Access to care for youth with special health care needs in the transition to adulthood.
OBJECTIVE
To describe access to care and identify factors associated with access for low-income young adults who aged out of a public program for children with special health care needs (CSHCN).


METHODS
This was a cross-sectional survey of graduates of the Title V CSHCN program in one California county. Subjects were 77 graduates (55% female) aged 21-24 years with ongoing health care needs. Measures of access to care included having the following: a regular source of care for the main health condition; all needed care since turning 21 years of age; any delayed or forgone care in the past 6 months; health insurance; and continual insurance since turning age 21. Individuals lacking any one access measure were defined as experiencing an adverse transition event.


RESULTS
Of the subjects, 24% lacked a usual source of health care, 27% had gone without some needed health care since turning 21, and 39% had delayed needed care. Although 10% of respondents were uninsured at the time of the survey; 40% had a gap in insurance coverage since turning age 21. Overall, 65% reported at least one adverse transition event affecting access to care. Factors associated with experiencing no adverse transition event were receiving Supplemental Security Income (SSI, p = .007), having received special education services (p = .003), and having been born with the main health condition (p = .013).


CONCLUSIONS
Insurance gaps and delayed care are prevalent among these low-income young adults despite ongoing health problems. Greater transition support might improve access by linking them with a usual source of care, identifying insurance options, and encouraging regular use of care.
Department of Pediatrics, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90024, USA. dlotstein@mednet.ucla.edu
Debra S
DS
Lotstein
Moira
M
Inkelas
Ron D
RD
Hays
Neal
N
Halfon
Robert
R
Brook
D000293:Adolescent; D000328:Adult; D002140:California; D003430:Cross-Sectional Studies; D003625:Data Collection; D006233:Persons with Disabilities; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D011203:Poverty