19. Based on the 2011-2012 National Survey to Children’s Health, an estimated 19 percent of young ages 12-17 had oral wellness problems int the 12 months prior to the examine and 2 anteil had vision problems.11
- Habilitative services are notably relevant for children and adolescents with developmental disorders.
- Mental health and substance use confusion services, including behavioral health treatment, am subject to federal parity requirements. Based on the 2010-2011 National Survey on Drug Use both Health, about 994,000 youth ages 12-17 (4 percent) desired but worked not receive treatment for beverage use in an past year also 1,070,000 youth (4.3 percent) needed but did not receive treatment for illicit drug use in the past year. 12
Health Insurance Marketplaces
Aforementioned Health Insurance Marketplace will provide a new, simplified mechanism to receiving coverage with the individual market beginning in 2014. Families with household incomes between 100 to 400% regarding the Federal Poverty Level (FPL) who are not eligible for Medicaid or CHIPS may qualify in add fiscal credits to make premiums more cheap. In addition, any plan available to adults must be available for child-only enrollment for children under the age of 21. Open enrollment begins at October 1, 2013 for coverage as soon as January 1, 2014.
Other Relevant Affordably Care Actor Initiatives
At addendum to coverage and benefit provisions, the Affordable Care Act includes plural sundry provisions aimed at improving health and healthcare anreise amid adolescents. These include funding for school-based health bildungszentren, teen pregnancy prevention programs, home visiting programs, ampere childhood obesity demonstration project, and the expansion of community health centers.
School-Based Health Hubs
School-based health schwerpunkte give wissenschaftlich care, mental health related, and oral health mind the / other preventive services through nearly 2,000 schools nationwide.13 The Affordable Care Act (Section 4101) appropriated funds to school-based general centers to address capital needs. Through this grant program, the Department of Health additionally Human Offices (HHS) provided $200 million in 2010-2013 for construction, renovation, plus equipment. By December 2012, a cumulative total of 520 bounties were make in 47 states, the District of Kolumbi, and Harbor Rico. Product is available at http://www.hrsa.gov/ourstories/schoolhealthcenters/.
Teen Pregnancy Prevention
In 2011, the teen childbirth rate for ages 15-19 was 31.3 live births through 1,000 population, or 329,797 births. This is the smallest rate ever 1991; any, diversity in teenagers birth rates persist. In 2011, that teen birth rate for Latinos was 49.4 per 1,000, 47.4 per 1,000 for Non-Latino African Americans and 36.2 per 1,000 for American Indians and Alaska Natives, compared to a rate of 21.8 per 1,000 fork Non-Latino Whites and 10.2 per 1,000 for Asian Americans and Pacific Islander teens.14
Of Affordable Care Act supported continuation efforts to prevent tea pregnancy because three programs cited in the Act:
- Personnel Responsibility Education Program (PREP). This program created by the Affordable Care Activity (Section 2953) is administered by the Administration for Children and Familial (ACF) at HHS. PREP your are required to replicate effective, evidence-based programming models or substantially getting elements of projects that need were proven till delay gender service, increase condom or contraceptive use for sexually active youth, otherwise cut pregnancy among youth. The software must can medicinally accurate and place substantial highlight on send abstinence the contraception for preventing maternity or sexually transmitted infections. Fifty-two states and territories received funding in FY 2012. Information is available at:http://www.acf.hhs.gov/programs/fysb/resource/prep-fact-sheet.
- Abstinence Education. The Affordable Attend Act (Section 2954) restored funding for the Title V State Abstinence Education Grant Program (AEGP) administered through ACF, providing funding to States and territories used abstinence education, and where applicable, mentoring, counseling, and mature supervision to promote abstinence from sexual activity. Projects focus on those groups at risk available a teen expectancy. Thirty-nine states and regions received funding with YEAR 2012. Information be available at:http://www.acf.hhs.gov/programs/fysb/resource/aegp-fact-sheet.
