ASSOCIATION OF MATER NAL & CHILD HEALTH P ROGRAMS

January 2016 Fact Sheet Health Reform & Adolescent Health

Introduction

The AMCHP Role Adolescence is an important time to promote optimal health and to prevent many of the behaviors that can place youth at-risk for health problems. Although many adolescents (10 to 17 years of age) have health insurance, AMCHP supports state maternal a significant proportion (10 percent) lack health care coverage, and the and child health (MCH) proportion of adolescents with private insurance is declining. Among young programs and provides national adults (18 to 26 years old), nearly one-third are uninsured, which leadership on issues affecting represents more than one in five of all uninsured individuals. The Patient women and children. We work Protection and Affordable Care Act (ACA) presents a significant with partners at the national, state opportunity for state MCH programs and their partners to improve the health care delivery system overall, promote adolescent health and ensure and local levels to promote that adolescents have access to quality health care. women’s health; provide and promote family-centered, Adolescent Health Provisions in the Patient Protection community-based, coordinated and Affordable Care Act care for women and children; and facilitate the development of The ACA contains numerous provisions that impact health programs and community-based systems of services for all children and youth. Additionally, the law includes several services for women, children and prevention-oriented provisions, including investments in teen pregnancy their families. prevention. The scope and impact of many of these provisions will unfold over the coming years as federal rules and regulations are promulgated and states and communities continue to implement them. Highlights of key The AMCHP National Center for ACA provisions that affect adolescents are set out below. Health Reform Implementation provides state MCH leaders and Coverage and Benefits their partners with the information, tools and resources to optimize Extend Coverage for Young Adults on Parent’s Plans Requires that health insurance plans, which offer dependent coverage, the opportunities presented by the make that coverage available for young adults up to age 26, even if the Patient Protection and Affordable young adult no longer lives with his or her parents, is not a dependent on a Care Act (ACA) for improving parent’s tax return, is no longer a student, regardless of the young adult’s services, systems and health marital status. ACA and federal regulations also provide important tax outcomes for MCH populations. credits to families by excluding the value of any employer-provided health coverage for an employee’s child from the employee’s income through the end of the taxable year in which the youth turns 26.

Health Reform & Adolescent Health

Preventive Care Medicaid. The ACA created a mandatory eligibility Eliminates cost-sharing (co-pays or co-insurance) category for former foster care youth. Youth who for services recommended by the U.S. Preventive have aged out of foster care and were receiving Services Task Force (USPSTF) and immunizations Medicaid while in foster care can remain on recommended by the Centers for Disease Control Medicaid and receive the full scope of benefits until and Prevention (CDC). Eliminates cost-sharing for they turn 26. All states must comply with this evidence-informed preventive care and screenings requirement, regardless of their state Medicaid recommended for infants, children and expansion status. Currently, former foster care adolescents, in the comprehensive Bright Futures youth can receive extended Medicaid coverage guidelines supported by the Health Resources and only in the state where they aged out of the foster Services Administration (HRSA). Preventive care system. State legislative action is required for services for adolescents with no cost-sharing former foster care youth to receive Medicaid include, but are not limited to, depression benefits after moving to a different state. screening, behavioral assessments, and screening and counseling for sexually transmitted infections. Children’s Health Insurance Program (CHIP) Screening for these preventive services can occur Requires states to maintain, at a minimum, the during an annual adolescent well visit, beginning at income eligibility levels for CHIP and Medicaid that age 11, as recommended by the Bright Futures existed in their state when the ACA was passed in guidelines. March 2010. States are allowed to expand eligibility, but must maintain the March 2010 Essential Health Benefits eligibility criteria through September 30, 2019. Requires that all qualified health plans sold in the From fiscal year 2014 to 2019, states will receive a Health Insurance Marketplace (Marketplace), and 23 percentage point increase in the federal CHIP new health insurance plans sold outside the match rate, subject to a cap of 100 percent. CHIP- Marketplace, include several essential health eligible children who cannot enroll in CHIP due to benefits as part of a comprehensive benefits federal allotment caps will be eligible for tax credits package. These benefits include outpatient care; in the state exchange. Although the ACA has emergency services; hospitalization; maternity and authorized the program through 2019, the Medicare newborn care; mental health and substance use Access and CHIP Reauthorization Act (MACRA) of disorder services, including behavioral health 2015 extended the program through September 30, treatment; prescription drugs; rehabilitative and 2017. To fund CHIP past September 2017, habilitative services and devices; laboratory legislative action is required. services; preventive and wellness services; chronic Expanded Access to Care disease management; and pediatric services, including oral and vision care. Community Health Center Expansion

