Transition Services

Many states struggle with the challenge of supporting and funding the transition of youth with special health care needs (YSHCN) from pediatric to adult health care. Some of the burden of funding health care services for youth in transition has been alleviated by a provision of the Affordable Care Act, which allows parents with private health insurance that offers family and/or dependent coverage to enroll their young adult children in their plan until they turn 26. State Title V programs and Medicaid agencies often play an important role in connecting YSHCN to information, services, and other resources during the transition period to ensure continued access to, and financing for, needed care.

The Colorado Health and Human Services (HHS) office, and the national Got Transition/Center for Health Care Transition Improvement created a book for youth transitioning out of Medicaid. It includes information about agencies and organizations that can assist with transition and the resources they offer, including how to continue Medicaid coverage. Colorado Medicaid is also working with teens to create YouTube and VINE videos to make youth aware of how important it is to go to the doctor. [VINE is a smart phone application for Apple, Windows, & Android phones and is an easy way to make and share looping videos.] The videos include tips for talking with health providers, issues to talk about, and how to discuss health issues with parents, foster parents, or other adults in their lives. In Colorado, only about 24% of the adolescent population is seeing a doctor for well adolescent visits. The state’s goal is to stress the importance of well visits for this age group by having providers and practices show the videos in their offices and other places.

Connecticut Voices for Children, a research and advocacy organization, identified that retention of older children in Medicaid was a problem that could be solved with effective outreach to make sure consumers were aware of their options. As a result of these findings, the Connecticut Title V program partnered with Medicaid to address the issue and provided statewide technical assistance sessions for Title V-funded care coordinators. These two agencies also presented an information session to the Medical Home Advisory Council. These sessions provided information about the details of reenrolling older children and addressed variables such as family coverage if the teen is still in high school and expected to graduate before or after age 19. If a teen is expected to graduate after age 19, the family has to provide proof their child is still in school. In addition, the Connecticut Department of Public Health sent notifications about the requirement to maintain coverage through the Community Health Center (CHC) and School Based Health Center (SBHC) list serves. All transition meetings for older teens included a discussion regarding the potential need to reenroll in Medicaid. In addition, Medicaid simplified the paperwork to reenroll and distributed information to CHCs and SBHCs, asking those centers to distribute the information to teens and their parents. Medicaid also mailed information directly to consumers prior to aging out.

The Kentucky Commission for Children with Special Health Care Needs, the state Title V/CYSHCN program, supports the transition of children and youth with special health care needs through direct services, education, and collaboration. Staff works closely with young people and their families, providing care coordination and using a transition checklist to help them plan for the future and move from pediatric to adult health care, school to work, and from living at home to independent living. Staff talks to youth about health insurance options when they become an adult, the importance of having and maintaining health insurance, and helps them understand how insurance works.

Texas Medicaid has staff who are solely dedicated to helping with transition. The STAR Kids program requires that each of the Medicaid Managed Care Organizations (MCOs) have transition specialists on staff and begin the transition process when a client turns 15 years old.