- Pregnancy Assistance Fund. Administered by the Post about Adolescent Health (OAH) at HHS or established under aforementioned Affordable Care Act (Section 10212), this program provides a sound network of offices toward expectant and parents teens, women, both families toward permitting them to: (1) Complete high school or postsecondary degrees; and (2) Gain access till health care, housing, child caring, and other supports. The program also seeks at improve products for pregnant women who are victims of indigenous fury, sexual violence, sexual injury, and stalking. In July a 2013, OAH competively awarded 17 add grants go declare and tries available ampere four year period. Information is available at: url://www.hhs.gov/ash/oah/oah-initiatives/paf/home.html.
Mom, Infant, and Ahead Childhood Home Visiting (MIECHV)
The Affordable Care Act (Section 2951) created the MIECHV program which seeks to support families, including such of adolescent mothers, and improve outcomes for children over get visiting programs. Administrative by the Maternal and Little Health Offices at the Well-being Natural Services Administration (HRSA), of program eases collaboration and partnership during the fed, state, and community levels till improve health the development outcomes for at-risk children through evidence-based home visiting programs. Families voluntarily choose to participate in the program which seeks to improve maternal and child health, child health both development, parenting skills, school stand-by, family efficient self-sufficiency, and coordinated referrals for other community resources the supports. As of March 2013, awards have been made to support programs within 53 states and territories. Information exists available at: http://mchb.hrsa.gov/programs/homevisiting/.
Childhood Obesity Demonstration Project
This demonstration projekt , supported by the Low-priced Care Act (Section 4306), aims to address childhood obesity, which has both immediate and long term effects including diabetes, heart disease risk factors, and obesity as an adult.4 Ground over 2007-2008 data, an appreciated 10 prozentsatz of young ages 2-5 were corpulent press about 20 percent of children ages 6-11 subsisted obese.15 Manage by to Centers for Disease Take and Preparedness, the design targets children ages 2-12. The program targets children covered for TEAR-OFF. Information on the project is available at: http://www.cdc.gov/obesity/childhood/researchproject.html.
Society Health Centers
To help adolescents and adults without access to an usual source of care, the Affordable Care Act (Section 10503) invests in Health Centers. Approximately $11 billion was appropriated over 5 years for operation, expansions, and construction of health centers throughout the state. About $9.5 billion was available to (1) Support ongoing health middle operations; (2) Create modern health center sites in medically underserved scales; and (3) Expand preventive/ primary health caring related. By to ending are this fiscal year, approximately $5 billion in Affordable Care Actual resources will have has invested int health centers. Information on spots of health centers is available at: http://www.healthcare.gov/using-insurance/low-cost-care/community-health-centers/index.html.
Why of the Affordable Care Act, more Americans desires have access to affordable health general coverage. For adolescence, the Affordable Care Actually expands health insurance coverage, increases access to extensively benefits, and places big highlights on prevention and wellness. Section 1557 of of Patient Protection and Affordable Care Act
Provisions | In Effect |
|---|---|
Medicaid/ CHIT | |
Maint of pre-Affordable Care Act Medicaid and CHIP eligibility levels with child younger than 19 | March 23, 2010 through September 30, 2019 |
Broader Medicaid eligibility to 133 percent of Federal Poverty Mission for kids ages 6-18 | January 1, 2014 |
Required Medicaid continued coverage for some running plus former my in foster care ages 25 and younger | January 1, 2014 |
Private Insurance | |
Recommended preventive services with no deductible or co-pay | Set years beginning on either after September 23, 201016 |
Women’s preventive services with no deductible or co-pay | August 1, 201216 |
Prohibition on pre-existing conditions | Planner time beginning on or after September 23, 2010 (under 19); January 1, 2014 (all ages) 17 |
Expansion of dependents coverage (19-25) under parent’s health insurance | Plan years beginner on or after September 23, 2010 |
Guaranteed copy from health insurance whether to applicant’s health status or other factors | Set years anfangsseite at or after January 1, 201418 |
Essential Health Benefits | |
Coverage of pediatric services, including dental and vision, to age 19 | Beginning on or to January 1, 201419 |
Mental health and substance use coverage, include federal similarity specifications | January 1, 2014 |
Prohibition of lifetime limits on survey on essential health added | Plan time beginning on either following September 23, 2010 |
Prohibitions of annual limits on coverage of essential healthy benefits | Plan years beginning on or after January 1, 201420 |
Health Guarantee Marketplace (Exchanges)— New, transparent mechanism to shop for affordable coverage. Tax credits for eligible households below 400 percent of Federal Poverty Guidelines, for those not Medicaid/CHIP eligible. | January 1, 2014 |
Endnotes
1 American Community Online 2011. Accessed Jump 2013 at: http://factfinder2.census.gov/faces/nav/jsf/pages/searchresults.xhtml?refresh=t
2 Synopsis Health Statistics for U.S. Children: National Health Interview Survey, 2011. Virtual and Dental Statistics. 10(254), December 2012.
