Long-Term Solutions Can Improve Health of Children in Medicaid

Medicaid and the Children’s Health Insurance Program (CHIP) can play a strong role in children’s mental and physical health following the coronavirus pandemic by introducing long-term solutions, according to a report from the National Association of Medicaid Directors (NAMD).

NAMD recommended that Medicaid leaders focus on developing strategies for three different levels consisting of children, families, and systems.

First, Medicaid should support the development of the nation’s children. Medicaid and CHIP provide health insurance for 2 in 5 children and cover nearly half (43 percent) of all births, NAMD pointed out. This puts Medicaid programs in a position to assist children from the moment they are born.

Streamlining eligibility pathways for children is one action that Medicaid leaders could take to support children. Implementing a system that enrolls children in CHIP coverage either before they are born or the moment they are born would prevent any delays in care for newborns.

The report recommended leveraging presumptive eligibility for pregnant women and children as well to ensure that they are connected to coverage and care more quickly. Instituting 12-month, continuous eligibility for children would prevent disruptions in care even if their family experienced changes in income.

Increasing access to healthcare services is another way Medicaid leaders can support children’s development. Medicaid programs can ensure that young children have access to services that support their social and emotional health by incentivizing plans and providers to follow standards and guidelines that comply with healthy development.

Providing access to integrated physical health, mental health, and addiction treatment is another step Medicaid leaders can take to support adolescents, children with complex healthcare needs, and children involved in the child welfare system. Medicaid agencies could work with pediatric primary care providers to implement this support for children.

Supporting children’s academic and school success also promotes strong development. Medicaid programs can expand access to school-based services under the free care rule to allow all Medicaid-eligible children to receive physical and behavioral health services in schools.

Children in stable and nurturing environments often have better behavioral and health outcomes, therefore it is important to focus on families as well.

Providing support for parents will ultimately help children, too, as parents that have access to care for their own physical and mental can usually provide better support for their children.

The report recommended that Medicaid programs extend coverage for pregnant women to 12-months postpartum to ensure stable coverage for new mothers, which will improve her ability to care for her child.

To support parents’ mental and physical health, Medicaid programs can cover dyadic treatment under the child’s Medicaid benefit. Receiving mental health treatment as a pair can be helpful especially for parents of children with special healthcare needs. 

Providing other social supports such as Supplemental Nutrition Assistance Program (SNAP) can benefit pregnant women and new moms. Home visiting programs and peer support programs can also provide emotional and social support to moms.

Systems is the last level that Medicaid programs should focus on, according to the NAMD report. The goal is to integrate the supports and services on which children rely.

Sharing information and lessons learned between Medicaid and other programs could build a solid foundation and make it easier for the systems to work together. Enabling communication between state agency partners as well as hiring staff with expertise in child-serving programs could also promote integration.

Finding opportunities for these systems to share resources can help support children holistically as well. Medicaid programs can leverage data sharing, incentivize plans to align with and collaborate with partners, and braid and blend funding to identify gaps in service and successfully cover them.

Finally, equipping care providers to jointly deliver healthcare and social services could help advance integration of child support systems. Medicaid programs can provide technical assistance to providers and develop alternate payment models that support this integration.

While these recommendations are long-term transformations, NAMD also provided short-term opportunities in which Medicaid and CHIP can support children.

“For example, as a starting point, Medicaid leaders can examine Medicaid data and external data to understand the current realities for children and families,” explained the report. “They can then launch a ‘sprint’ team to respond to those realities and prepare for a return to daycare, school, and other activities in the fall.”

If Medicaid and CHIP take action to improve children’s health outcomes, a next step may be expanding CHIP’s coverage to reach more children in need. Creating a federally-funded, combined Medicaid-CHIP benefit that encompasses those up to 300 percent of the federal poverty level would allow more children to have stable coverage.

Medicaid coverage for children can be a lifesaver. A past study by The Commonwealth Fund reported that each additional year of childhood Medicaid eligibility is associated with decreased mortality rates among young adults.