Reproductive health services for adolescents under the State Children's Health Insurance Program

Context: The federal government enacted the State Children's Health Insuran ce Program (CHIP) in 1997 to provide insurance coverage to uninsured, low-i ncome children up to age 19. Individual states' decisions when designing th eir CHIP efforts will in large part determine the extent to which the progr am will help the nation's nearly three million low-income uninsured adolesc ents get needed reproductive health services. Methods: CHIP administrators in all states and the District of Columbia wer e sent a survey concerning reproductive health services for adolescents age d 13-18 provided under their state's CHIP effort. The questionnaire asked a bout services covered, information provided to adolescents, confidentiality , outreach and enrollment activities, managed care and performance measures . Results: Of the 46 respondents to the survey, 29 states and the District of Columbia included a Medicaid component to their CHIP effort and 28 states included a state-designed component. Overall, states provided relatively co mprehensive coverage of reproductive health services, with all 58 CHIP prog rams covering routine gynecologic care, screening for sexually transmitted diseases and pregnancy testing. Fifty-four covered the full range of the mo st commonly used prescription contraceptive methods, although only 43 cover ed emergency contraception. Twenty of 58 CHIP programs required that adoles cents be provided with information about coverage for the full range of rep roductive health services, and 18 required that information be provided abo ut accessing care. Seventeen programs reported guarantees of confidentialit y before and after receipt of reproductive health care. In 26 programs, enr ollees in managed care were guaranteed access to contraceptive services thr ough out-of-network providers. Twenty-six states and the District of Columb ia reported targeting outreach activities specifically to adolescents, and 41 states and the District of Columbia stated that they provide outreach ma terials at middle schools, high schools and community-based organizations s erving teenagers. Conclusions: Despite their nearly comprehensive coverage of reproductive he alth services, programs were inconsistent in guaranteeing the information, confidentiality and flexibility in choosing providers that is critical to a dolescents' ability to access care. In addition, many states failed to crea tively use strategies to target uninsured adolescents for enrollment, altho ugh new initiatives are under way to correct this problem.