lonelyteenThis January marks a major milestone in US history, the initiation of the Affordable Care Act (ACA). This Act has been put in place in an effort to help bring healthcare coverage to millions of uninsured Americans and has been the topic of much debate. There is much nuance in the details of the Act and it’s challenging to understand, but I wanted to highlight a special population that may continue to remain uninsured despite the implementation of the ACA: vulnerable teens and young adults.

There are 3 specific populations of teens and young adults who are likely to remain uninsured: homeless youth, older teens in foster care, and youth in juvenile detention. Unfortunately, these teens and young adults are at high risk for poor health, mental illness, poverty, and lack of positive adult role models. They also have higher proportions of under-represented minorities and LGBTQ youth. This special group of teens, in my opinion, has the greatest need for health care coverage.

Before the ACA, teens in poverty (living below 100% of the federal poverty level) and teens in foster care were eligible for Medicaid up to age 18. Some states have enacted laws that allow teens to remain in foster care past age 18 which has been associated with better educational attainment, employment, and other good outcomes. Under the ACA, states that opt for Medicaid expansion could allow these teens and young adults who remain in foster care past age 18 to have coverage through age 26. The downside: states must opt to have this coverage and must also have opted to allow for extended time in foster care. Unfortunately, thousands of teens age out of foster care each year. These teens are unlikely to transition into high paying jobs with private insurance, yet they may make more than 133% of the FPL which is the new cutoff for Medicaid eligibility. This leaves thousands of youth who could fall through the cracks and be uninsured.

Homeless teens and young adults are also unlikely to benefit from the ACA. These youth are often cutoff from parents so won’t benefit from their insurance coverage and face barriers to being able to access Medicaid. Two major barriers, the need for a permanent address and cumbersome paperwork, are not going to change with the ACA. While the expansion of health care coverage through age 26 could definitely be a benefit, the reality of being homeless, lacking resources including access to a case worker to help complete forms, and a permanent address means this population will likely continue to go without healthcare.

The final group, youth in juvenile detention, face similar obstacles to homeless and foster care youth. Currently, youth lose their Medicaid coverage when incarcerated and have to re-apply upon release. Some states have opted for suspended coverage until the youth is released which is much easier than termination of coverage because they don’t have to complete the cumbersome paperwork to re-apply. Unfortunately, youth in juvenile detention are often living in poverty. Under the ACA, the option for coverage if living on 133% or less of the FPL is Medicaid. These youth face the same challenge of needing to reside in a state that has opted in for Medicaid expansion in order to continue to have medical coverage past 18.

Whether you are or are not the parent of one of these vulnerable teens, awareness of this lack of coverage is important. There are over 1 million youth arrested each year, over 23,000 youth aged out of foster care in 2012, and estimated 1.7 million homeless youth. This constitutes a large number of young people who will continue to face the challenge of inadequate access to health care.

Resources for more information:

The National Alliance to Advance Adolescent Health

The National Adolescent & Young Adult Health Information Center

To enroll in health coverage through the ACA: HealthCare.gov