National Academies Report Charts Pathway to Better Health Coverage for Adolescents

Sustaining investments in the health of children as they enter their second decade of life is sound public policy, according to a new report by the National Academies of Sciences, Engineering, and Medicine (NASEM).  Not only is adolescence — the developmental period roughly from the age of 10 to 24 — a time of immense vulnerability, it is also a critical time of life full of great opportunity.

Research shows that despite adolescents making up one-quarter of the U.S. population, many face an array of barriers when trying to access developmentally-appropriate and culturally-responsive health care, particularly racial and ethnic minority adolescents. Many advocates know that access to health coverage and physical and behavioral health services are vital for adolescents, both in the here-and-now for their well-being today, but also to set them on a path of wellness and good health for a lifetime. However, many of the health issues adolescents face are intersectional in nature and fueled by social and structural inequalities, such as poverty, racism, and other forms of discrimination, that require systems-level policy change to improve the conditions for adolescents to flourish.

The NASEM report, The Promise of Adolescence: Realizing Opportunity for All Youth, offers concrete recommendations for maximizing the opportunity adolescence presents. It offers a blueprint for creating an adolescent-friendly health system, including recommendations for strengthening financing of health care services for adolescents, such as insurance coverage for uninsured or underinsured populations.

The report offers four recommended adjustments within Medicaid to increase health insurance access for adolescents:

  1. Expand Medicaid within the states that have not yet done so.
  2. Increase Medicaid reimbursement rates for pediatric health services to be on par with those for Medicare.
  3. Allow for equitable reimbursement for comprehensive health services, including psychosocial, behavioral health, dental, optical, and nutrition services.
  4. Eliminate the five-year eligibility restriction on the use of Medicaid for lawfully residing immigrant adolescents, opening up health insurance access to adolescents from immigrant families.

As noted in our seventh installment of The Future of Children’s Health Coverage series, How Medicaid and CHIP Can Support Student Success through Schools, adolescents are less likely to be enrolled in Medicaid/CHIP, even if they are eligible, and receive fewer child/adolescent health and wellness check-ups than younger children.

“Too many adolescents are being left behind at this critical stage of development because their families, schools, and neighborhoods lack the resources they need to overcome adversity and flourish,” said Richard Bonnie, director of the Institute of Law, Psychiatry, and Public Policy at the University of Virginia and chair of the NASEM committee that wrote the report.

According to the report, adolescence is emerging as a second “critical window of opportunity” following the first 1000 days of life, “for positive, life-altering development.” Due to the increased malleability of adolescent brains during this period of life and the resilient nature of adolescents, many marked disparities in adolescent health and educational outcomes can be overcome.

With the growing mental and emotional health crisis among adolescents in our country, it is no surprise that the NASEM consensus report points to the need for appropriate financial investments in high-quality, culturally responsive, integrated physical and behavioral health services for adolescents.

In the eyes of child and family health advocates, the recommendations outlined in this NASEM report are an important step in the right direction to identifying clear policy options that can strengthen the financing of adolescent health care services. Exactly how big of a step will largely depend on how much we galvanize the support of policymakers to be champions for children in their second decade of life.

We hope the blueprint  in this report offered by the adolescent health experts convened by NASEM is just the beginning of a fruitful and much-needed focus on the need to “close the opportunity gap for adolescents in our country.” We will continue to do our part and keep pressing toward achieving the goal of better health coverage for all adolescents.