Office of Adolescent Health  Adolescents and the Affordable Care Act

Wilma  Robinson, PhD, MPH

Deputy Director

Office of Adolescent Health

US Department of Health and Human Services

OJJDP Coordinating Council

November 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

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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. 

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Why Focus on Adolescents?

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| United States Eligible Uninsured* Ages 10-19 by Race Ethnicity |                                               |              |
|----------------------------------------------------------------|-----------------------------------------------|--------------|
| Race/Ethnicity                                                 | Percentage of Eligible Uninsured  Adolescents | Total Number |
| Hispanic                                                       | 34.9%                                         | 1,464,000    |
| White (Non-Hispanic)                                           | 40.3%                                         | 1,691,000    |
| Black (Non-Hispanic)                                           | 15.5%                                         | 649,000      |
| Asian (Non-Hispanic)                                           | 4.3%                                          | 178,000      |
| Hawaiian/ Pacific Islander  (Non-Hispanic)                     | .2%                                           | 7,000        |
| American Indian/ Alaskan Native  (Non-Hispanic)                | 1.8%                                          | 76,000       |
| Multiracial  (Non-Hispanic)                                    | 3%                                            | 126,000      |
| Total US 10-19 Population                                      | 10.1%                                         | 4,192,000    |

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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%                            | 2,203,000    |
| 139% to 400% of the Federal Poverty Level                     | 40.2%                            | 1,685,000    |
| >400% of the Federal Poverty Level                         | 7.3%                             | 304,000      |
| Total 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 Effect                                                                                  |
|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|--------------------------------------------------------------------------------------------|
| Medicaid/ 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, 2010                                        |
| Women’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

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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

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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/

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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 Health

US Department of Health and Human Services

1101 Wootton Parkway, Suite 700

Rockville, MD 20852

Wilma.Robinson@hhs.gov

240-276-8610 (office)

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	  Use OAH’s Award Winning Website

www.hhs.gov/ash/oah/

	  Follow Us on Twitter

@TeenHealthGov

	  Sign up for E-Updates 

	  Watch us on YouTube

www.youtube.com/teenhealthgov

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For More Information

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