Affordable Care Act Provisions for Adolescents: Insights and Impact

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 1

Overview 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 2

Why Focus on Adolescents? 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. 3

Uninsured Adolescents, 2011 United States Eligible Uninsured* Ages 10-19 by Race Ethnicity Race/Ethnicity Percentage of Eligible Uninsured Adolescents 34.9% 40.3% 15.5% 4.3% .2% 1.8% 3% 10.1% Total Number Hispanic White (Non-Hispanic) Black (Non-Hispanic) Asian (Non-Hispanic) Hawaiian/ Pacific Islander (Non-Hispanic) American Indian/ Alaskan Native (Non-Hispanic) Multiracial (Non-Hispanic) Total US 10-19 Population 1,464,000 1,691,000 649,000 178,000 7,000 76,000 126,000 4,192,000 United States Eligible Uninsured* Ages 10-19 by Poverty Level Percentage of Eligible Uninsured Poverty Level Total Number 138% of Federal Poverty Level 139% to 400% of the Federal Poverty Level >400% of the Federal Poverty Level Total US 10-19 Population 52.6% 40.2% 7.3% 10.1% 2,203,000 1,685,000 304,000 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. 4

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. 5

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 Private Insurance Recommended preventive services with no deductible or co-pay January 1, 2014 Plan years beginning on or after September 23, 2010 August 1, 201216 Plan years beginning on or after September 23, 2010 (under 19); January 1, 2014 (all ages) Women s preventive services with no deductible or co-pay Prohibition on pre-existing conditions 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 Plan years beginning on or after January 1, 2014 Prohibition of annual limits on coverage of essential health benefits 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. 6

Other Relevant Affordable Care Act Initiatives 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 7

Center for Consumer Information and Oversight (CCIIO) http://cciio.cms.gov/program s/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 8

HHS: Asst. Sec for Planning and Evaluation ASPE Assistant Secretary for Planning & Evaluation Issue Briefs on ACA Impact including one on young adults and Adolescents: http://www.aspe.hhs.gov/ 9

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) 10

For More Information 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 11 11