Adolescent care standards and state CHIP efforts.(State Children's Health Insurance Program)

Although widely thought of as a health insurance program for younger children, the State Children's Health Insurance Program (CHIP) also has enormous potential to expand insurance coverage, including coverage of reproductive health guidance and services, to millions of uninsured teenagers. The extent to which CHIP meets this potential will largely be determined by the individual states, which have considerable discretion in designing their own efforts and benefit packages. For guidance in making critical coverage decisions, states can look to several comprehensive guidelines for adolescent health care, including reproductive health services, developed in recent years.

Congress established the State Children's Health Insurance Program (CHIP) in 1997 in response to data indicating that there were over 10 million uninsured children in the United States that year--including 2.7 million teenagers between the ages of 13 and 18 (1.3 million females and 1.4 million males). With nearly $40 billion in federal funds available to them over 10 years, the states are charged with establishing CHIP programs, which may enroll children under age 19 in families with incomes up to 200% of the federal poverty level. The Health Care Financing Administration (HCFA), the federal agency that administers CHIP, reports that two million children were enrolled nationwide as of September 30, 1999.

According to the federal CHIP statute, a state may design its CHIP program in one of three ways: by expanding its Medicaid program, by creating or expanding a state-designed program not based on Medicaid or by using a combination of the two approaches. A 1999 review by The Alan Guttmacher Institute (AGI) of the initial state plans submitted to HCFA found that 21 states and the District of Columbia had opted to expand their Medicaid program, 16 states were developing an entirely separate program, and 13 states intended to take a combination approach.

In the states choosing to expand their Medicaid program, CHIP enrollees are regular Medicaid enrollees; as such, they are entitled to the full range of Medicaid-covered services, including routine gynecologic examinations, Pap tests, diagnosis and treatment of sexually transmitted diseases (STDs) as well as family planning services and supplies. (The federal Medicaid statute specifically mandates coverage of family planning services for "minors who can be considered to be sexually active.")

In contrast, the states choosing to design programs of their own have wide latitude in crafting a benefit package. The CHIP statute itself requires coverage of only such basic services as physician and hospital care, laboratory and X-ray services, well-child care and immunizations. According to the AGI review, of the 29 approved state plans that had some state-designed component, 16 specifically indicated that family planning services and supplies would be covered, while most of the remaining plans indicated that the general category "prenatal care and pre-pregnancy family planning services" would be covered.

Teens' Reproductive Health Needs

Teens need a range of educational and medical services related to reproductive health. Half of all U.S. teens are sexually experienced. While sexual activity is rare among younger teens, it is common in the later teenage years; by age 19, over three-fourths of females and 85% of males have had intercourse. Yet, teens are less likely than older women to report consistent use of effective contraceptive methods. In addition, sexually active teens younger than 18 are less likely to use any method of contraception, compared with older women.