First Steps: A Spotlight on Health and Developmental Screenings for Young Texans

By Adriana Kohler and Rebecca Hornbach, Texans Care for Children

Every family looks forward to their child’s first smile, first step, and first words. Routine well-child visits and developmental screenings allow doctors and families to monitor a child’s health and development and celebrate these kinds of milestones. Ongoing screenings for young children also help identify possible social, behavioral, and developmental delays that can be addressed with early intervention services. Through regular check-ups and strong developmental surveillance systems, families can be referred to the services and supports their children need, as early as possible, giving them a greater opportunity to learn, socialize, and thrive.

The American Academy of Pediatrics (AAP) recommends eight well-child visits within the first 15 months of life and developmental screenings for children at 9 months, 18 months, and 24 or 30 months. How well are states and communities following through on these recommendations?

Texans Care for Children collected state and regional data to find out how many young Texas children are getting recommended check-ups and developmental screenings. We recently put together an interactive map showing the percent of children enrolled in Medicaid and Children’s Health Insurance Program (CHIP) who received the recommended developmental screens and well-child and primary care visits in 2015. In Texas, this data is available statewide and for each of Texas’ 13 geographic managed care regions. Fortunately, Texas Medicaid and CHIP health plans track and make publicly available specific measures for children’s health and development, including:

  • Developmental Screening: The rate of children screened at the recommended age interval (9 months, 18 months, and 24 or 30 months) for risk of developmental, behavioral, and social delays. Screening rates are tracked for children under age three and also separated by age group (kids under 12 months, kids age 12 to 24 months, and kids age 24 to 36 months;
  • Infant Well-Child Visits: The rate of children who had six or more well-child visits within the first 15 months of life (AAP recommends 8 well-child visits in the first 15 months);
  • Primary Care Visits for Young Children: There are two measures in this area – the rate of children age 12 to 24 months and rate of children age 25 months through 6 years who had a primary care visit in the last year.

We found some good news but also clear room for improvement. As our issue brief highlights, rates varied widely across regions of Texas, particularly for developmental screenings and the rate of kids with six or more well-child visits in the first 15 months of life. At the state level, 55 percent of Texas children in Medicaid/CHIP received six or more well-child visits during the first 15 months of life. Among slightly older children, 96 percent of kids age 12 months to 24 months and 90 percent of kids age 25 months through 6 years had at least one visit with their primary care physician in the last year. This is great news – the vast majority of children are seeing their doctor during the first few years of life.

However, not every child who visited the doctor received a developmental screen. Among children under age 3 in Medicaid/CHIP, less than one half (45 percent) were reportedly screened with a standard tool for risk of developmental, social, or behavioral delays. The rate varies widely across regions of Texas. For example, only 1 in 4 children under age three (28 percent) received a developmental screen in the Lubbock Managed Care Service Area (i.e. Texas Panhandle), while 58 percent of children under age three received a developmental screen in the Travis Managed Care Service Area, which includes Austin and surrounding counties. It’s important to note that this developmental screening measure is endorsed by National Quality Forum and takes into account the number of kids eligible for a developmental screen. So we know that this screening rate is out of the number of young children in Medicaid/CHIP who should have been screened.

Identifying possible development issues early will help ensure more children receive the early intervention services and supports they need to grow and thrive. For instance, children may be referred to Early Childhood Intervention or Part C of IDEA programs. Known in Texas as ECI, the program provides targeted high-quality interventions for children under age 3 with disabilities and developmental delays, such as Down syndrome, speech and language delays, and autism. Unfortunately, as our recent report shows, over the past several years Texas lawmakers made budget cuts and policy changes to the ECI program that left thousands of eligible babies and toddlers without the early intervention supports they need. This legislative session, the proposed budget misses the mark by underfunding ECI again, even though ECI providers continue to withdraw from the program due to the financial strain of state budget cuts.

Texas Care for Children looks forward to exploring a number of issues and questions raised by these data, including:

  • Why kids might not be screened for developmental delays when they receive well-child visits;
  • Whether more education about developmental screening tools is needed among clinicians;
  • What steps Medicaid and CHIP health plans can take to ensure more children receive well-child visits and developmental screenings at the appropriate intervals; and
  • What are effective ways to encourage follow-up visits for recommended screenings when primary care visits that occur are mainly to address a specific medical issue or illness.

Access to developmental screenings, well-child visits, and ECI must be considered within the context of federal policy discussions around health care and Medicaid/CHIP. As the President and Congress consider significant changes to the way the federal government works with states to support children and families, changes to Medicaid/CHIP policies could drastically cut or eliminate health benefits for children. For instance, the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit (known in Texas as Texas Health Steps) ensures that children enrolled in Medicaid are covered for individualized screenings and treatments, such as vision and hearing screens, developmental screens, and treatments to address conditions discovered through screenings and diagnostic tests.

The EPSDT benefit is one of the hallmarks of the Medicaid program, but this critical benefit is under great risk. Debates in Congress to repeal the Affordable Care Act have included proposals to radically restructure Medicaid to a “block grant” or per capita cap. Under these plans, Congress would cut Medicaid funding and provide states with a set amount of federal funds to operate their Medicaid programs. If a block grant or per capita cap option were to pass, it would shift the costs of health services from the federal government to the states and counties. In practical terms, children would no longer be guaranteed the EPSDT benefit, which has been in place for decades to ensure that kids are able to access needed screenings and treatment. Governors and state legislatures would have to decide what benefits a child could get through Medicaid. It is clear that decisions made by federal policymakers will have ripple effects on Medicaid and children’s access to health care and screenings they need to stay healthy, succeed in school, and grow up to fulfill their potential.