What Healthcare Rights Does a Minor Have?
In 1996, Congress passed the Health Insurance Portability and Accountability Act (HIPAA), a groundbreaking piece of legislation that was initially designed to ensure individuals maintained insurance coverage when transitioning between jobs.
Since then, different regulations and guidelines have been added to HIPAA. Today, it’s most commonly known for the protection it offers in regards to patient privacy and confidentiality. While the rules and regulations that HIPAA offers adults are relatively cut and dry, the lines become blurry when applying the law to unemancipated minors.
Steven A. Shapiro, DO, chair of the Pediatrics Department at Abington - Jefferson Health, has been a practicing pediatrician since well before the enactment of HIPAA. We spoke with him to gain some insight into some common questions regarding HIPAA rights for minors.
Q: A hot-button topic of the last few years has been vaccines, with some parents opting not to vaccinate their children. Do teens have any say in the vaccinations they receive?
Dr. Shapiro: The guardians’ rules and wishes are the ones we have to follow in these circumstances. So, if a minor wants to get a certain vaccine, but the guardian says no, we stick to what the guardian says.
Q: One would imagine that these situations can be filled with tension. How do you suggest that teens navigate these conversations?
Dr. Shapiro: These situations can cause real tension in a home environment. Aside from the issue of the actual vaccine, the stress that it puts on the family relationship poses a secondary issue. It’s painful for a kid to say to his parents, “I want something that you don't want for me.” The best path for both parents and teens is to have an open conversation about it, with your doctor playing a role.
Q: The HIPAA laws specifically call out a distinction between an emancipated minor and an unemancipated minor. What is the difference?
Dr. Shapiro: In most states, a child is considered to be unemancipated until the age of 18. This is where a parent or legal guardian takes responsibility for the care of the child, and as such, is empowered to make decisions for them.
An emancipated minor functions more or less as an adult in society, and has the ability to make medical decisions for themselves, including getting vaccinations. There are a handful of ways that someone becomes emancipated, including joining the military or becoming pregnant. However, being emancipated is an enormous responsibility to take on, and is not something that should be thought about as an easy choice.
Q: So, what rights does a minor have in regards to their health care?
Dr. Shapiro: These rights vary greatly on a state-by-state basis, but generally, minors are allowed to consent for things such as substance abuse treatment, birth control and mental health care. Additionally, consent is presumed in emergency situations where a parent or guardian cannot be reached promptly, and a child’s life would be endangered if treatment was delayed.