Health Insurance Program policies to increase enrollment and retention of eligible but uninsured adolescents; and improve incentives for private health insurers to provide such coverage (e.g., by requiring school-based coverage and allowing nongroup policies tailored to adolescents). Note that while these options would increase insurance coverage among adolescents, broader health care reform efforts would be required to ensure universal coverage. A consequence of allowing more segmentation in nongroup health insurance policies across age groups could be increased costs for older adults if younger, healthier adults are removed from the risk pool. In addition, expanding access to and election of coverage among poor adolescents would be necessary to increase the rates of insured adolescents.

Recommendation 9: Federal and state policy makers should ensure that health insurance coverage for adolescents is sufficient in amount, duration, and scope to cover the health services they require. Such coverage should be accessible, acceptable, appropriate, effective, and equitable.

Public and private health plans, including self-insured plans, should consider several options for carrying out this recommendation. First, they could see that benefit packages cover at a minimum the following key services for adolescents: preventive screening and counseling, at least on an annual basis; case management; reproductive health care that includes screening, education, counseling, and treatment; assessment and treatment of mental health conditions, such as anxiety disorders and eating disorders, and of substance abuse disorders, including those comorbid with mental health conditions; and dental services that include prevention, restoration, and treatment. Second, they could ensure coverage for mental health and substance abuse services at primary or specialty care sites that provide integrated physical and mental health care, and require Medicaid to cover mental health rehabilitation services. Third, they could make certain that providers are reimbursed at reasonable, market-based rates for the adolescent health services they provide. Finally, they could ensure that out-of-pocket cost sharing (including mental health and other health services) is set at levels that do not discourage receipt of all needed services.

Research Agenda

Recommendation 10: Federal health agencies and private foundations should prepare a research agenda for improving adolescent health services that includes assessing existing service models, as well as developing new systems for providing services that are accessible, acceptable, appropriate, effective, and equitable.

Federal health agencies should consider a number of options for carry-

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