Using Medicaid to Ensure the Healthy Social and Emotional Development of Infants and Toddlers

In This Report:

Part I: Executive Summary

Each child’s social-emotional development underpins overall development and greatly influences his or her lifelong trajectory. Infants and toddlers experience a period of rapid brain development marked by great possibility and vulnerability, depending on their family and community contexts. The first years of life are particularly crucial to a child’s development of a sense of security and attachment with others, foundational activities that undergird subsequent social and emotional development. Prolonged stress brought on by trauma – parental substance abuse, poverty, and other family, social, and/or environmental factors – places healthy development at great risk. Nurturing relationships with parents and caregivers can mitigate these risks, especially with early identification and support for young children’s mental health needs along with those of their parents. But when such stress gets in the way of consistent caring and, responsive parent-child relationships, it can lead to a host of health, behavioral, social, and emotional difficulties for the child throughout his or her life.

Young children’s social and emotional development, also called infant and early childhood mental health (IECMH), lays the foundation for lifelong success.1 Many interventions to prevent and treat young children’s emotional health, often focused on relationships with their parents or caregivers, are available and effective. Yet federal and state health care, mental health and early childhood policies do not reflect the evidence base for IECMH.2

Read Part 1.

Part II: What is Infant and Early Childhood Mental Heath (IECMH) and Why Is It Important

Infant and early childhood mental health (IECMH) is a young child’s ability to experience, express, and regulate emotions; form close, secure interpersonal relationships; and explore his or her environment and learn, within the context of family and cultural expectations.

Read Part II.

Part III: Medicaid and IECMH

As the primary health insurance source for young, low- income children, Medicaid is the logical system to reach them with their families before they enter school. More than one-third of all children rely on Medicaid and CHIP for health coverage, and the programs play an even greater role for the nation’s youngest children.

Read Part III.

Part IV: Recommendations and Conclusion

Without clear guidance or intentional effort to incorporate the unique developmental needs of young children, health and mental health systems often apply practices tailored for adults that may be inappropriate in pediatric care. And as knowledge and evidence about IECMH has grown, it has not fully translated to widespread system change.

Read Part IV.

Part V: Getting Started – Questions to Guide Discussions on Medicaid and IECMH

There are many places to begin to assess a state’s potential to do more for Infant Early Childhood Mental Health (IECMH) in Medicaid.

Read Part V.

Part VI: Additional Resources and Appendices

Read Part VI.

Full Report

Download and read the full report.


Tip Sheet: Why Advocates Should Elevate the Importance of Social and Emotional Development for Young Children


Archived Webinar: Medicaid’s Role in Ensuring Young Children’s Healthy Emotional Development

Webinar Slides: Medicaid’s Role in Ensuring Young Children’s Healthy Emotional Development

Webinar Slides: Infant & Early Childhood Mental Health Financing Policy Project

Webinar Slides: Advocating for a Comprehensive Early Childhood Mental Health System in Virginia

Webinar Slides: How States use Medicaid to Cover Key Infant and Early Childhood Mental Health Services


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ZERO TO THREE created the Think Babies™ campaign to make the potential of every baby a national priority. Funding partners for Think Babies™ include the Robert Wood Johnson Foundation, which supports the campaign’s public education aspects, and the Perigee Fund, which supports the campaign’s public education and advocacy aspects. Learn more at

  1. Cronholm, P.F., C. M. Forke, R. Wade, M.H. Bair-Merritt, M. Davis, M. Harkins-Schwarz, L.M. Pachter, J.A. Fein. (2015). Adverse Childhood Experiences: Expanding the Concept of Adversity. American Journal of Preventive Medicine, 49(3): 354–361. Felitti, V., R. Anda, D. Nordenberg, D.F. Williamson, A.M. Spitz, V. Edwards, M.P. Koss, and J.S. Marks. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4): 245–258.