Improving the Implementation of State Children's Health Insurance Programs for Adolescents Report of an Invitational Conference Sponsored by the American Academy of Pediatrics, Section on Adolescent Health*, September 26–27, 1999

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Abstract
* Abbreviations: SCHIP = : State Children's Health Insurance Program • AAP = : American Academy of Pediatrics • AIDS = : acquired immunodeficiency syndrome • FPL = : federal poverty level • EPSDT = : Early and Periodic Screening, Diagnosis, and Treatment The enactment of the State Children's Health Insurance Program (SCHIP)‡ in 1997 and Medicaid eligibility expansions over the past decade have enormous implications for all children, and particularly for adolescents. While adolescents continue to lack insurance at a higher rate than most other age groups in the United States, large numbers of adolescents are eligible for, but not enrolled in, Medicaid and SCHIP. Even for those who are enrolled, additional barriers impede them from fully benefiting from the coverage they have. American Academy of Pediatrics (AAP) projections for the year 2000 suggest that 1 in 6 adolescents 13 through 18 years old will be without insurance, despite SCHIP and Medicaid expansions. Since 1991, adolescent uninsurance rates have averaged 16.5%. Many more adolescents are underinsured, with health insurance that does not include preventive care, mental health and substance abuse treatment, medications, or dental care. The importance of public programs such as Medicaid has grown in recent years, as the decline in the percentage of 10- through 18-year-old adolescents with private health insurance coverage has been offset by the increase in the proportion covered by public programs.1 Uninsurance rates among adolescents are higher than those of most age groups in the United States. Yet recent year 2000 projections from the AAP suggest that nearly 2.4 million adolescents 13 through 18 years old are eligible for, but not enrolled in, Medicaid and SCHIP programs. If states were to raise their eligibility limits for SCHIP to the limits allowed by federal law, an additional 65 000 adolescents would be eligible. Together these programs could cover almost two thirds of the adolescents who lack insurance.2 Insurance coverage through Medicaid and SCHIP is of critical importance because it can provide the majority of uninsured adolescents access to health care they urgently need. This can be …