Eligibility and enrollment of adolescents in Medicaid and SCHIP: recent progress, current challenges

To examine the effect of recent federal and state policy changes on adolescents' eligibility and enrollment in Medicaid and the State Children's Health Insurance Program (SCHIP).

By analyzing relevant provisions in federal and state laws, approved state plans and amendments, annual reports and evaluations, and enrollment data provided by states, this article explores the extent to which states have taken full advantage of opportunities to expand Medicaid and SCHIP eligibility for adolescents.

Between March 1997 and September 2001, states made significant progress toward expanding Medicaid and SCHIP coverage for adolescents. During that time, the number of states that provided Medicaid coverage to all poor adolescents aged younger than 19 years doubled, most states eliminated the disparities that previously existed in Medicaid eligibility levels for younger children and adolescents, and virtually every state raised the income level at which adolescents are eligible for public coverage in either Medicaid or SCHIP. These changes resulted in an increase in the number of adolescents who are enrolled in Medicaid and SCHIP. Nevertheless, many states implemented other policies that create barriers to adolescents' eligibility and enrollment.

Despite recent expansions of public insurance eligibility, millions of adolescents remain uninsured. Much work remains to address eligibility gaps and to ensure that eligible adolescents are actually enrolled and use services. The current political and economic environment threatens to undermine the ability of adolescents to access services through these important programs.