Re: Expanding Access to Health Care Services and Work-Based Experiences for Youth 

with Chronic Health Conditions and Disabilities

Dear Colleague:

July 26, 2015 marks the 25th anniversary of the Americans with Disabilities Act (ADA). 

The ADA promotes full inclusion of individuals with disabilities to participate in all 

aspects of society, including work, education, and transportation. While much progress 

has been made, much remains to be accomplished. That is why the Department of 

Labor’s Office of Disability Employment Policy (ODEP) and the Maternal and Child 

Health Bureau (MCHB) in the Department of Health and Human Service’s Health 

Resources and Services Administration are joining together to emphasize the importance 

of health care transition to have success in other transition domains, and to highlight 

opportunitiesto integrate health care transition and career planning available to youth 

with chronic health conditions, and other disabilitiesafforded through the Affordable Care 

Act (ACA) and the Workforce Innovation and Opportunity Act (WIOA). 

Interdependence Between Health and Wellness and Employment

All youth need to be connected to programs, services, activities, and supports that prepare 

them for meaningful post-secondary school options, enhance their ability to manage their 

physical, mental, and emotional well-being, and develop life-readiness skills to make 

informed choices. This is especially true for youth with disabilities, including those with 

chronic health conditions.

The World Health Organization defines health as "complete physical, mental and social 

well-being and not merely the absence of disease or infirmity." Because the ability to 

manage one’s health is critical to going to school, learning, and transitioning into 

employment, ODEP commissioned a study on health care transition. Despite the growing 

recognition of the importance of healthin the overall transition from school to work and 

independent living, the study revealed a number of challenges exist for youth with 

disabilities and their families. Included among these are low expectations, lack of time, 
inadequate payment and training for health care providers, systems with distinct and 

disparate outcomes and goals, and lack of coordinated transition planning.The Healthy 

Transitions: A Pathway to Employment for Youth with Chronic Health Conditions and 

Other Disabilities Policy Brief is available at: 

http://www.dol.gov/odep/pdf/2013ODEPHealthyReport.pdf.

This must change. Unmet health care needs can jeopardize education, employment, and 

other aspects of the lives of youth with disabilities in ways that their peers without 

disabilities may not experience. Having access to economic and social opportunities –

such as employment – is one of the key social determinants of health. In addition to 

financial benefits, including access to employer-based health insurance, work contributes 

to overall health by helping youth feel better about themselves and their prospects and 

assist them in maintaining physical and mental fitness. In addition, youth who learn to 

manage their healthcare are simultaneously developing important transitional skills such 

as problem solving, self-advocacy, informed decision-making, and communication that 

can enhance their job readiness and career development and exploration. 

Therefore as we celebrate the 25th anniversary of the ADA, we urge professionals within 

each transition domain, including education, health, community living, employment, 

housing, and transportation, to strive to work together more collaboratively to explore 

how transition in the different realms can be better linked to maximize youth success. 

Affordable Care Act and Workforce Innovation and Opportunity Act Transform 

Health Care Transition Planning and Career Transition Planning

A number of provisions in the Affordable Care Act (ACA) are already transforming

access to health insurance coverage for youth and young adults with disabilities by 

ensuring that they have quality, affordable health insurance choices, regardless of how 

their lives change, particularly as young adults frequently changeor hold part-time or 

temporary jobs. Through the elimination of pre-existing condition exclusions, expansions 

of dependent coverage to age 26, Medicaid eligibility expansions, and subsidized private 

plans, new coverage opportunities are available. Young adults, either by themselves or 

with their parents, can confidently purchase insurance coverage that includes essential 

health benefits, includingmental health and substance use disorders services, prescription 

drugs, rehabilitative services and devices, preventive and wellness services, and chronic 

disease management. Moreover, if needed, theycan receive subsidies for this 

coverage.With expanded income eligibility requirements for Medicaid and increased 

employer-sponsored options, more young adults with disabilities are able to start or 

continue working while maintaining their insurance coverage. Furthermore, Medicaid 

agencies have a new patient-centered medical homes (PCMH) option for individuals with 

chronic conditions designed to strengthen the physician-patient relationship. Once the 

individual decides who is on the physician-led care team, the team is responsible for 
coordinating all of the individual’s health care needs, and arranges for care with other 

qualified physicians and support services to make sure team members work together to 

meet the individual’s needs in an integrated fashion while lowering health care costs. 

