View From Washington

Teen Pregnancy Prevention and Adolescent Health

By Brent Ewig, MHS
Director of Public Policy & Government Affairs, AMCHP     

Since passage of the Patient Protection and Affordable Care Act (PPACA) we have been engaged in the great scramble to help our members better understand what is in the law and when specific provisions take effect. We have also been engaged in numerous conversations about what the law means for the future of state Title V MCH programs, and how we will best support state MCH leaders’ roles in the multitude of implementation opportunities and challenges.  

Suffice to say, everyone has more questions than answers at this point but as HHS begins to put out additional guidance we are confident those answers will emerge! We are centralizing the most pertinent resources and information for state MCH programs on our health reform resources page, and encourage you to check often for the latest information. 

The PPACA did include a handful of provisions addressing this issue’s theme of teen pregnancy prevention and adolescent health. Primary among them is the guarantee of health insurance coverage for all American adolescents and their families through the Medicaid expansion or the state exchanges that will go into effect in 2014. As states begin to plan for this coverage expansion we will be providing assistance, support and advocacy with a focus on assuring that the essential benefits package design takes into account the unique needs of adolescents. In particular, the requirement for insurers to cover services recommended in the Bright Futures guideline will be of critical importance.  

More immediately, the single most targeted provision supporting teen pregnancy prevention in health reform is the creation of Personal Responsibility Education Program (PREP). This new section of Title V provides a mandatory appropriation of $75 million per year through FY 2014 for Personal Responsibility Education grants for programs to educate adolescents on both abstinence and contraception for prevention of teenage pregnancy and sexually transmitted infections, including HIV/AIDS. Funding is also available for 1) innovative teen pregnancy prevention strategies and services to high-risk, vulnerable, and culturally under-represented populations, 2) allotments to Indian tribes and tribal organizations, and 3) research and evaluation, training, and technical assistance. The bill also restores funding for abstinence education and appropriates $50 million per year through FY 2014. 

The PPACA also authorizes $50 million over four years to establish a new grant program to support construction and equipment for school-based health centers that provide health services to children and adolescents. The law also authorizes funding for school health center operations, but does not provide a mandatory appropriation so Congress will need to appropriate funding in the future – a prospect which will be difficult considering the current fiscal realities. 

Additionally, within the new Maternal, Infant, and Early Childhood Home Visiting Program there is a provision specifying that priority should be given to providing services to high risk populations which are defined to include “eligible families [with] pregnant women who have not attained age 21.” 

Finally, the bill authorizes and appropriates $25 million annually for 10 years (FY 2010-FY 2019) for a new pregnancy assistance fund, which requires the HHS Secretary (in collaboration with the Secretary of Education) to establish a competitive grant program to states to help pregnant and parenting teens and women. Grants are available to institutions of higher education, high schools and community service centers to provide support services as well as state’s attorneys general to increase public awareness and education. Institutions that receive grant funds will be required to identify public and private providers, establish programs with providers to meet the specified needs (housing, childcare, parenting education, post-partum counseling) of pregnant or parenting students, assist eligible persons in locating and obtaining appropriate services, and make necessary referrals for prenatal care and delivery, infant or foster care, or adoption. 

Opportunities for State Coordination of Investments

With each of these new investments comes an opportunity to conduct careful planning to assure coordination and integrations with existing state programs and efforts, as well as opportunities to strengthen partnerships with new federal partners. For example, both the new Personal Responsibility Education Program (PREP) and the continued Abstinence Education grants will be administered by the Administration for Children and Families (ACF). These are complimented by the new $110 million Teen Pregnancy Prevention Initiative (TPP) created by last year’s omnibus appropriations act and now administered by the new HHS Office of Adolescent Health (OAH).  

While the PREP evidence based grants and Abstinence Education grants will be administered through formula grants to states, the new TPP as well as the PREP innovative strategies funds are competitive grants open to a range of eligible public and private organizations. We therefore anticipate some potential for competition, confusion, fragmentation, and possible duplication with these different funding streams. We are therefore urging state MCH leaders to consider strategies to help key stakeholders understand the purposes of these related programs and continue seeking ways to coordinate investments to promote statewide implementation and integration of systems serving adolescents.  

Overall, we are promoting the message that Title V has a key role in implementing coordinated investments in adolescent health based on experience coordinating among federal, state and local entities in support of adolescent health; experience administering adolescent and sexual health programs; and a mandate to assure accountability for reducing teen pregnancy rates. We will continue this advocacy and share new program guidance as it is released.