Editor’s Note:  Welcome to the fourth in a series of blogs on how covering parents helps children.  Previous blogs on this topic have pointed out that extending Medicaid coverage to parents will provide a good value to states; maternal, infant and early childhood home visiting programs help prevent child maltreatment; and the single best way to ensure kids access the coverage and care they need is by covering their parents.

By Dr. Olivia Golden, Urban Institute

Children’s advocates and policymakers take justifiable pride in the strides made toward providing health insurance to all children through Medicaid and CHIP over the past decade. Yet while children’s own health coverage is crucial to child development, it is not sufficient, because parents’ untreated medical and mental health problems can pose major risks to children’s well-being. Accordingly, an Urban Institute research team is delving into the opportunities the Affordable Care Act offers to support children’s healthy development by enabling parents to get help with mental health problems. The team’s focus is maternal depression, which is highly prevalent among low-income mothers of young children and poses well-documented risks to children when untreated.

Depression risks not only a mother’s well-being but also her child’s safety, learning, and healthy development, the National Research Council/Institute of Medicine reported in 2009. By compromising parenting practices, untreated maternal depression jeopardizes the cognitive, psychosocial, and behavioral development of children and may adversely affect their long-term mental and physical health. Research has also identified associations between infants living in poverty with severely depressed mothers and exposure to other environmental risk factors, including domestic violence and substance abuse.

Fortunately, effective treatments for depression—ranging from medication to psychotherapies and behavioral therapies—are available. But the NRC/IOM suggests that far too few low-income mothers are able to take advantage of them. Reasons include a lack of access to health insurance that covers mental health services, inadequate availability of trained providers and linguistically and culturally appropriate mental health services, and stigma and distrust of mental health providers.

Upon implementation of the Affordable Care Act in 2014, many mothers who previously lost Medicaid eligibility once their babies were born will keep their Medicaid coverage (or, if income rises, gain access to subsidized coverage through a health insurance exchange). This will allow more mothers in poverty who have been screened for depression as part of prenatal care, a child’s pediatric visit, or a regular check-up to obtain lasting and effective treatment.

However, in states that do not implement the ACA’s Medicaid expansion, mothers will not have these new opportunities for treatment, with their resulting benefits for children’s safety, well-being, and development.  Thus, the stakes are high for children and adults as states make this choice.

Motivated by this major public health opportunity, Urban Institute researchers who have been exploring a wide range of policy and system reforms that could help identify depressed mothers of young children and link them to effective treatment are now focusing in on opportunities through Medicaid and the ACA. This fall, two new papers will address the critical role of Medicaid and the opportunities offered by ACA implementation:

• The first paper compares access to treatment by low-income depressed mothers with Medicaid to those who are uninsured and those (at all income levels) with private insurance.
• The second explores opportunities provided by the ACA for state Medicaid agencies, federal officials, and philanthropic funders to combine efforts addressing maternal depression.

Two earlier reports shed light on other aspects of maternal depression and the service strategies that can help mothers and children. The Linking Depressed Mothers to Effective Services project’s debut report provides first-ever data on the prevalence of depression among mothers of infants living in poverty and touches on services that reach these families (prior analyses generally looked at adults or children but not specifically parents). Among its findings:

• Among 9-month-old infants living in poverty, one in nine has a mother who is severely depressed, and more than half have a mother experiencing some level of depression.
• Only 30 percent of severely depressed mothers have received any kind of treatment (defined as talking to anyone about the problem in the past year).
• On the positive side, and indicative of the opportunity to reach troubled mothers, 96 percent of poor infants with severely depressed mothers lived in a household that received benefits under the Special Supplemental Program for Women, Infants, and Children (WIC), and 82 percent lived in a household where someone received Medicaid.

Other papers highlight home visiting and its potential links to strong mental health services and discuss state Medicaid and CHIP choices that can enhance delivery of medical, mental health, and related services to parents.

The Urban Institute’s project leaders are Dr. Olivia Golden (ogolden@urban.org) and Dr. Marla McDaniel (mmcdaniel@urban.org). Other researchers include the Institute’s Dr. Embry Howell (ehowell@urban.org), Dr. Tracy Vericker (tvericker@urban.org) , and Karina Fortuny (kfortuny@urban.org ), as well as senior project consultant Dr. William Beardslee of Children’s Hospital (Boston) and the Harvard Medical School. Lead project funding is from the Doris Duke Charitable Foundation.