August 4, 2010 

Jim Mayhew 

Office of Consumer Information and Insurance Oversight 

U.S. Department of Health and Human Services 

P.O. Box 8016 

Baltimore, MD 21244-1850 

Attention: OCIIO-4150-IFC 

 

Dear Mr. Mayhew: 

On behalf of First Focus, I appreciate the opportunity to comment on the Interim Final Rule 

(IFR) for Group Health Plans and Health Insurance Issuers Relating to Dependent Coverage of 

Children to Age 26 under the Patient Protection and Affordable Care Act (PPACA) (45 CFR Parts 

144, 146, and 147). First Focus is a bipartisan children’s advocacy organization dedicated to 

making children and families a priority in federal policy and budget decisions. Our core mission is 

to ensure that all of our nation’s children are able to get the services they need and deserve. 

First and foremost, we applaud the provisions of the IFR which will ensure coverage for millions 

of young Americans up to the age of 26. As you are no doubt aware, approximately 30 percent of 

young adults are currently uninsured, representing more than one in five of uninsured Americans. 

This rate is higher than any other age group. Many young adults lose coverage as they transition 

into the job market, because they are often employed in entry-level jobs, part-time jobs, or jobs in 

small businesses that do not offer an employer-sponsored health coverage option. By allowing 

young adults to stay on their parents’ health plans until age 26, this regulation is a critical step 

toward ensuring that all of our nation’s young adults have access to affordable health coverage. 

First Focus offers its full support for the provisions of the IFR which clarify that health plans may 

not exclude dependents under age 26 from coverage based on their tax dependent status, residence 

with parents, marital status, or student status. In addition, we are pleased that health plans may not 

apply additional costs or surcharges to coverage for the young adult population. These provisions 

are essential to ensure that coverage is not only available for young adults, but as important, 

affordable so that families are able to actually access this option. 

We are concerned, however, that the IFR does not restrict a plan’s flexibility to define who is a 

child for purposes of determining which children are eligible for dependent coverage. In fact, the 

IFR specifies that plans may define a “dependent” for purposes of eligibility for coverage based on 

the relationship between the child and the plan participant. The IFR also specifies that plans are 

not required to cover the children of young adults receiving dependent coverage, stating 

specifically that coverage is not required for a plan participant’s grandchildren. Consequently, these 

provisions allow plans to exclude coverage for young adults who are stepchildren, adopted 
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children, young adults who are grandchildren in kinship care with their grandparents, and young 

adults who are in kinship care with their aunts, uncles, or other family members. 

While it is clear that other parts of the IFR will greatly increase access to health insurance coverage 

for young adults, we are concerned that as currently drafted the IFR excludes some of our most 

vulnerable young people from much-needed coverage. We urge you to revise the IFR to ensure 

that the regulation includes a basic definition of dependent that also requires an offer of coverage 

for stepchildren, adopted children and children in kinship care arrangements. 

In addition, we also request that the Administration clarify the provisions of the IFR that permit 

so-called grandfathered health plans not to offer dependent coverage for young adults who are 

eligible to enroll in employer-sponsored coverage. Specifically, we are concerned that as currently 

drafted young adults who have entered the workforce but are subject to a waiting period for 

employer-sponsored coverage may not be deemed as eligible to continue on their parents’ health 

plan. Because it is not uncommon for a young person entering the workforce to be subject to a 

waiting period before an offer of coverage goes into effect, we urge the Administration to clarify 

that a young adult continues to be eligible for the dependent coverage option until the point at 

which their employer-sponsored coverage becomes effective. 

We applaud the Administration for all of its efforts to ensure improve access to care for everyone 

in America, including our children. We are grateful for the opportunity to comment on this 

important policy for our nation’s young people. We would be happy to provide any additional 

information you may require. 

Sincerely, 

Bruce Lesley 

President