Why aren't teenagers taking advantage of no-cost insurance?

Aug 28, 2013

A teen in the Turn the Corner fitness program and an instructor at The Corner health center in Ypsilanti. The Corner works to deliver preventative health services to adolescents and tries to sign them up for government sponsored insurance.
A teen in the Turn the Corner fitness program and an instructor at The Corner health center in Ypsilanti. The Corner works to deliver preventative health services to adolescents and tries to sign them up for government sponsored insurance.
Credit Sarah Alvarez

Earlier this year, Jacquise Purifoy had a problem many people are familiar with. Purifoy is an attorney, but she was between jobs and tangled in health insurance red tape, so she and her daughter went without health insurance for about half a year.

Purifoy admits she may have "buried her head in the sand," a little bit. She also says a combination of pride and a desire not to take up scarce government resources kept her from seeing if she could qualify her 17-year old daughter Jasmine for Medicaid or MIchild.

Purifoy thinks she probably could have qualified for one of these state and federally funded insurance programs that come at no-cost to the beneficiary. But instead she made sure to take her daughter for a full range of preventative doctor visits before her insurance ran out, and then just hoped there wouldn't be an emergency before she was insured again. 

Then she got a call from Jasmine, who has asthma and a heart condition. 

"I knew it was urgent. She said she just couldn't move and with every step she took she felt she was going to pass out," Purifoy recounts. "I knew I didn't have health insurance, but it was really life or death."

Purifoy was relieved to discover, after a visit to a children's hospital and around $1,800 in tests, that there was nothing wrong with Jasmine's heart; she was having muscular trouble as a result of her asthma. Purifoy is paying off the bill and says she knows it could have been much worse, and she also says she won’t let her daughter’s insurance lapse again.

Most teenagers are dependent on their parents to keep their insurance up to date. Minors can't sign up for Medicaid and MIchild independently, and for what seems like a combination of reasons, there are large numbers of adolescents and teenagers eligible for government insurance who aren't being signed up.

Providers say they've long noticed the trend. Kathy Fessler is Medical Director at The Corner Health Center, an adolescent health clinic in Ypsilanti, MI. The Corner, as it's known, is able to file Medicaid and MIchild applications for their clients, like they recently did for a 19-year old young woman the day I was there.

Despite the efforts of the Corner staff and others in the public health community, Medicaid numbers for teenagers in Washtenaw County (where the clinic is located) paint a picture of a disturbing trend. 

The number of babies enrolled in Medicaid in the county was just over 1,500 as of July, the most recent month for which the state has data.

But once those infants start growing up, that number drops dramatically. By the time they're 15 years old, about half of them will still be enrolled in the program.  After that, the numbers fall through the floor. There are less than 60 18-year olds enrolled in the program. The number of 19- and 20-year olds enrolled? 11. 

It's the same story in counties all across the state, although small counties tend to do better keeping children enrolled in the program as they age. 

Nobody really knows why this is happening, Lori Partin, a patient advocate at The Corner, has a theory. "When they get to a certain age it doesn't become as important to them or maybe to their parent or guardian to keep the insurance up," she says. "They seem to be healthy."

That may be part of the phenomenon. Partin and other health care professionals also think it's likely it has something to do with the fact parents don't feel teenagers need to visit the doctor in the same way younger children do. Well-child visits and vaccination schedules keep kids going to the doctor until about age 10 or 11.

After that, the Corner's Fessler says peditricians often don't see children for yearly check ups unless they are involved in sports and need a doctor to conduct a physical exam before they are cleared to participate.When kids go to the doctor infrequently, there are fewer opportunities to catch a lapse in insurance. That can happen easily for kids on Medicaid in particular as program requirements demand children be re-enrolled every year.

Some providers think another barrier could be that parents might not realize government programs can insure kids sometimes until age 21. Or, they might not know MIchild income limits are much higher than Medicaid. The program covers children whose parents make up to 200% of the poverty line, or about $44,000 a year for a family of four.

The federal Center for Medicare and Medicaid Services hopes to boost teenage Medicaid enrollment in Washtenaw County with a grant to the Washtenaw County Health Plan worth about $665,000. Part of the grant will be used to try out a new strategy for targeting eligible teens through their school district.

While the reason young people are not getting signed up for government health insurance may continue to be murky, Fessler says the consequences are anything but opaque.

She points out that the American Academy of Pediatrics recommends adolescents continue to get a yearly check-up until age 18. She talks about the counseling and preventative care available around issues of high risk behavior involving safety, substance abuse, and of course sex. And she talks about the patients who could have gotten a booster vaccination for Pertussis, commonly known as whooping cough. (The disease is undergoing a resurgence partly because it is spreading among teenagers.)

Fessler wants all teens eligible for government insurance signed up to avoid things like whooping cough, but also just so they get more regular treatment in a place that isn't the Emergency Room. 

*This story was informed by the Public Insight Network