Medicaid and early childhood care providers, including Head Start, child care centers, and home visiting programs, serve many of the same low-income children, yet the two systems rarely collaborate to improve overall population health.
Reaching vulnerable children in their early years of physical, social and emotional development is essential to setting them on a path to achieve their full potential, and mitigating the harm of other factors, such as food and housing insecurity and addressing other social determinants of health.
However, merging these two sectors can be challenging, as each has their own jargon and culture. But early partnership results show that the collaboration is worth the effort.
Nemours Children’s Health System recently hosted a webinar and published a new paper to encourage the early childhood sector to engage with Medicaid and the Children’s Health Insurance Program (CHIP) to help improve child health and wellbeing outcomes. The Nemours’ paper lays out strategies for early childhood care providers to engage Medicaid and CHIP to improve child health and well-being and offers examples of promising projects from several states. The webinar specifically focused on including Medicaid in developing state applications for the Preschool Development Grant Birth through Five funding opportunity, while the paper gives suggestions for broader engagement.
Suggested strategies include finding a high-level champion for young children in state government and developing an understanding of the state’s basic Medicaid/CHIP structure and delivery system. Debbie Chang, one of the authors of the paper and a former Medicaid director in Maryland, says the best way to approach the Medicaid agency is to understand the agency’s goals, and highlight how your goals align with theirs.
Starting the conversation from a place of shared goals also helps build trust and focuses the attention of Medicaid officials who have many other priorities competing for their their attention and budget allocation. For instance, Medicaid/CHIP may already be paying incentives to health care providers for increasing or improving well care visits for children. Early childhood providers who want to see more well visits for the children in their care could help Medicaid/CHIP achieve the goal by facilitating partnerships with Head Start agencies to host health fairs and provide well care visits for a large number of their insured children at one time.
Another strategy to get started in partnership is to start small. For instance, in the District of Columbia, Nemours is working on a pilot project between child care centers, primary care providers, the Medicaid/CHIP agency and child-serving Medicaid MCOs to address the possible duplication or gaps in developmental screenings for young children.
When a child receives a developmental screening at their child care center, these partners are developing workflows so that those results get to the health care provider, and vice versa. The project is intended to reduce duplicative screens and more quickly refer children with abnormal screening results for specialty care.
The relationships developed through a small project like the D.C. effort could evolve into a system like the one created in Vermont where physicians train early childhood educators to administer developmental screenings that may be reimbursed by Medicaid. Because the educators are trained and use screening tools designated by doctors, the results can be directly added to the child’s medical record.
Advocates for young children have a key role to play to bring Medicaid administrators and early childhood educators together. Read the paper to find out more about how to get started.