School Readiness as an “Essential Quality Metric” for Children: A Hook for Medicaid in Cross-System Work

The importance of a child’s first months and years can’t be overstated. It’s a time of rapid brain development and learning, where relationships and environments set the course for a child’s lifelong trajectory—even shaping the architecture of the brain. In 2016, Medicaid and CHIP served close to half of all children under 6, and more than 85% of young children under the poverty line. It is clear that Medicaid plays a critical role in meeting the health care needs of the nation’s youngest children and also many of their family members and caretakers. Medicaid is one of the few systems that reaches most low-income children before they enter school, making it “uniquely positioned to identify potential problems and facilitate connections with needed social services”, according to the Early Childhood Policy Innovation Lab at the Center for Health Care Strategies.  

We know that many systems serve low-income families systems  – Medicaid, social welfare, food assistance, housing, child welfare, and others. It’s critical that these systems work in concert to connect families to needed supports and services – especially those that can prevent more complex challenges as children get older. But true collaboration, even with similar goals and priorities, is easier said than done. Even when the overall goals and objectives overlap, each system has separate federal requirements, funding sources, provider payment mechanisms, and even basic language and terminology.

These challenges are not new, neither is the knowledge about the importance of children’s early years and the critical role of parents and caregivers. What is fairly new (though less so to us at CCF!) is the broader recognition and understanding of Medicaid’s foundational role for young children. So it’s imperative that we look for ways to align systems in meaningful ways. How best to work to eliminate unnecessary system and program-level barriers? Or to paraphrase Kalin Scott of New York Medicaid: How can each system, each agency, each player recognize each child as “our” collective responsibility — not “yours” or “mine”?

Two new pieces offer concrete ideas on how to tackle that task:

First, the folks at CHCS’s Early Childhood Innovation lab provide a few initial lessons learned from their work with states and communities aiming to include Medicaid as a central player in forging cross-system solutions for young children. It means aligning priorities and goals, narrowing the scope of work to identify initial shared steps, and using coordinating bodies, such as Children’s Cabinets to help drive cross-system accountability.

The Lab also highlighted the importance of shifting mindsets to view a child’s needs outside of the system’s usual lens, using the shared goal of school readiness as an example. Education departments use Kindergarten readiness scores, health payers look at developmental screening—both are different ways of gauging whether a child is ready for kindergarten.

Second, pediatricians and other experts took to the Health Affairs blog to highlight the opportunity to use school readiness as an essential quality metric that systems can share, highlighting efforts in Oregon and New York:

School readiness is perhaps the best summary population-health indicator, and hence quality metric, of young children’s well-being. School readiness is correlated with better trajectories over the life course—such as attainment of higher levels of education and ability to secure stable employment. School readiness is also highly sensitive to context: only 48 percent of US children living in poverty are school ready at five years of age, as compared to nearly 75 percent of children living in families with moderate or high income. 

We know the brain science. We know no one system or program—including Medicaid and the health system –can successfully serve young children alone. It’s past time for policymakers to drive meaningful cross-system partnerships with Medicaid as an active player. The shared goal of school readiness is a great place to start.

Elisabeth Wright Burak
Elisabeth Wright Burak is a Senior Fellow at the Center for Children and Families

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