Advocates for runaway and homeless youth in New York state, medical professionals and community-based service groups have long argued that minors who have run away or end up homeless should have the right to consent to their own health care.
Yet due to strict parental consent laws, vital treatment ranging from routine physicals to prescription refills and lifesaving vaccines has long been out of reach for these young people.
Now the state is loosening those restrictions.
Under Senate Bill 8937, signed in December by Gov. Kathy Hochul (D) and amended in March, all homeless youth 17 and younger described as “decisionally capable,” can consent to their own health care. The same access is afforded to minors defined as “runaways,” provided they are receiving services from a state-approved youth crisis program.
“In New York, the default expectation is the parents or guardians will consent to health care for their children until those young people turn 18,” said Allie Bohm, policy counsel for The New York Civil Liberties Union, describing the need for the legislation. “Unfortunately, not all young people live in safe family relationships.”
Beginning March 23, that default is expected to change, with more runaway and homeless youth able to access medical, dental, and mental health care without consent from a legal guardian. The law was fueled in part by the pandemic, with minors denied access to COVID-19 vaccines when their parents couldn’t be reached or opposed the vaccinations.
There are some limitations to the new health care access. As with all patients, medical providers must determine that the young person can “understand the risks and benefits of their own treatment” and the alternatives to such treatment. And parents could still be notified by insurers or other parties once a minor child has received medical care.
Dr. Uri Belkind — associate director for Adolescent Medicine at New York City’s Callen-Lorde Community Health Center who consulted on the legislation — noted the law’s particular importance for LGBTQ+ youth.
“We know that transgender minors are often kicked out or have to run away from their homes because they’re not accepted, and by doing so, they also lose the ability to receive gender-affirming care, whether it’s hormones or other types of treatments,” Belkin said.
For staff at Buffalo’s Compass House, a shelter for 12- to 17-year-olds, the new law will improve access during the relatively rare occasions when a minor is sent to the doctor, said executive director Lisa Freeman.
“You have parents that don’t return the phone calls or you have parents that want nothing to do with their child — they’ve washed their hands,” she said.
The law and a subsequent amendment insisted upon by the governor’s office sets slightly different terms of health care access for youth defined as homeless and those considered runaways. All homeless minors — defined under the law as “a person under the age of eighteen who is in need of services and is without a place of shelter where supervision and care are available” — can independently consent to their own care. Runaways under age 18 — defined as “absent from his or her legal residence without the consent of his or her parent, legal guardian or custodian” — must be receiving shelter or crisis services from a program certified by the state’s Office of Children and Family Services.
Youth advocates say the final legislation represents significant progress. But they wanted broader access, and expressed concerns for young people who don’t appear to meet the criteria for the government-defined status of “runaway” or “homeless,” as well as those who may not be in close proximity to a state-certified shelter, particularly in upstate New York.
The underserved population of homeless youth is often misunderstood by the public, said attorney Bohm.
“The mythological young person who runs away on Saturday morning, gets health care their parents disagree with on Saturday afternoon and returns home Saturday evening — that young person does not exist,” she said.
Problems experienced on the streets
The number of runaway and homeless youth is difficult to track. But according to the most recent state figures, in 2020, 4,162 runaway and homeless youth ages 24 and younger were admitted to state-certified residential programs, and 3,062 entered crisis shelters. An additional 1,100 youth and their 91 dependents entered transitional independent living programs, which provide longer-term supportive housing.
“You have parents that don’t return the phone calls or you have parents that want nothing to do with their child — they’ve washed their hands.”— Lisa Freeman, Compass House
It is unclear how many of these youth moved between these various programs that year, and the numbers are believed to be an undercount of total homeless youth in the state. The data do not include youth who are sleeping in public spaces, in cars or staying temporarily with friends or relatives.
A child may run away or become homeless because of “involvement in the juvenile justice or child welfare systems, abuse, neglect, abandonment, and severe family conflict,” according to the federal Interagency Working Group on Youth Programs.
Nationwide, LGBTQ+ youth were twice as likely to experience homelessness as other youth, the University of Chicago’s Chapin Hall concluded in a 2018 policy brief. They also had twice the rate of early death during homelessness.
People on the frontlines working to combat youth homelessness have witnessed how frustrating and complicated it can be for these young people to access health care.
Jamie Powlovich, executive director of the New York Coalition for Homeless Youth and a driving force behind the recently passed legislation, recalled one teen’s struggle to receive routine care. The homeless minor from upstate had received a government internship, but it required a physical exam.
“Because the young person’s legal guardian wasn’t available to consent for her to go to the doctor, she couldn’t do the internship,” Powlovich said.
Advocates are also concerned about the impact the new requirement would have on young people in rural communities.
“The reality is there are so many young people where there’s not a program around,” Powlovich of the homeless coalition said, “and it doesn’t mean they don’t need the care.”
In New York State, there are 31 emergency shelters for youth, 14 of which are located in New York City. Minors outside of the city tend to have far fewer options, particularly in the more rural counties.
Limiting health care to those who can reach a shelter means the state is “removing a significant barrier to access, but then imposing another one,” said Jack Kavanaugh, the executive director of GLYS Western New York, an agency serving LGBTQ+ youth.
He noted that “a very high percentage of homeless and runaway youth in New York State do identify as part of the LGBTQ community — particularly a lot of transgender and gender non-conforming young people.”
A big reason for that is a lot of them, unfortunately, do not have safe home lives,” he added.
That means countless youth have long missed out on vital health care, said Dr. Belkind, who works at an LGBTQ+ health center and runs a mobile unit that treats homeless and runaway youth in New York City.
Doctors have always been able to act immediately in emergencies or to save a minor’s life. But situations can become murky when the line between emergency and routine treatment is unclear.
Belkind said his team has had to turn away some runaway and homeless minors — specifically those who have a “strained, limited or nonexistent relationship with their parents.”
“Sometimes with even prescribing an asthma pump or epinephrine for someone who could develop an allergic reaction, we were treading that line of whether or not we were allowed to do so,” he said. “We oftentimes did what we felt was right but not always sure that we would be protected by the law.”
Under the new state law, physicians will no longer be on such shaky ground.
But many are still awaiting more complete direction from the state. On April 4, the Office of Children and Family Services sent informational letters to medical professionals, offering guidance on complying with the new law, but the Department of Health’s guidance is still pending.
“Most youth under 18 will not need to rely on this law,” said Solomon Syed, a spokesperson for the state’s Office of Children and Family Services. “But for any instance in which they do, this legislation is yet another tool to ensure that New York’s youth do not face additional hurdles to maintaining their health and well-being.”