Improving Health Equity Through Early Childhood Primary Health Care and Medicaid

It is in the first 1000 days of life that health practitioners actually can have the greatest impact upon a person’s healthy growth and development. The P.A.R.E.N.T.S. Science (Protective factors, Adverse childhood experiences, Resiliency, Epigenetics, Neurobiology, Toxic stress, and Social determinants of health) points to the critical importance of setting a positive health trajectory during these years by strengthening the safety, stability, and nurturing in the home environment.

Thanks to hard-fought advances in Medicaid and CHIP coverage, nearly all children are seen by a primary child health practitioner in these first 1000 days. Both Medicaid and CHIP can provide important anticipatory guidance to families about their young child’s development AND identify and respond to family and social determinants of health as well as bio-medical ones. Half of all these young children are covered by Medicaid and its EPSDT provisions, which offer opportunities to cover much more than screening children for specific medical conditions and responding with clinical treatments focused only on the child.

The Learning Collaborative on Health Equity and Young Children has drawn upon leading pediatric experts to produce a policy framework for transforming young child pediatric practice to do so, building upon a number of evidenced-based programs that have produced dramatic gains in child well-being. The Collaborative also has produced a discussion paper on how to make use of Medicaid to finance such transformations, both within fee-for-service and managed-care environments.

Child health advocates have been very effective in expanding child health coverage under Medicaid and CHIP. The next great opportunity for advocates is to expand the provision of primary, preventive, developmental and ecological services under Medicaid and CHIP to improve health trajectories and ensure health equity. The policy framework, Transforming Young Child Primary Health Care Practice: Building Upon Evidence and Innovation, and discussion paper, Young Child Primary Pediatric Practice Transformation – Medicaid Financing to Improve Child Health Trajectories, offer good starting points for developing champions for this important work.

Charles Bruner is Co-Principal Investigator, Learning Collaborative on Health Equity and Young Children, a partnership between the child and Family Policy Center and the BUILD Initiative. For other resources available through the Learning Collaborative, see: Until recently, he was director of the Child and Family Policy Center, which was successful in securing state funding for 1st Five, patterned after Help Me Grow in Connecticut, and drawing down Medicaid to finance many of its core components.