This brief is one in a series of seven on key Medicaid issues for state policymakers. The series is designed to assist new state leaders in understanding the Medicaid program and their role in using it to improve the health of their states’ residents and communities.
Medicaid and its smaller companion program, the Children’s Health Insurance Program (CHIP), cover more than 46 million children, including almost half of all children under the age of six. While medically complex adults drive much of the program’s costs, Medicaid plays an outsize role for children, particularly young children and children with special health needs. Through their Medicaid programs, state policymakers have substantial opportunity to affect the health—and future well-being and productivity—of their youngest residents.
Why It’s Important
Medicaid pays for nearly half of all births in the country and covers a full range of services for children after birth, from essential screenings to critical treatments and supports for children with special needs. Medicaid also funds health services for children outside the traditional health care system.
Beyond providing access to needed care and services, Medicaid coverage offers long-term health and economic benefits:
Medicaid is critical in helping to identify and provide treatment for developmental disabilities in children.
Medicaid enrollment during childhood is associated with better health in adulthood.
Expanded access to Medicaid leads to lower high school dropout rates, increased college attendance, and more bachelor's degrees.
Considerations for State Policymakers
States are implementing a number of strategies in Medicaid to maximize the health and well-being of children. New state policymakers will want to assess current state policy to determine if these strategies are being or should be pursued.
Ensure Robust Coverage. One of the most effective ways to improve child health is to maximize Medicaid eligibility and coverage. Policies that promote coverage include continuous eligibility, streamlined enrollment and renewal processes, and targeted outreach. Notably, policies that constrain coverage for parents—such as waivers that interrupt or otherwise reduce coverage for adults—can negatively impact the coverage status of their children.
Strengthen Access to Comprehensive Care. States can take meaningful steps to promote children’s health and well-being through strengthening care that serves the “whole child.”
Implement the comprehensive benefits available to children through Medicaid. Federal law requires states to provide comprehensive health services for all Medicaid-covered children, as medically necessary, under a provision known as Early and Periodic Screening, Diagnostic and Treatment (EPSDT). States can set clear requirements for their plans and providers and strengthen their oversight of the delivery of these benefits.
Enhance access to specialty pediatric services, with a focus on vulnerable populations. States can develop quality metrics on access to specialty pediatric care, set and monitor compliance with strong network adequacy and access standards, and consider payment enhancements, use of telehealth and other initiatives to improve access to specialists.
Address the community around the child. Social and economic factors, such as food insecurity, homelessness and transportation—often referred to as “social determinants of health”—play a huge role in children’s health. Medicaid is uniquely positioned to identify nonmedical but health-related needs and link children to services that can address those needs. (See Medicaid Brief #5 for more details on social determinants of health.)
Develop a Health Care Delivery System That Rewards High-Value Care for Children. Delivery and payment systems serving children should align with children’s social, emotional, physical, and mental health needs, rather than rely on systems designed for adults. Children with special needs require intense care coordination and case management across child- serving systems.
Deploy a “medical home” model focused on children that includes well child visits and primary care services, care coordination, case management, and other needed services—such as effective linkages to services that address children’s social needs.
Tailor financing and payment models and risk adjustment programs so they are designed to address the longer-term “return on investment” of pediatric interventions.
Pursue two-generation approaches that shift the traditionally singular focus on children’s health care needs to children and parental health.
Leverage federal opportunities to reform delivery systems serving children, such as the enter for Medicare and Medicaid Innovation Integrated Care for Kids (InCK) Model.
For additional information on how states can get the most out of their Medicaid managed care programs, please refer to the resources included in the downloadable PDF.
About Manatt Health
Manatt Health is an interdisciplinary policy and business advisory division of Manatt, Phelps & Phillips, LLP, one of the nation’s premier law and consulting firms. Manatt Health helps clients develop and implement strategies to address their greatest challenges, improve performance, and position themselves for long-term sustainability and growth. For more information, visit www.manatt.com/Health.
Stable, affordable health coverage for people in the U.S. is the starting point to improving health outcomes and building a Culture of Health. In the U.S. nearly 75 million people rely on Medicaid for health coverage.