State CHIP programs vary in reproductive health services offered for adolescents
State CHIP programs vary in reproductive health services offered for adolescents
A survey conducted by the Alan Guttmacher Institute in New York City found that despite nearly comprehensive coverage of reproductive health services, state Children’s Health Insurance (CHIP) programs were inconsistent in guaranteeing the information, confidentiality, and flexibility in choosing providers that the organization thinks is critical to adolescents’ ability to access care.
Adam Sonfield, public policy associate at the institute, tells State Health Watch that when the federal government developed the CHIP program, it gave state governments flexibility to do what they wanted to do and address needs that were most important in their states.
While many states have better programs than they had before, in terms of reproductive health services for adolescents, Mr. Sonfield says, the survey found some deficiencies in the range of covered services and problems that could impede adolescents’ access to covered services.
Not all states cover ECs
The report says that only 43 of 58 Medicaid-based and state-designed CHIP programs reported coverage of emergency contraception. "This is a disappointing but unsurprising finding," the survey report says in the March/April 2001 issue of Family Planning Perspectives:
"Despite recent publicity campaigns, emergency contraception — high-dose regimens of oral contraceptives that can prevent pregnancy if taken within 72 hours of unprotected intercourse or known or suspected contraceptive failure — is still a relatively unknown method. Some policy-makers [and even providers] confuse it with the medical abortion drug mifepristone, and others insist that it is an abortifacient because it, like other hormonal contraceptive methods, may prevent implantation of a fertilized egg in the uterus."
The report also notes that medically necessary abortion is rarely covered, but this is as expected because the federal government will not help to pay for abortion in cases other than life endangerment, rape, or incest. States choosing to pay for medically necessary abortions must do so entirely with their own funds, and few states choose to do so even under their basic Medicaid programs, let alone for adolescents under CHIP, the report adds.
In addition to coverage gaps, Mr. Sonfield says, there are three serious problems that could adversely affect adolescents’ access to covered reproductive health services:
1. Only about half the programs provided information to adolescents, even about whether contraceptive services were covered, and only 18 of the 58 programs offered information about coverage and accessing care for the full range of reproductive health services.
"Particularly because of the sensitive nature of contraceptive, STD [sexually transmitted diseases], and similar services, adolescents need to be made fully aware of the extent of their coverage and need to be given such information directly," the report says.
2. According to the study, there is a lack of protections for adolescents’ confidentiality. Only 17 programs reported the maximum level of confidentiality both before and after the provision of care.
A larger number of programs required only a limited degree of confidentiality. That lack creates the potential for even accidental notification of a teenager’s parents — for example, through routine insurance billing practices of sending an explanation of benefits to the home — and can delay or dissuade a teen from seeking critical, sensitive care, and put a female at risk for unintended pregnancy, STDs, and future infertility.
3. Only a small number of programs allowed access to out-of-
network providers, even for contraceptive services and supplies, and much less for other reproductive health services.
"In fact, six Medicaid components did not provide enrollees the freedom to choose to obtain contraceptive services and supplies from a provider not affiliated with their managed care plan, despite a clear federal mandate that enrollees be able to do so.
"Freedom of choice was even less available under state-designated components, as would be expected because there is no comparable federal requirement," according to the report.
"While Medicaid managed care enrollees overwhelmingly seek contraceptive services from providers within their own managed care plans, the freedom-of-choice provisions in the overall Medicaid program have been important for providing access over the years to women who, for a variety of reasons, need to obtain care elsewhere. Because of the heightened importance of confidentiality to teenagers, this option is particularly critical for enrollees in all CHIP efforts," the report says.
Results valid three years later
Mr. Sonfield says that while data collection for this study is from 1999, he believes the results remain valid because states have been focusing on solving enrollment and outreach problems rather than on the services available for adolescents.
When information isn’t readily available, he says, it’s hard for adolescents to know where to go for care, especially when some insurers and some providers don’t cover or provide some services for various reasons.
"No one is looking to reopen CHIP, especially not just to address these concerns," he says, "and that may be a good thing because it could become very controversial. We think that states should look at what other states are doing and implement models they find that are working. Often they may be able to implement something that they just hadn’t thought of. The CHIP program was primarily designed for younger children. States could give some conscious thought to the issues that are pertinent to adolescents and adjust their programs accordingly."
[Contact Mr. Sonfield at (202) 296-4012, ext. 4223.]
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