Well, if she is 19 and doesn't want to cooperate with what she needs to do in order to maintain her health insurance, if something happens, it's really not going to be your problem is it? She'll be the one responsible for the medical bills.
Here's the deal with a 19 year old. They are an adult. They can't be an adult for the fun stuff and not be an adult for the not fun stuff. Life doesn't work that way.
If your kid is college material, then tell them to get their butt in gear and get into a college...be it 2 or 4 years...and find a program they like that will earn them a living. OP, if your DS is expressing interest in COTA, then tell him to find a COTA program and apply. Or tell him to find a job, or 2 jobs or 4 jobs in order to support himself because that is what he will be doing as of X date.
My parents made it very clear to my brother and I. They preferred we go to college. If we went to college we could live home rent free as long as our grades were good and they would help us pay for as much college as they could afford. We would be expected to participate in the household (ie-shovel snow, rake leaves etc) as needed, if it did not interfere with school. Our GPA needed to be maintained at 3.0, as they would not be paying for wasted college classes. Both of us had the ability to easily maintain a 3.0, so this was not a huge hardship. They also made it clear that they strongly preferred that we save some money too, since both of us worked all through college and did not have a rent payment. Any of our own bills (ie-credit card, car payment) were our responsibility. Cell phones were not in the picture back then, but if they were, we probably would have been giving some amount toward the cell phone family plan, I would imagine.
If we did not choose to go to college, then we would be working 40 hours per week at however many jobs it took to do that and we would be repsonsible for our own bills, including a rent payment. If we chose not to work 40 hours per week and thought we could hang out at home playing video games, then we also would have found ourselves living elsewhere.
A powerpoint presentation would have never played into it because my parents would have never felt the need to "present" anything to me. The above information was not imparted to me the day I turned 16...it was always just discussed as we were growing up...it was a known entity of my life..."you will go to college or you will work full time and we'd prefer college because we think it will set you up better for your life". There was no in between.
They weren't coddlers. They took it as their responsibility to prepare us for life and they started making their expectations clear at an early age.