In the first three years of life, a child’s brain is developing at an unparalleled pace. During this extremely sensitive period, the factors that influence social and emotional development—including a strong parent-child relationship, nurturing interactions, and safe and stable living conditions—can have important and enduring consequences. A strong foundation can affect whether a child is prepared to begin school, achieve academic success and become a productive member of the community; it also is a predictor of physical and mental health and well-being as an adult. With so much to gain, it is vital that policymakers, healthcare providers, payors, advocates and healthcare leaders focus greater attention on strategies for optimizing the healthy development of young children.
A Role for Medicaid and CHIP in Supporting Children’s Social and Emotional Health
Nearly half of children under age three in the United States are enrolled in Medicaid and the Children’s Health Insurance Program (CHIP).1 Roughly nine out of 10 children under age three enrolled in Medicaid or CHIP visited a primary care provider in 2017, with a clear majority attending regularly scheduled well-child visits (the American Academy of Pediatrics recommends 12 well-child visits during this period).2 By definition, Medicaid and CHIP beneficiaries are in families with low or moderate incomes.3 They also are at higher risk for experiencing a range of challenges that can adversely affect their social and emotional development, including low birth weight, living with a caregiver who suffers from depression, food insecurity, housing instability and toxic stress. With such broad reach, Medicaid and CHIP have a central role in steering the course of care delivery toward a more responsive, family-centered standard of primary care addressing children’s social and emotional development.
National Medicaid and CHIP Blueprint: Policy in Action
With generous funding from the Pediatrics Supporting Parents initiative and in partnership with the Center for the Study of Social Policy (CSSP), Manatt Health has developed a new resource, Fostering Social and Emotional Health through Pediatric Primary Care: A Blueprint for Leveraging Medicaid and CHIP to Finance Change, which is designed as a practical, flexible guide for advancing action in the pediatric primary care setting for young children and their families.
The Blueprint not only suggests what could be done to utilize Medicaid and CHIP financing opportunities, but also shows how to implement these strategies. The Blueprint draws upon critical input from Medicaid leaders both inside and outside of federal and state government and a thorough review of: federal statutes and regulations; Medicaid and CHIP State Plans and policy documents; Medicaid and CHIP managed care contract language; and other resources to provide specific tools for implementation.
Central to the Blueprint are five core strategies, with action steps, tools and resources for implementation, and notable state examples of existing policies and activities, aimed at optimizing the social and emotional development of young children. State Medicaid and CHIP agencies, managed care plans, and pediatric care providers can leverage these core strategies to impact young children’s development:
- Cover and support a full range of screening, assessment and treatment services for children and their parents. Medicaid has a long-standing commitment to the health of young children, providing a comprehensive benefit package designed to meet their unique health and developmental needs. Medicaid’s companion program, CHIP, features similar (although sometimes more limited) services. States have broad flexibility to mandate benefits and policy strategies that support children’s social and emotional development.
- Leverage quality and performance improvement initiatives to spur changes in pediatric practice. States can incorporate a focus on social and emotional development into their statewide Medicaid quality strategy. They can require reporting on measures related to social and emotional health, require plans to implement performance improvement projects to increase the extent to which providers deliver services designed to help foster children’s social and emotional health, and reward plans and providers that embrace these changes through financial incentives.
- Establish payment models that support and incentivize a focus on the social and emotional development of children, ideally as part of a high-performing pediatric medical home. States can offer financial incentives to health plans and providers to focus on children’s social and emotional development, including through enhanced reimbursement for high-performing pediatric medical homes. Increasingly, states are looking for ways to address children’s needs as part of their value-based payment initiatives, creating an important opportunity to promote high-performing pediatric medical homes.
- Facilitate investment in team-based care and training on children’s social and emotional development. States can support the use of team-based care to make it more feasible for pediatric practices to connect families to public benefits and community resources, and offer support to help strengthen parenting and prevent problems with social and emotional development. They also can use Medicaid administrative funds to cover allowable expenditures associated with practice transformation and training on relevant topics, such as trauma-informed care and the impact of adverse childhood experiences, as they relate to the delivery of services to Medicaid beneficiaries.
- Leverage a CHIP Health Services Initiative to finance interventions aimed at supporting children’s social and emotional development. Using CHIP administrative funds, states can implement a wide array of interventions to foster children’s social and emotional development. These can include interventions to support home visiting, address exposure to violence, promote lead screening and abatement, train providers on practices that strengthen the parent-child relationship, develop early literacy skills, and other efforts, including initiatives that ordinarily cannot be financed with Medicaid funds.
The strategies and tools presented in the Blueprint reflect the broad flexibility available in Medicaid and CHIP to foster the social and emotional health of young children, including strategies deployed by “leading edge” states that have already taken steps to launch and begin implementing pathbreaking initiatives.
For additional information on how to leverage Medicaid and CHIP financing opportunities to improve young children’s social and emotional development, please see Manatt and CSSP’s recent publication Fostering Social and Emotional Health through Pediatric Primary Care: A Blueprint for Leveraging Medicaid and CHIP to Finance Change.
Additional Resources and Events
- Manatt Health and CSSP hosted a webinar walking through the Blueprint’s core strategies and tools on Wednesday, June 26; the introductory webinar is available for download.
- Follow the recently launched blog series that will continue to chronicle the implementation of the Blueprint in select states to detail their experiences, challenges and success stories; the first blog post is available for reading.
1 Haley, J., Wang, R., Buettgens, M., Kenney, G. Health Insurance Coverage Among Children Ages 3 and Younger and Their Parents in 2016. Urban Institute. January 30, 2018. Available here.
2 Centers for Medicare & Medicaid Services. Quality of Care for Children in Medicaid and CHIP: Findings from the 2017 Child Core Set Chart Pack. December 2018. Available here.
3 Kaiser Family Foundation. Medicaid and CHIP Income Eligibility Limits for Children as a Percent of the Federal Poverty Level. January 1, 2019. Available here.