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MMR State Chart

The following chart, adapted from research conducted by The Alan Guttmacher Institute,126 represents minors' access to various forms of non-abortive medical services in the respective states, with exclusions and limitations notated in parenthesis (see key).127 This chart may be useful in considering statutory schemes for Massachusetts with the goal of expanding health care access for minors (or, alternatively, homeless minors). Since this chart reflects research conducted in July of 2000 by The Alan Guttmacher Institute, and that conducted in January, February, and March of 2002 by the Law Office, the authors encourage readers to seek current information in conjunction with utilizing this chart. The research was not aimed at examining whether the actual practice of health care in each state is consistent with, or diverges from, the common or statutory law as it is written. For that reason, this chart must be read with that consideration in mind. Finally, since the research was aimed at capturing specific material from state statutes or case law, and additional information located elsewhere may bear on the issue of minors' access to health care depending upon how the inquiry is framed, the authors encourage readers to consider additional sources of information.

Click here for the chart comparison of mature minor laws across the 50 states.

Of the 50 states and the District of Columbia analyzed, 49% allow minors some form of access to general medical care. Of these states, Oregon requires that the minor be at least 15 years of age, while South Carolina requires the minor to be at least 16 years of age. Seven states128 provide that the health care provider may notify the parents following the rendering of general health care services to the minor. Alabama and Pennsylvania require that the minor must be a high school graduate, married, pregnant, or a parent in order to give consent; Alaska allows the minor to consent if he is a parent; six states129 allow the minor to consent if she is married or a parent; six130 allow the minor to consent if she is a parent, married, or pregnant; and Nevada allows a minor general health care access if she is a parent, or if the provider believes the minor will suffer a probable health hazard if she is not treated. Six states131 allow surgical care under ``general health care'' services. Arkansas, Nevada, and New Hampshire require that the minor must be able to understand the nature and consequences of the medical or surgical treatment proposed. Four states132 allow minors health care access only when the parent ``is not immediately available.'' Finally, South Carolina allows minors of any age general health care access if the provider believes the services are necessary, with the exception that all minors at least 16 years of age may consent to all health care services with the exclusion of operations.

With respect to mental health care, 45% of the states allow minors some form of access. Of these states, California and Illinois require that the minor be at least 12 years of age; Florida and Washington require that the minor be at least 13 years of age; Michigan, Ohio, and Oregon require that the minor be at least 14 years of age; Colorado requires that the minor be at least 15 years of age; and five states133 require the minor be at least 16 years of age. In seven states134 the health care provider may inform the parents of the minor's mental health treatment. Again, South Carolina allows minors of any age mental health care access if the provider believes the services are necessary, and full access to such services if the minor is at least 16 years of age.

Ninety percent of the states allow minors to seek treatment for substance abuse. Of these states, eight135 require the minor be at least 12 years of age; Washington requires the minor to be at least 13 years of age; North Dakota and Oregon require the minor to be 14 years of age; and Mississippi requires that the minor be at least 15 years of age. In twenty136 of the 45 states allowing minors access to substance abuse treatment, the health care provider may notify the parents that the minor has or is seeking such treatment. Missouri and Montana provide for incidental surgical care with substance abuse treatment without parental consent. Massachusetts requires that a substance abuse diagnosis be made by two health care providers prior to treatment, and specifically excludes methadone treatment. Finally, South Carolina allows minors of any age mental health care access if the provider believes the services are necessary, and full access to such services if the minor is at least 16 years of age.

All of the states allow minors access to care for communicable diseases (which may or may not include HIV care). In five states,137 the minor must be at least 12 years of age to receive communicable disease treatment; while in five others,138 the minor must be at least 14 years of age. Eighteen139 of the 50 states140 that permit minors access to communicable disease treatment allow that the health care provider may inform the parents as to the minor's request for this form of health care. Nine141 of the states specifically allow the minor to consent to surgical care in connection with communicable disease treatment, while Hawaii specifically precludes surgical care incident to communicable diseases. The state of Iowa specifically calls for parental notification if the minor receives a position outcome on his or her HIV test. South Carolina allows minors of any age communicable disease care access if the provider believes the services are necessary, and full access to such services if the minor is at least 16 years of age.

With respect to contraceptive care, 65% of the states allow minors some form of access to these services. Delaware requires that the minor be at least 12 years of age, while Hawaii requires the minor be at least 14 years of age. Nine142 states allow for a health care provider to notify the minor's parents upon a request for contraceptive services. Illinois allows a minor to consent only if she is a parent; Maine and Mississippi allow consent when the minor is a parent or is married; and Colorado and Florida allow a minor to receive contraceptives if the minor is a parent, married, or pregnant. Hawaii excludes surgical care in connection with contraceptives, Oklahoma allows female minors to consent if they have ever been pregnant, and South Carolina allows minors of any age contraceptive care access if the provider believes the services are necessary, and full access to such services if the minor is at least 16 years of age. Finally, Florida and Maine provide that contraceptive care may only be provided if the minor is a parent or a provider believes that the minor will suffer a probable heath hazard if the services are withheld; Illinois allows for minors to access contraceptive care if the minor is a parent, or is referred by a doctor, clergy, or Planned Parenthood clinic; and Colorado and Mississippi allow access to contraceptive care by minors when the minor is a parent, or is referred by a doctor, clergy, family planning clinic, school of higher education, or state agency.