TheWorkforce Innovation and Opportunity Act (WIOA), which supersedes the 

Workforce Investment Act of 1998, presents an extraordinary opportunity to revitalize 

the workforce system. It provides state and local areas the flexibility to collaborate across 

systems, including workforce, education, post-secondary education, public welfare, and 

economic development in an effort to better address the employment and skills needs of 

current employees, jobseekers, and employers. To support youth and young adults, 

including those with disabilities in achieving their career goals, WIOA authorizes the 

provision of career planning for individuals. Career planning is a client-centered 

approach designed to develop comprehensive programs and to coordinate supportive 

services, including child care, transportation, and mental health services, during program 

participation and after job placement. In addition, WIOA also mandates that 20 percent of 

youth formula funding be spent on work-based experiences, which have been shown to 

be the strongest predictor of adult employment success among youth with disabilities. 

The Training and Employment Guidance Letter (TEGL) No. 19-14 on the Vision for 

the Workforce System and the Initial Implementation of the Workforce Innovation 

and Opportunity Act is available at: 

http://wdr.doleta.gov/directives/attach/TEGL/TEGL_19-14_Acc.pdf. 

The TEGL No. 23-14 on Workforce Innovation and Opportunity Act on Youth 

Program Transition is available at: 

http://wdr.doleta.gov/directives/attach/TEGL/TEGL_23-14_Acc.pdf.

Alliance on Health Care Transition Planning and Career Transition Planning

ODEP, the Youth Transitions Collaborative (the Collaborative), and MCHB’s Center for 

Health Care Transition Improvement (Got Transition) established a collaborative 

relationship in April 2014 to strengthen linkages between health care transition planning 

and career transition planning for youth and young adults, including young veterans, with 

chronic health conditions and disabilities. To accomplish its goal, the Alliance is 

leveraging members’ networks to disseminate its career planning and health care 

transition resources. 

The Six Core Elements of Health Care Transition, which define the basic components 

of health care transition support for youth and young adults, is available at: 

http://www.gottransition.org/resources/index.cfm. 

TheTransition QuickGuide: Take Charge of Planning and Managing Your Own 

Health and Career Goals, which includes information and resources about health 

insurance coverage, self-care, health care transition, decision-making, and career 

planning and management, is available at: 

http://www.dol.gov/odep/pdf/HealthCareCareerTransitionQuickGuide.pdf. 
Information about the Alliance is available 

at:http://www.dol.gov/odep/alliances/hscf2.htm.

To learn more about health care transition planning and career transition planning see the 

following:

Got Transition http://www.gottransition.org/

National Collaborative on Workforce and Disability for Youth http://www.ncwdyouth.info/

Disability.Gov https://www.disability.gov/

The 2020 Federal Youth Transition Plan: A Federal Interagency 

Strategyhttp://findyouthinfo.gov/feature-article/federal-partners-in-transition

Healthy People.Gov http://www.healthypeople.gov/

For additional information on ODEP and MCHB, take a look at: 

http://www.dol.gov/odep/ and http://mchb.hrsa.gov/.

Sincerely,

Jennifer Sheehy Michael C. Lu M.D., M.S., M.P.H.

Acting Assistant Secretary Associate Administrator

Office of Disability Employment Policy Maternal and Child Health 

U.S. Department of Labor Health Resources and Services 

Administration

U.S. Department of Health and Human 

Services