insured: eligibility rates are 65 percent, 62 percent, and 67 percent among adolescents aged 10–13, 14–16, and 17–18, respectively, compared with 20 and 12 percent, respectively, among those aged 19–21 and 22–24.

Enrollment in public coverage appears to improve access to care relative to being uninsured for adolescents aged 18 and under (Dick et al., 2004; Kenney, 2007; Klein et al., 2007). In the three studies referenced here and previously described dental studies, enrollment in public coverage increased the likelihood of having a usual source of care and of receiving preventive care. In addition, Klein and colleagues (2007) found that the extent to which confidential care and preventive counseling were provided to adolescents increased following enrollment in public coverage. Both they and Kenney (2007) also found that enrollment in public coverage reduced unmet health care needs among adolescents.

Together, Medicaid and SCHIP could address nearly two-thirds of the uninsured problem among those aged 10–18 and 84 percent of the problem among those in low-income families in this age group (defined as having an income below 200 percent of the federal poverty level). The bulk of the remaining low-income uninsured adolescents aged 10–18 who do not qualify for Medicaid or SCHIP coverage are legal immigrants who are ineligible for coverage because they have not been in the country for more than 5 years; are undocumented immigrants and qualify only for emergency Medicaid, which is very limited in scope; live in the nine states that have income thresholds below 200 percent of the federal poverty level; or do not live in selected California counties or states that have targeted insurance coverage initiatives with state or local funds. Access to employer-sponsored coverage is also very limited among noncitizen children (Ku and Matani, 2001; Ku and Waidmann, 2003; Schur and Feldman, 2001). Therefore, reducing uninsurance among noncitizen adolescents will likely require expanding Medicaid and SCHIP coverage to more immigrant children.

More than 80 percent of all low-income parents say they would enroll their uninsured adolescents aged 13–17 in Medicaid/SCHIP if told the adolescents were eligible (see Figure 6-2). Therefore, policies aimed at increasing awareness of Medicaid and SCHIP among families whose adolescents could qualify for public coverage hold promise for being successful (Kenney, Haley, and Tebay, 2004). However, just 43 percent of parents of low-income uninsured adolescents believed their adolescents were eligible for coverage, a much lower proportion than found for younger children (Kenney, Haley, and Tebay, 2004). Moreover, 40 percent believed that the Medicaid and SCHIP application processes were easy, a figure again lower than that for parents of younger children (Kenney, Haley, and Tebay, 2004). Thus, increasing participation in Medicaid/SCHIP among adolescents may require targeted outreach and enrollment efforts aimed specifically at families with adolescents.

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