Lastly, 61% of the states make provision for some access to prenatal care for minors. Of these states, Delaware requires the minor to be at least 12 years of age, while Hawaii requires the minor to be at least 14 years of age. Eleven states143 allow the health care provider to inform the parents that services were or are being sought by the minor. Eleven states144 also specifically exclude abortive services under their prenatal care statutes, while ten include ``surgical care.''145 South Carolina allows minors of any age to consent to prenatal care if the provider believes the services are necessary, and full access to such services if the minor is at least 16 years of age. New Mexico limits prenatal care to pregnancy testing and diagnosis, while Hawaii excludes ``surgical care.''146 Illinois allows for minors to access prenatal care if the minor is a parent, or is referred by a doctor, clergy, or Planned Parenthood clinic, while Kansas provides that minors can obtain prenatal care if the parent is ``not available.''

In summary, a broad range of access is allowed to minors across the 50 states and District of Columbia examined, coupled with a wide range of restrictions and limitations. Communicable disease care is the most commonly provided-for health care item for which minors may give consent, followed by substance abuse, contraceptive care, prenatal care, general medical health, and mental health. Overall, the District of Columbia, and Virginia appear to provide the most access to specified health care issues with the least restriction to health care services for minors, by allowing minors to consent to mental health, substance abuse, communicable disease, contraceptive, and prenatal care and, in the case of Virginia, general health care if the parent is not ``immediately available.'' Alabama and South Carolina are also liberal in terms of allowing minors to consent to all forms of health care. However, in South Carolina, minors under the age of 16 must evidence to the health care provider that the services are necessary, while minors at least 16 years of age may consent to all health services, excluding operations.

Massachusetts presently provides for each form of health care herein considered, but general health care is restricted to minors who are parents, married, pregnant, in the armed forces, or living separate from their parents and managing their own finances; mental health care cannot be consented to before the age of 16; substance abuse treatment requires the diagnosis of two health care providers, and excludes methadone treatment and minors below the age of 12; and prenatal care of a minor younger than 12 years of age is unattainable on the minor's consent alone. The specific analysis of the consent statutes for the states of Alabama, Arizona, California, Michigan, Minnesota, and Washington are discussed further in the State Research section of this report.



Footnotes

...126
The Alan Guttmacher Institute, Minors and the Right to Consent to Health Care <www.agi-usa.org/pub/ib_minors_00.html> (last updated Jan. 24, 2002).
...127
According to The Alan Guttmacher Institute, it ``has periodically reviewed state laws pertaining to minor's authority to consent to medical care and to make other important decisions without their parents' knowledge or permission.'' In July of 2000, ``its review was expanded to also take into account state court decisions and attorneys general opinions that affect young people's access to confidential services.'' The information provided by The Alan Guttmacher Institute does not identify if the minor's access to a particular heath care service is provided by statute or common law, and it is unclear to what extent those researchers specifically considered the issue of the ``mature minor'' doctrine as it applies to access to the various forms of non-abortive health care presented here. The Law Office's research, utilizing research from The Alan Guttmacher Institute, was conducted during the months of January, February, and March of 2002, and captures statutes and case law in effect during that time. The Law Office was unable to verify all of the information contained in the research of The Alan Guttmacher Institute; however, spot verification did reveal some discrepancies (see, e.g., Minn. Stat. (14)4.34(1) (2002), which provides that a minor living apart from parents and managing his or her financial affairs can consent to mental health services), which may have resulted from changes in laws since the time of their research. Such discrepancies, when discovered, were corrected on this chart. Since the Law Office is focusing on the states of Arizona, Alabama, California, Michigan, Minnesota and Washington, each of those states was thoroughly verified with respect to the above-described health services, and the applicable statutes of those states are presented in Appendix B.
... states128
Kentucky, Louisiana, Maryland, Minnesota, Montana, Oklahoma and Oregon.
... states129
Delaware, Kentucky, Maryland, Minnesota, Missouri, and Nevada.
... six130
Illinois, Massachusetts, Montana, New Jersey, New York, and Oklahoma.
... states131
Illinois, Kansas, Louisiana, Missouri, Montana, and Oregon.
... states132
Kansas, North Carolina, South Dakota, and Virginia.
... states133
Kentucky, Maryland, Massachusetts, Montana, and Texas.
... states134
California, Colorado, Illinois, Kentucky, Maryland, New York, and Oregon.
... eight135
Arizona, California, Delaware, Illinois, Massachusetts, New Hampshire, Vermont, and Wisconsin.
... twenty136
California, Georgia, Hawaii, Illinois, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Missouri, Montana, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, Tennessee, and Texas.
...137
Alabama, California, Delaware, Illinois, and Vermont.
...138
Hawaii, Idaho, New Hampshire, North Dakota, and Washington.
... Eighteen139
Alabama, Arkansas, Delaware, Georgia, Hawaii, Illinois, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Missouri, Montana, New Jersey, Oklahoma, and Texas.
... states140
plus District of Columbia
... Nine141
Arkansas, Delaware, Georgia, Missouri, Montana, New Jersey, Oregon, Texas, and Washington.
... Nine142
Delaware, Hawaii, Kentucky, Maryland, Minnesota, Montana, Oklahoma, Oregon, and Utah.
... states143
Delaware, Hawaii, Kentucky, Maryland, Michigan, Minnesota, Missouri, Montana, New Jersey, Oklahoma, and Texas.
... states144
Arkansas, California, Delaware, Georgia, Hawaii, Kentucky, Massachusetts, Missouri, North Carolina, Oklahoma, and Texas. Note: as is the case of Massachusetts, abortion services may be addressed and provided for in other statutes.
...145
It is unclear if this includes abortive services. Since the focus of the inquiry was not aimed at the issue of abortive services for minors, because Massachusetts provides for such services under Mass. Ann. Laws ch. 112, 12S (2002), whether or not the term ``surgical care'' included abortive services in the respective states under prenatal care statutes was not investigated.
...146
See id.

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Next: Legal Access Up: Mature Minor Rule Previous: What Standards Should Be   Contents   Index
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