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PEDIATRICS Vol. 110 No. 6 December 2002, pp. 1328-1335

Access to Health Care: Health Insurance Considerations for Young Adults With Special Health Care Needs/Disabilities

Patience H. White, MD

From the Children’s National Medical Center, Washington, DC

--> Youth with special health care needs/disabilities want what all youth in America want: independence, health, friends, and jobs. Yet, between 19 and 23 years of age (depending on the state), youth with special health care needs/disabilities often find little availability of health insurance or health providers that were an essential part of why they survived and now are looking to participate in adult society. This article reviews the complex system of health insurance options that young adults with special health care needs/disabilities face as they move from pediatric to adult health insurance systems. Yet because of a maze of different eligibility criteria, many of these options are not available to young adults with special health care needs, and they are left with out health insurance. Similarly, the issues surrounding health provider reimbursement often leave the young adult with special health care needs without health care professionals who can manage their complex health conditions as they transition into adulthood. In conclusion, this article outlines what steps could be taken by associations and the health policy, advocacy, and governmental communities to improve the situation.

Key Words: access • health insurance • Medicaid • Medicare • transition

Abbreviations: NCHS, National Center for Health Statistics • SCHIP, State Children’s Health Insurance Program • SSI, Supplemental Security Income • HIV, human immunodeficiency virus • CMS, Center for Medicare and Medicaid Services • OASDI, Old Age, Survivors, and Disability Insurance • HIPAA, Health Insurance Portability and Accountability Act • COBRA, Consolidated Omnibus Budget Reconciliation Act • CPT, Current Procedural Terminology

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Received for publication Jul 2, 2002; Accepted Aug 26, 2002.

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