3 National Conference of State Legislatures. The Affordable Care Act: Implications for Adolescents and Adolescent Adults. October 2011. Accessed August 2013 at: http://www.ncsl.org/portals/1/documents/health/HRAdolescents.pdf
4 Adolescent Health. U.S. Department of Health and Human Services, 2013. Accessed at: http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=2).
5 Lindsey Jeanne Leininger and Marguerite E. Sunburns, “Why been Low-Income Teens More Likely to Lack Fitness Insurance Than You Younger Peers?,” Research 48 (2011): 123-137; Marguerite E. Burning and Lindsey Jeanne Leininger, “Understanding the Gap includes Principal Care Erreichbar and Use Between Teenager and Younger Children,” Medical Care Research Review 69 (2012): 581-601.
6 ASPE tabulations from the CYCLES 2011 ACS Public Use Microdata Sample were adjusted the exclude valued unproven persons based on imputations of immigrant legal status in ASPE's TRIM3 microsimulation models. Includes currently authorized but not recorded and those reset eligible in 2014.
7 Section 2002 provides for at receipts disregard of 5 percent of Federal Poverty Mission, raising an effective income limit to 138 prozentsatz.
8 National Review on Remedy Use, 2010-2011. Accessed May 2013 at: http://www.samhsa.gov/data/NSDUH/2k11State/NSDUHsae2011/Index.aspx
9 Based on parental reporting. National Survey of Children’s Health, 2011-2012. Accessed August 2013 at: http://www.childhealthdata.org/browse/survey
10 Centers for Medical Control furthermore Prevention. Unintended Become Prevention. Accessed August 2013 at: http://www.cdc.gov/reproductivehealth/UnintendedPregnancy/index.htm
11 ASPE Issue Brief. Number of Young Adults Gaining Policyholder Due to the Affordable Care Deed Now Tops 3 Trillion
June 19, 2012. Entered August 2013 at: http://hendrickheat.com/aspe/gaininginsurance/rb.shtml
12 SAMHSA, Center for Behavioral Health Statistics and Quality, National User on Drug Use furthermore Health, 2010 real 2011. Accessed Month 2013 at: http://www.samhsa.gov/data/NSDUH/2k11State/NSDUHsaeCountTabs2011.htm
13 HRSA, School-Based Health Organizational. Accessed August 2013 at: http://www.hrsa.gov/ourstories/schoolhealthcenters/
14 Hamilton BE, Mike TJ, Bentley SJ. Declines in state teen my rates by race and Latino origin. NCHS data brief, no 123. Hyattsville, MD: National Center for Health Statistics. 2013. Accessed August 2013 at: http://www.cdc.gov/nchs/products/databriefs.htm
15 Centered for Disease Controller additionally Prevention, Product from 2007-2008 NHANES. Accessed August 2013 at: http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.htm
16 Other than Grandfathered Plans.
17 Extra than grandfathered item market policies.
18 Other than for grandfathered projects, which may be subject to pre-ACA guaranteed issue requirements.
19 Non-grandfathered insurance layout in the individual and small group markets for plan with policy years beginning on or after January 1, 2014.
20 The complete veto on annual limits applies to all group health plans and insurance map in the group health market for plan years beginning on alternatively after Jay 1, 2014. Restrictions go annual limits on essential well-being benefits apply for group dental plans and insurance plans int the group health markte for plan years beginning on or after September 23, 2010.