Creates a Community Health Center Fund that Expansions in Medicaid Coverage and Services provides $11 billion in mandatory funding over five Creates a mandatory Medicaid eligibility category years for the Community Health Center program, for all low-income individuals to gain coverage (the the National Health Service Corps, and 2012 Supreme Court ruling in National Federation construction and renovation of community health of Independent Business vs Sebelius made the centers. In August 2015, HHS awarded an expansion voluntary for states). As of January additional $169 million to 266 community health 2016, 32 states, including the District of Columbia, centers across the country for the delivery of have expanded Medicaid eligibility to all individuals comprehensive and quality health care in earning incomes at or below 138 percent of the communities that are in need. Federal Poverty Level (FPL). The ACA extends

Early and Periodic Screening, Diagnosis, and School-Based Health Center Expansion Treatment (EPSDT) services to all children and Provided $200 million in ACA funding from 2010– youth up to age 21 who are gaining coverage under 2013 to create new school-based health center

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sites, support expansion of services and improve reform in primary care, including patient- delivery of care. As a result, an estimated 2,400 centered medical home models for high- schools and 2 million students benefitted from the need individuals and medical homes that expansion program. These centers continue to address women’s unique health care needs. serve youth and adolescents.  State Grants to Promote Community Health Teams that Support the Patient- Medical Homes and Care Coordination Centered Medical Home (Sec. 3502): Provides new investments to promote medical Authorizes funding for community-based home models in Medicaid, CHIP and private interdisciplinary teams to provide support insurance plans. The investments focus on care services to primary care practices, including coordination and health promotion, transitional OB/GYN practices. care, patient and family support, and referrals to  Community-Based Collaborative Care community services. Medical homes are directed Network Program (Sec. 10333): Authorizes by a designated provider (physician, clinical group funding to support consortiums of health practice, rural clinic, community health center, care providers in coordinating and community mental health center, pediatricians, integrating health care services for gynecologists and/or obstetricians, or by a team low-income uninsured and underinsured that would include physicians and other allied populations. health professionals, such as nurse care  Pediatric Accountable Care Organization coordinators, social workers and behavioral health Demonstration Project (Sec. practitioners. These homes must provide 2706): Authorizes funding to participating comprehensive case management, care states to recognize pediatric medical coordination and health promotion, transitional providers as an accountable care care, patient and family support, referral to organization (ACO) for the purposes of community services and use health information receiving incentive payments. technology, as appropriate. The ACA contains several provisions to promote and advance the For more information on medical homes, please medical home model at the state and local level. navigate to the AMCHP fact sheet here. Key provisions include but are not limited to the following: Prevention and Public Health

 Health Homes in Medicaid (Sec. 2703) Teen Pregnancy Prevention Authorizes up to $25 million in planning Provides several investments related to teen grants to states to develop a state plan pregnancy prevention. The Personal Responsibility amendment to provide health homes for Education Program (PREP) provided $75 million Medicaid enrollees with chronic conditions. per year from FY 2010 through FY 2014, funded by  Center for Medicare & Medicaid the ACA and administered by the Administration for Innovation (Sec. 3021): Establishes a Children and Families (ACF). PREP grants are Center for Medicare & Medicaid Innovation awarded to states, including the District of within the Centers for Medicare & Medicaid Columbia and territories, for programs that educate Services (CMS), with a mandatory adolescents on both abstinence and contraception appropriation of $10 billion over a10 year to prevent teenage pregnancy and sexually implementation period (FY 2011–FY 2019). transmitted infections, including HIV/AIDS. These An additional $10 billion was appropriated programs replicate evidence-based teen pregnancy for each subsequent 10-year period. The prevention strategies and incorporate other topics Center will “test innovative payment and on adult responsibility, such as maintaining healthy service delivery models for Medicare, relationships, developing healthy attitudes and Medicaid, and CHIP programs.” Models values on growth and development, increasing should promote payment and practice healthy parent-child communication and enhancing

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financial literacy. In 2015, Congress extended the The Title V Role in Promoting program through FY 2017 at its current annual Adolescent Health funding level of $75 million.

