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Aligning, Leveraging Medicaid Across Sectors to Improve Early Childhood

Allison Inserro
Eight states are participating in a project from the Center for Health Care Strategies (CHCS) that aims to break down the silos and the barriers that exist among different agencies and better connect Medicaid to early childhood programs.
An infant is born into poverty, and then later, as a young child, may interact with multiple different government agencies and systems—not only Medicaid, but also perinatal health care, early intervention, child care, preschool education, and more.

Recognizing that intervening early in life can improve the trajectory of adulthood by reducing adverse childhood experiences and improving the factors that contribute to poor social determinants of health (such as inadequate housing, food insecurity, or income), 8 states are participating in a project from the Center for Health Care Strategies (CHCS) that aims to break down the silos and the barriers that exist among different agencies and better connect Medicaid to early childhood programs.

“Unless you start way upstream, you’re not going to prevent this stuff. You’re just going to be treating it,” said Stephen A. Somers, PhD, CHCS’ president, chief executive officer, and founder.

However, intervening early to address the factors that can affect health later, even into adulthood, as one 2010 landmark study examining the relationship between childhood poverty and adult outcomes found, is not a strategy of Medicaid, despite its prevalence in the lives of American children.

The focus on prevention and intervention came after earlier work showed that so-called “super utilizers” of health services like emergency department visits and inpatient services had challenging backgrounds.

It’s an issue that has been the focus of professionals in this field for a while now.

“How did they land in that situation? What had happened in their life to get them there? What we learned, not surprisingly, was that people had really challenging lives, challenging childhoods, challenges finishing school, challenges with drug and alcohol and mental health, criminal justice involvement,” said Christine Bernsten, director of strategic initiatives of Health Share of Oregon, the largest coordinated care organization (CCO) in the state, with about 315,000 Oregon Health Plan (OHP) members. Oregon’s CCOs are unique; they were approved by the state legislature and a Section 1115 Medicaid demonstration waiver from CMS. Health Share said 40% of their members are under age 18.

Across the country, Medicaid covers nearly half of all births and in some states, far more. In New Mexico, for example, Medicaid pays for 72% of all births.

Medicaid’s main focus in early childhood health is contained in its Early and Periodic Screening, Diagnostic and Treatment (EPSDT) provision, which requires all states to cover comprehensive health services. However, the extent of what each state might cover may vary.

Despite the fact that Medicaid (along with the Children’s Health Insurance Program) provides health coverage to more than 46 million children, including almost half of all children under the age of 6, it has not previously worked directly with early education programs.

With that in mind, CHCS is working with the National Association of Medicaid Directors and ZERO TO THREE on an initiative called Aligning Early Childhood and Medicaid.


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