Ensuring continuous health coverage for children from birth until kindergarten can improve future health outcomes, according to a new report.
Offering five continuous years of coverage and fostering social and emotional health through primary care could be highly advantageous to children and families in the long term, according to a new report from the Center for the Study of Social Policy (CSSP), Manatt Health and Pediatrics Supporting Parents (PSP).
“Medicaid and CHIP long have been a lifeline for America’s children, but pediatric care more broadly is at a critical moment right now,” Jocelyn Guyer, managing director at Manatt Health, the healthcare legal and consulting group of Manatt, Phelps & Phillips LLP, told FierceHealthcare. “It is increasingly clear that social and emotional health are major drivers of outcomes for kids. We need to work together to ensure that Medicaid and CHIP are supporting pediatric care providers in addressing the social and emotional needs of children, especially in their earliest years.”
Medicaid and the Children’s Health Insurance Program (CHIP) together provide healthcare to almost half of America’s children under three years of age. Children who receive Medicaid and CHIP are more likely to suffer from depression, low birth weight, food and housing insecurity and other social and emotional developments, according to the report.
Therefore, this subsidized coverage is integral to a child’s well-being, as a previous study showed that children who are enrolled consistently in Medicaid for the first two years of life are more likely to have the recommended number of well-child visits and school readiness scores than those with fewer visits.
Using all of this background information, Manatt created a blueprint recommending five strategies for state Medicaid and CHIP agencies, managed care plans and pediatric providers in order to optimize the social and emotional development of children.
First, pediatric practices should offer screenings, assessments and treatment services for children and their parents. Second, states should require reporting on measures related to social and emotional health and require plans to implement improvement projects to increase providers delivery services. Third, providers should offer payment models that support and incentivize the social and emotional development of children, including reimbursements for high-performing pediatric medical homes. Fourth, programs should invest in team-based care and training of children’s social and emotional needs. Finally, providers should leverage the CHIP Health Services Initiative to finance interventions aimed at supporting children’s social and emotional development.
The blueprint also includes action steps to help implement these core strategies, tools for implementation and policies in effect across the country. Guyer says that the biggest challenge to implementation will be the competing demands facing Medicaid directors and other state leaders who are juggling several immediate crises.
“The reality is that—in the short term—a failure to attend to the social and emotional development of young children does not result in skyrocketing medical bills or even terrible news headlines,” she said. “Luckily, state leaders increasingly recognize that investing more in the social and emotional health of our children will pay off in the longer run and are increasingly turning their attention to these issues.”
To measure the outcomes of these early childhood objectives, organizations like the Annie E. Casey Foundation are tracking the progress, or lack thereof, of American children’s health and well-being. In its recently released annual Kids Count Data Book, of the 16 specific areas that were tracked, 11 have improved results for children since the first edition 30 years ago.
Some of the improvements include an uptick in children’s access to health insurance compared to seven years ago and more financially stable parents. However, in the health category, the risk of babies being born at a low weight continues to rise. In fact, among all babies born in 2017, 8.3% had a low birth weight, tying a four-decade high.
State by state, New Hampshire took the top spot for overall child well-being, followed by Massachusetts and Iowa. On the flip side, Mississippi, Louisiana and New Mexico ranked as least well. Other than California and Alaska, the 18 lowest ranked states fall into the Appalachia, the South or Southwest regions of the country.
While the Data Book reports that over the past 30 years, the number of children without health insurance has shrunk by 62%, American Indian children are more than three times as likely as their peers to lack health insurance. And about 12% of children (8.5 million) still live in high-poverty areas, ranging from just 1% of kids in Wyoming versus 84% of kids in Puerto Rico.
“Our pediatric advisors tell us that social and emotional health follows from the early relational experiences infants and young children have with their caregivers,” Donna Cohen Ross, senior adviser at CSSP, told FierceHealthcare. “A strong foundation can affect whether a child is ready to begin school, is on the path to achieve academic success, and is prepared to become a productive member of the workforce and the community, factors that play a role in future physical and mental health, including later struggles with chronic conditions.”
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The Data Book (PDF) also examines the social and emotional changes over the past 30 years by examining the number of child and teen death rates.
These deaths reflect a number of factors: physical and mental health; access to healthcare; community issues, such as violence and environmental toxins; use of safety practices; and, especially for younger children, the level of adult supervision. The 2017 mortality rate for African American children and teens (38 per 100,000) was noticeably higher than the death rates for children and youth of other racial and ethnic groups.
Moving forward, Medicaid and CHIP will continue to play integral parts in supporting changes in pediatric primary care visits. In fact, Guyer calls them “game changers” when it comes to promoting change in the industry that will support the social and emotional development of young children.
“We developed the Blueprint as part of the Pediatrics Supporting Parents initiative, which is backed by a consortium of generous private funders whose investments are focused on optimizing the opportunities embedded in the pediatric well-child visit to promote social and emotional development, the foundation for early learning and future health and well-being,” Cohen Ross added.
“With so much to gain, we wanted to place a set of actionable strategies and tools directly into the hands of policy makers, program administrators, managed care plans and others, sharing not only what could be done to advance pediatric care for young children, but how to get it done. We want to help accelerate progress towards the goals so many state Medicaid and CHIP agencies are already pursuing," Cohen Ross said.