1. 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

2.  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 Overview

3.  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 Why Focus on Adolescents?

4. 4 Uninsured Adolescents, 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. 5 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.

6. 6 Key Provisions of the Affordable Care Act Relevant to Adolescents ProvisionsIn Effect Medicaid/ CHIP Maintenance of pre-Affordable Care Act Medicaid and CHIP eligibility levels for children younger than 19March 23, 2010 through September 30, 2019 Expanded Medicaid eligibility to 133 percent of Federal Poverty Guidelines for children ages 6-18January 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-payPlan years beginning on or after September 23, 2010 Women’s preventive services with no deductible or co-payAugust 1, 2012 16 Prohibition on pre-existing conditionsPlan 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 insurancePlan years beginning on or after September 23, 2010 Guaranteed issue of health insurance regardless of applicant’s health status or other factorsPlan years beginning on or after January 1, 2014 Essential Health Benefits Coverage of pediatric services, including dental and vision, to age 19Beginning on or after January 1, 2014 Mental health and substance use coverage, with federal parity requirementsJanuary 1, 2014 Prohibition of lifetime limits on coverage on essential health benefitsPlan years beginning on or after September 23, 2010 Prohibition of annual limits on coverage of essential health benefitsPlan 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] [1] Other than Grandfathered Plans. [2] [2] Other than grandfathered individual market policies. [3] [3] Other than for grandfathered plans, which may be subject to pre-ACA guaranteed issue requirements. [4] [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] [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.

7.  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 Other Relevant Affordable Care Act Initiatives

8.  http://cciio.cms.gov/program s/marketreforms/ 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 http://cciio.cms.gov/programs/ exchanges/assistance.html 8 Center for Consumer Information and Oversight (CCIIO)

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

10. 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

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