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Office of Adolescent Health

Adolescents and the Affordable Care Act

Wilma Robinson, PhD, MPHDeputy DirectorOffice of Adolescent HealthUS Department of Health and Human Services

OJJDP Coordinating CouncilNovember 13, 2013

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Why focus on Adolescents? Current uninsured rate among adolescents Brief background on the Affordable Care Act

Coverage provisions already in effect Coverage provisions taking effect in 2014

Other relevant Affordable Care Act initiatives Federal Resources

Overview

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Over 42 Million Adolescents (ages 10-19) live in the United States.

The health care needs of adolescents are different from those of adults and children.

Behavioral patterns of adolescents influence their risk of health conditions as adults.

There are significant health disparities that exist among adolescents.

Why Focus on Adolescents?

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United States Eligible Uninsured* Ages 10-19 by Race EthnicityRace/Ethnicity Percentage of

Eligible Uninsured Adolescents

Total Number

Hispanic 34.9% 1,464,000White (Non-Hispanic) 40.3% 1,691,000Black (Non-Hispanic) 15.5% 649,000Asian (Non-Hispanic) 4.3% 178,000Hawaiian/ Pacific Islander (Non-Hispanic) .2% 7,000American Indian/ Alaskan Native (Non-Hispanic) 1.8% 76,000Multiracial (Non-Hispanic) 3% 126,000Total US 10-19 Population 10.1% 4,192,000

Uninsured Adolescents, 2011

United States Eligible Uninsured* Ages 10-19 by Poverty Level Poverty Level Percentage of Eligible Uninsured Total Number

≤ 138% of Federal Poverty Level 52.6% 2,203,000139% to 400% of the Federal Poverty Level 40.2% 1,685,000>400% of the Federal Poverty Level 7.3% 304,000Total US 10-19 Population 10.1% 4,192,000

*Eligible uninsured means non-elderly uninsured legal residents (i.e., U.S. citizens and legal immigrants). Source: ASPE tabulations from CY 2011 American Community Survey, adjusted to exclude estimated undocumented persons.

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Number of Eligible Uninsured by State, 2011

*Eligible uninsured means non-elderly uninsured legal residents (i.e., U.S. citizens and legal immigrants).Source: ASPE tabulations from CY 2011 American Community Survey, adjusted to exclude estimated undocumented persons.

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Key Provisions of the Affordable Care Act Relevant to Adolescents

Provisions In EffectMedicaid/ CHIP Maintenance of pre-Affordable Care Act Medicaid and CHIP eligibility levels for children younger than 19 March 23, 2010 through September 30, 2019

Expanded Medicaid eligibility to 133 percent of Federal Poverty Guidelines for children ages 6-18 January 1, 2014

Required Medicaid continued coverage for some current and former children in foster care ages 25 and younger

January 1, 2014

Private Insurance Recommended preventive services with no deductible or co-pay Plan years beginning on or after September 23,

2010Women’s preventive services with no deductible or co-pay August 1, 201216

Prohibition on pre-existing conditions Plan years beginning on or after September 23, 2010 (under 19); January 1, 2014 (all ages)

Expansion of dependent coverage (19-25) under parent’s health insurance Plan years beginning on or after September 23, 2010

Guaranteed issue of health insurance regardless of applicant’s health status or other factors Plan years beginning on or after January 1, 2014

Essential Health Benefits Coverage of pediatric services, including dental and vision, to age 19 Beginning on or after January 1, 2014

Mental health and substance use coverage, with federal parity requirements January 1, 2014

Prohibition of lifetime limits on coverage on essential health benefits Plan years beginning on or after September 23, 2010

Prohibition of annual limits on coverage of essential health benefits Plan years beginning on or after January 1, 2014

Health Insurance 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

[1] Other than Grandfathered Plans.[2] Other than grandfathered individual market policies.[3] Other than for grandfathered plans, which may be subject to pre-ACA guaranteed issue requirements.[4] Non-grandfathered insurance plans in the individual and small group markets for plan or policy years beginning on or after January 1, 2014.[5] The complete prohibition on annual limits applies to all group health plans and insurance plans in the group health market for plan years beginning on or after January 1, 2014. Restrictions on annual limits on essential health benefits apply for group health plans and insurance plans in the group health market for plan years beginning on or after September 23, 2010.

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Marketplace Navigators School Based Health Centers Teen Pregnancy Prevention and Pregnancy

Assistance Child Obesity Prevention Maternal, Infant, and Early Childhood Home Visiting Health Center Expansion

Other Relevant Affordable Care Act Initiatives

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http://cciio.cms.gov/programs/marketreforms/

Includes information on: Coverage for Young Adults FAQs on ACA Implementation

– including coverage of preventive services

Student Health Plans In-Person Assistance including

Fact sheet on Helping Consumers apply and Enroll: http://cciio.cms.gov/programs/exchanges/assistance.html

Center for Consumer Information and Oversight (CCIIO)

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ASPE – Assistant Secretary for Planning & Evaluation Issue Briefs on ACA Impact including one on young adults and Adolescents: http://www.aspe.hhs.gov/

HHS: Asst. Sec for Planning and Evaluation

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Acknowledgements: Laura Skopec at ASPE and Trina Anglin at HRSA for the use of some of their slides on Affordable Care Act and federal resources.

Contact information:Wilma M. Robinson, PhD, MPH Office of Adolescent HealthUS Department of Health and Human Services1101 Wootton Parkway, Suite 700Rockville, MD 20852Wilma.Robinson@hhs.gov240-276-8610 (office)

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www.hhs.gov/ash/oah/ Follow Us on Twitter

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For More Information

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