Medicaid; health insurance; adolescents; young adults


Health Services Research | Other Public Health | Public Health



Introduction: Churning on and off and/or experiencing coverage gaps is common among public health insurance recipients. Although the Affordable Care Act (ACA) provisions to extend parental coverage for adolescents transitioning to young adulthood on private insurance plans were implemented in 2010, no such protection was mandated for adolescents with public health insurance.

Methods: Oregon public health insurance enrollment and electronic health record data from community health centers were used to conduct a retrospective, observational cohort study of Oregon adolescents (17-19 years of age) with public coverage [January 1, 2011-December 31, 2013 (n=51,988)] to assess loss. Time-to-event methods determined the association of coverage loss with sociodemographic characteristics.

Results: Although adolescents are vulnerable to coverage loss as they age out of child public health insurance coverage, >35% of 19 year olds in this study kept their coverage for up to one year after their 19th birthday.

Conclusions: Our findings suggest that the support many community health centers offer to help their patients maintain insurance coverage may be having an impact, especially during this important transition period. Additional research to understand how these 19 year olds were able to keep coverage will provide recommendations for future adolescents as they transition to young adulthood.


This work was supported by the Agency for Healthcare Research and Quality grant number R01HS024270 and by the National Cancer Institute grant number R01CA1814520. This work was reviewed and approved by the Institutional Review Board at Oregon Health and Sciences University, registration numbers IRB00009862 and IRB00011858.