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Uninsured teens in your care may be eligible for free or low-cost insurance, including coverage for reproductive health services, provided through your state-administered Children’s Health Insurance Program (SCHIP). According to a just-published analysis, however, state programs are inconsistent in guaranteeing the kinds of information, confidentiality, and flexibility in choosing providers that teens need to access such care.1
Most SCHIP programs are covering a nearly complete range of reproductive health care services and contraceptive drugs and devices, but some key deficiencies exist, points out analysis co-author Rachel Benson Gold, assistant director for policy analysis of the Washington, DC, bureau of the Alan Guttmacher Institute (AGI). At the time of the nationwide survey:
Family planners can serve as advocates by reviewing the design of their state CHIP coverage and identifying the gaps, says Claire Brindis, DrPH, professor of pediatrics and health policy in the Division of Adolescent Medicine and the Institute for Health Policy Studies at the University of California at San Francisco. Brindis co-authored a 1999 report that analyzed strategies tested in 12 states to use the SCHIP program to improve health care.2
"SCHIP represents an unprecedented opportunity for states to expand health insurance for children of all ages, but particularly the underserved population of adolescents," Brindis states.
Passed by Congress in 1997, the SCHIP program targets children up to age 19 whose families earn too much to qualify for Medicaid but cannot afford private health insurance. With nearly $40 billion in federal funds available to them over 10 years, the states are charged with establishing SCHIP programs, which may enroll children under age 19 in families with incomes up to 200% of the federal poverty level.3
States are allowed to design their SCHIP programs in one of three ways: by expanding Medicaid programs, creating or expanding a state-designed program not based on Medicaid, or using a combination of the two programs.3
It takes a teen-oriented message to reach adolescents with information about SCHIP programs, says Brindis. Outreach materials targeted to teens and their parents and use of adolescents to spread the message have been shown to be effective. Simplified application and enrollment procedures also aid in ease of enrollment.
Brindis points to an effort in Escambia County, AL, where a local pediatrician enlisted seven of her adolescent patients for SCHIP outreach efforts targeting teens in their county. The young counselors were trained to help identify other adolescents and their families in need of health insurance. Their efforts were highly effective: In one local hospital, the percentage of children and youth coming in without insurance dropped from 25% to 11%.2
Groups such as the Washington, DC-based American College of Obstetricians and Gynecolo-gists (ACOG) and the New York City-based Planned Parenthood Federation of America have asked members to advocate for the extension of adolescent reproductive health coverage in their states and actively participate in outreach efforts to enhance teen access to health care. Since about 41% of SCHIP-eligible children use a doctor’s office as their regular source of care, OB/GYN gynecologists are well positioned to assist with SCHIP recruitment efforts, says ACOG.4
While it is important to enroll qualified teens into SCHIP, equal efforts must be made to educate them on available services, particularly when it comes to reproductive health care, says Brindis. According to the AGI analysis, only about half the programs surveyed provided teens with information, even about whether contraceptive services were covered, and less than half of the programs were clear on coverage and accessing care for the full range of reproductive health services.1
Also look at what kind of adaptations have been made to your state’s SCHIP program so that those who are enrolled can have access to appropriate care, says Brindis.
"We found no states really planned for identifying adolescent-friendly providers, so that kids could really have a chance to find those providers who would be more teen-friendly," she says.
The AGI analysis also found that many programs provided a limited degree of confidentiality. Many teens may delay or shun reproductive health services if high levels of confidentiality are not maintained.
States should establish procedures to ensure confidentiality for adolescent health care, to work with health plans and providers to increase awareness of each state’s confidentiality law, and to educate adolescents about the confidentiality protections available to them, says Brindis. There are concerns that current confidentiality laws will be dismantled, Brindis states. While the laws have not been perfect, they have worked for many adolescents, she notes.
"We need to be thinking about how we can help balance the rights of parents with the rights of teen-agers, [for those] parents who say, I want my kid to tell me.’ There are many kids who do talk to their parents," says Brindis. "But we need to be really helpful to those kids who don’t have that type of relationship."
1. Gold RB, Sonfield A. Reproductive health services for adolescents under the State Children’s Health Insurance Program. Fam Plann Perspect 2001; 33:81-87.
2. Brindis CD, VanLandeghem K, Kirkpatrick R, et al. Adolescents and the State Children’s Health Insurance Program (CHIP): Healthy Options for Meeting the Needs of Adolescents. Washington, DC, and San Francisco, CA: Association of Maternal and Child Health Programs, University of California, San Francisco, Policy Information and Analysis Center for Middle Childhood and Adolescence and National Adolescent Health Information Center; 1999.
3. Gold RB. Adolescent care standards provide guidance for state CHIP programs. Guttmacher Report on Public Policy 2000; 3:5-8.
4. American College of Obstetricians and Gynecologists. Help get the word out: More children and adolescents eligible for health insurance. ACOG Today 1999; May/June:7.