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Office of Adolescent Health
Adolescents and the Affordable Care Act
Wilma Robinson, PhD, MPHDeputy DirectorOffice of Adolescent HealthUS Department of Health and Human Services
OJJDP Coordinating CouncilNovember 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
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.
Why Focus on Adolescents?
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United States Eligible Uninsured* Ages 10-19 by Race EthnicityRace/Ethnicity Percentage of
Eligible Uninsured Adolescents
Total Number
Hispanic 34.9% 1,464,000White (Non-Hispanic) 40.3% 1,691,000Black (Non-Hispanic) 15.5% 649,000Asian (Non-Hispanic) 4.3% 178,000Hawaiian/ Pacific Islander (Non-Hispanic) .2% 7,000American Indian/ Alaskan Native (Non-Hispanic) 1.8% 76,000Multiracial (Non-Hispanic) 3% 126,000Total US 10-19 Population 10.1% 4,192,000
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% 2,203,000139% to 400% of the Federal Poverty Level 40.2% 1,685,000>400% of the Federal Poverty Level 7.3% 304,000Total 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 EffectMedicaid/ 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,
2010Women’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
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
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/
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 HealthUS Department of Health and Human Services1101 Wootton Parkway, Suite 700Rockville, MD [email protected] (office)
Use OAH’s Award Winning Websitewww.hhs.gov/ash/oah/
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For More Information
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