Pregnancy Assistance Fund The ACA represents a significant opportunity to Provides $25 million in ACA funding annually for 10 improve access to health care for adolescents and years (FY 2010–FY 2019) as a competitive grant young adults. Yet, more work remains to be done. and is administered by the Office of Adolescent As ACA provisions have been implemented over Health. The competitive grants are funded to states the past five years, much of the responsibility for and Tribal entities to provide expectant and the architecture of health reform and its related parenting teens, women, fathers, and their families program investments resides with states and with support and services to help them complete communities. As states proceed with implementing high school or postsecondary degrees and gain the ACA, state MCH programs and their partners access to health care, child care, family housing must ensure that the law includes a focus on and other critical supports. The funds are also used adolescents and young adults by implementing to improve services for pregnant women who are multiple strategies including the following: victims of domestic violence, sexual violence, sexual assault and stalking. In some states, the Ensure that the implementation of coverage Title V program has received this funding to provisions includes a focus on the needs of administer programs. adolescents. Benefits packages need to include prevention, screening, diagnosis and treatment Maternal, Infant, and Early Childhood Home services in the array of physical, mental and Visiting (MIECHV) Programs behavioral health issues and conditions that Creates a new section in the 2010 Title V MCH concern adolescents. Services need to be available Services Block Grant to provide $1.5 billion over in a wide range of settings where adolescents five years to states, tribes and territories to develop spend time, such as school and community-based and implement one or more evidence-based health centers, family planning clinics and Maternal, Infant, and Early Childhood Visitation physicians’ offices. It is especially important to model(s). Model options would be targeted at ensure access to care for special populations of reducing infant and maternal mortality and its youth, including youth in foster care, in child welfare related causes by producing improvements in and in the juvenile justice systems, homeless prenatal, maternal and newborn health; child health youth, low-income young adults with special health and development; parenting skills; school care needs, and pregnant or parenting teens. readiness; juvenile delinquency; and family Families with pregnant or parenting teens who are economic self-sufficiency. The Medicare Access covered on their parent’s insurance may have and CHIP Reauthorization Act (MACRA) of 2015 difficulty understanding the complex coverage reauthorized funding for the MIECHV program at options for the dependent’s child. The rules vary for $400 million per annum through March 2017. covering dependents of dependents based on the health plan the parents have. In addition, when Childhood Obesity Demonstration Project youth and adolescents are on their parent’s Provided ACA funding to four grantees to carry out insurance, issues can arise in terms of handling a Childhood Obesity Research Demonstration privacy and confidentiality matters in the provision project (CORD), “which aims to improve children’s of health services. MCH programs can stay abreast nutrition and physical activity behaviors in the of these concerns and educate adolescents and places where they live, learn and play.” The funding their families on how to best optimize the health period ended in September 2015, and the projects care experience for this population. are currently in the evaluation phase. Coordinate federal, state and local efforts in support of adolescent health. States can maximize the opportunities presented by the ACA

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for adolescents by coordinating new and enhanced  American Academy of Pediatrics: programs and services among the key public and Recommendations for Preventive Pediatric private agencies that serve adolescents and their Health Care families. State MCH programs administer numerous public programs [e.g., school health,  Maternal and Child Health Bureau, HRSA: Women’s, Infants and Children (WIC) and teen Title V Maternal and Child Health Services pregnancy prevention], which are critical, natural Block Grant access points for building and strengthening integrated service delivery systems for adolescents  National Adolescent and Young Adult Health and their families. These programs have clear roles Information Center: The Affordable Care Act: to play in core areas of the service delivery system, Implications for Adolescents and Young Adults which includes outreach and enrollment, care coordination and medical homes. Moreover, they  National MCH Workforce Development play a key leadership role in administering several Center: The Affordable Care Act: A Working provisions related to teen pregnancy prevention. Guide for Professionals State MCH programs work with partners, such as Title X Family Planning programs, to support  Office of Adolescent Health, HHS: educational efforts ranging from teen pregnancy Adolescent Preventive Services prevention summits and conferences, to parent workshops, and media and social marketing Acknowledgment campaigns. State MCH programs often support state adolescent health coordinators who work to improve the health of adolescents within their This project was supported through cooperative states and territories. Finally, many state MCH agreement #UC4MC28035 from the Maternal and programs provide funding to school-based and Child Health Bureau, Health Resources and school-linked health centers. Services Administration, U.S. Department of Health and Human Services. Continue to build and strengthen partnerships. Adolescents and their families are served by AMCHP Contact Information numerous agencies and organizations at the state and local level. As such, partnerships between the This fact sheet is part of a series of AMCHP tools, key public and private systems and programs that documents and resources on implementation of the serve adolescents are essential to maximizing Affordable Care Act and its impact on maternal and investments and minimizing duplication of effort. child health populations. For more information, State MCH programs have existing partnerships please visit the National Center for Health Reform with state and local health agencies, school-based Implementation. All AMCHP staff can be reached health centers, youth-serving organizations and via phone at (202) 775-0436. community-based health and social services agencies. These partnerships will continue to be critical as the ACA, particularly those provisions addressing teen pregnancy prevention, is implemented.

Resources

 Administration for Children and Families, HHS: PREP Pregnancy Assistance Fund and Abstinence Education Funds

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