Health Promotion

Leveraging Medicaid to Enhance Child Health Outcomes

By: Paul H. Dworkin, MD

As we strive to promote children’s optimal development, we are constantly reminded of the challenges that stand in the way of success. Poverty. Exposure to childhood trauma. Unidentified developmental delays and disorders. Unhealthy housing. Food insecurity. The challenge early childhood experts face is to find innovative ways to meet those needs. One to consider is leveraging Medicaid to address the social determinants of health, including poverty, which are proven to have a greater impact on health outcomes compared to medical care.

With Medicaid being a crucial lifeline for vulnerable children and families, there are huge opportunities for its funding to further new models that provide stronger support for families. Ideally, such models would bridge current gaps by 1) bringing all of the sectors that influence healthy development together, and 2) extending participation to vulnerable children rather than solely focusing on those with identified delays and disorders.

The Campaign for Grade Level Reading (CGLR) stands out with its efforts to advocate for the use of Medicaid reimbursements to better ensure that all children from low-income families are prepared to succeed in school and in life. I was honored to participate in a panel discussion at a recent CGLR Funder Huddle in Denver that highlighted best practices in using innovation to enhance Medicaid’s impact in improving child health outcomes.

During my presentation, I focused on our efforts at Connecticut Children’s Office for Community Child Health to utilize a cross-sector approach to promoting healthy development for all children, rather than solely focusing our efforts on the child health sector and on children with identified delays and disorders. We take this approach because research shows the excellence of medical and surgical care accounts for as little as 10 percent of overall outcomes. Because of that, we recognize the crucial importance of addressing the social, environmental, and behavioral factors that contribute to health outcomes in much greater ways.

In looking beyond child health, I explained how our work at the Office to build stronger child-serving systems brings partners together from a variety of sectors including family support, early care & education, food & nutrition, housing, workforce development & employment, neighborhood health & safety and other areas. We also focus on children who are vulnerable, but don’t yet have delays and disorders, in the hopes of moving them from an “at risk” or “vulnerable” trajectory to a “healthy” trajectory, instead of watching them spiral downwards towards a “delayed or disordered” trajectory.

I was inspired by my fellow participants on the panel who outlined the work they are already doing to better utilize Medicaid to transform child health services.

Deb Florio, the deputy Medicaid and CHIP director for Rhode Island, detailed how they are leveraging Medicaid in the fight against lead poisoning. Specifically, she described how Medicaid is reimbursing for case management, visual property assessments, nutritional counseling and other services for families of children who have high lead levels detected in their blood. In addition, Florio described how Medicaid is even able to reimburse for window replacements and remediation of other hazards in homes where children who have been exposed to lead are living.

Urcel Fields, the president of Amerigroup Georgia, detailed how Medicaid is reimbursing for appointments conducted through the state’s Telehealth network. The network is designed to facilitate health care access in underserved areas through county health departments, which saves time and money for patients, medical providers and public health staff. Fields also described how the state is leveraging Medicaid to reimburse families for nutrition coaching if members have illnesses that put them at nutritional risk.

Arlene Weldon, the director of Get Georgia Reading, discussed the importance of utilizing public/private partnerships to advance Medicaid innovations at local and state levels. One example Weldon highlighted was the “Talk With Me Baby” campaign in which six public and private partners were awarded a three-year grant from the United Way to design and implement a scalable and sustainable strategy to ensure that children are exposed to enough rich language to facilitate their growing brain development.

In Connecticut, our Help Me Grow National Center serves as an example of the power and promise of bringing innovations that promote children’s optimal development to scale. The National Center oversees a growing network of state affiliates around the country that work to advance the early detection of concerns among vulnerable children and link them to existing community based supports. Affiliates do so by utilizing a centralized approach to care coordination that shares resources with other like-minded organizations. The National Center’s affiliate network serves as a platform for us to diffuse successful innovations beyond Connecticut, such as our Mid-Level Developmental Assessment model which assesses children with mild to moderate concerns, who often go undetected or unidentified, to determine which community-based supports can intervene before concerns escalate.

We see great opportunity for Medicaid to support the development of similar centralized, shared resource care coordination utilities to connect children and families to community based programs and services. We see value in Medicaid supporting efforts to expand the capacity of medical homes for children. We also believe it’s vital for Medicaid to promote developmental screening activities as part of a comprehensive, integrated approach promoting healthy development through early detection and intervention.

At the Office, we are inspired by the work of CGLR in advocating for Medicaid to support innovative ways of improving health outcomes for vulnerable children. We are also inspired by the examples Rhode Island and Georgia are setting in terms of leveraging Medicaid resources for greater impact. As a result of such efforts, far more children are ready for success not only in school, but across their entire lifespans, which is a sign we’re all headed in the right direction on our path to promoting optimal development.

Photo Courtesy: Campaign for Grade Level Reading

Paul H. Dworkin, MD, is the executive vice president for community child health at Connecticut Children’s, the director of Connecticut Children’s Office for Community Child Health and the founding director of the Help Me Grow® National Center. Dr. Dworkin is also a professor of pediatrics at UConn School of Medicine. Learn more »

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