Another Place for Medicaid Attention: Young Children’s Social Emotional Development

Early childhood mental health is not as widely understood and does not look the same as mental health challenges for older children or adults. But there’s good news: effective, evidence-informed, and promising interventions that support infant and toddlers’ mental health are available. That’s where Medicaid can help.

Our latest paper, Using Medicaid to Ensure the Healthy Social and Emotional Development of Infants and Toddlers, underscores the critical role for Medicaid—which insures nearly half of all infants and young children—in preventing, diagnosing and treating infant and early childhood mental health disorders. It suggests ways states can ensure the youngest children and their families receive the support they need to ensure strong mental health. It builds on our earlier report on opportunities for young children in Medicaid, and looks more specifically at social-emotional development.

Young children’s social and emotional development, also called infant and early childhood mental health (IECMH), lays the foundation for lifelong success. Because infants and young children’s brains are rapidly developing, mental health challenges look different. For example, excessive crying, developmental delays, failure to seek comfort from caregivers, or lack of curiosity could be warning signs that a young child’s healthy emotional development could be at risk. Left untreated, these early signals can escalate into more serious mental health disorders (e.g. Depressive Disorder of Early Childhood, Anxiety Disorders, Post-traumatic Stress Disorder, Attention Deficit Hyperactivity Disorder, etc.) that can upend lifelong health, as well as educational and economic success.

How we talk about this is important. Advocates and other stakeholders should be mindful of their audience when selecting terms and crafting messages around social-emotional development. ZERO TO THREE’s research suggests that while mental health experts and providers may prefer infant early childhood mental health (IECMH), parents, pediatricians, and the general public may be more comfortable with terms like social and emotional development. We use “IECMH” most often to specifically call attention to screening, diagnosis, and treatment services that may be supported in Medicaid. “Social and emotional health” or “emotional development” refer more broadly to promotion and prevention activities.

What can Medicaid do? As usual, there’s not one clear answer and it’s entirely state specific. But we offer some starting places for states, which include:

  1. Improving preventive screenings based on expert-recommended schedules and guidelines.
  2. Adopting diagnostic criteria and guidelines specific to young children’s mental health (the DC:0-5TM).
  3. Update or clarify payment policies and processes for needed IECMH services.
  4. Consider new settings or provider types appropriate for IECMH services.
  5. Include IECMH in broader Medicaid improvements and reforms.

Medicaid alone can’t solve broader system challenges, such as stigma or the need for more qualified mental health providers, but it can be a leader for improvements across payers and systems. That’s because Medicaid’s benefit for children, EPSDT, holds incredible potential to strengthen access to IECMH services. The opportunity to reach young children as early as possible —including dedicated attention on the relationships with their parents and caregivers—can prevent conditions from escalating and requiring more complex, expensive interventions.  Exploring opportunities in Medicaid is not easy. And, Medicaid can’t do this alone. But it’s essential to helping children reach their full potential.

(Where to start? We created a tip sheet for advocates to get conversations started and consider possible angles.)

We’re incredibly grateful for our partnership with ZERO TO THREE and their Think Babies campaign, which made this work possible. Learn more at