Rural Health Policy Project

Opportunities for Supporting Children and Families through Pediatric Primary Care in the Time of COVID-19

The COVID-19 pandemic is causing serious health and economic consequences on families, children, and communities and is threatening the viability of the health care delivery system. While we can’t know the lasting consequences of the unprecedented stress confronting families, it is likely to have detrimental, lasting effects on the social and emotional health of our children. The routine well-child visit and the connections to pediatric primary care providers and community supports that many families rely upon for reassurance, guidance, and support have also been fundamentally disrupted. These impacts of COVID-19 are further magnified in communities of color where deep rooted structural inequities in wealth, housing and education, access to health care, and generations of discrimination and racism have fueled injustice and disparities.

A focus on the social and emotional development of young children, the important roles of pediatric primary care providers, parents and caregivers, and the potential of Medicaid, the Children’s Health Insurance Program (CHIP) (and other federal and state programs) which are the core pillars of the Pediatric Supporting Parents initiative are critical to responding to the impacts of the pandemic. To support and sustain high-performing pediatric primary care, the Pediatrics Supporting Parents Initiative has launched is supporting state and county health officials participating in our technical assistance workgroup to discuss strategies to navigate the pandemic that support pediatric practices’ efforts to continue to strengthen the social and emotional health of young children and the parent-child relationship.

This blog and our technical assistance to the PSP Initiative focuses on laying out newly available federal funding opportunities for states and health care providers as well as a near-term set of Medicaid/CHIP policy and financing strategies.

New Federal Funding Opportunities

To-date, four federal stimulus bills have made available trillions of dollars in federal aid. These federal funds have been distributed through a range of mechanisms, including supplemental allocations to existing health and social services co-operative agreements and grants to new opportunities for states and health care providers. Example federal funding opportunities include:

Program and Agency Purpose/Eligible Uses Implications/Considerations for Pediatric Providers
Department of Treasury’s Coronavirus Relief Fund $150 billion to states, tribal governments, and local governments for COVID-19 response efforts to support expenditures incurred due to COVID-19 from March 1 through December 30, 2020. Funds are fairly broad and flexible, pediatric providers will want to be at the table with state and local decision-makers to inform use of these funds.
Department of Health and Human Services’ Provider Relief Fund $175 billion in payments to providers for expenses or lost revenues attributable to COVID-19.

 

Early rounds of funding have been distributed to providers based on Medicare revenues, hospitals in COVID-19 “hotspots,” and providers in rural areas. Advocacy efforts ongoing to ensure future distributions are targeted to Medicaid and pediatric providers.
HRSA Community Health Center Funding Nearly $2 billion in supplemental awards to federally qualified health centers to respond to COVID-19, including funding dedicated to testing. Pediatric providers will want to coordinate with community health centers and clinics on leveraging these funds.
FCC COVID-19 Telehealth Program Funds for public and non-profit health care providers to purchase telecommunications, broadband connectivity, and devices for providing telehealth. If eligible, pediatric providers should be applying now as funding decisions are made on rolling basis until funding is exhausted.
Small Business Association Paycheck Protection Program $670 billion in loans to small businesses (500 employees or fewer) to pay workers and keep them on payroll during COVID-19. Provides for loan forgiveness, with certain limits. Pediatric practices may apply like other small businesses.
FEMA Disaster Relief Fund At least $45 billion in assistance to states, communities, health care providers, and families. Applications will be made through the state. Pediatric providers will want to be engaging with state designated agencies for opportunities, and ensure that they are maintaining detailed records if receiving these funds.

In addition to the opportunities specifically authorized under the stimulus packages, states will want to watch for other relevant funding opportunities being made available in the near-term by the federal government. For example, the Centers for Disease Control and Prevention (CDC) recently announced an opportunity for several cooperative agreements with states, localities, tribes, non-profits, and other organizations to invest in infrastructure and implementation for prevention of adverse childhood experiences (ACES).

To optimize federal funding, strategic analyses, and decision-making on state and local levels are needed. Key considerations include: focusing on needs and obtaining actionable data from stakeholders to assess needs and disparities; considering the whole care continuum, including health and social needs; and prioritizing federal funding streams while developing Medicaid and CHIP strategies concurrently.

Medicaid and CHIP Strategies

Medicaid and CHIP continue to offer levers to support high-performing pediatric primary care that holistically promote the social and emotional development of young children and connect families to the resources and supports they need in the community. However, it is critically important to acknowledge that states are also grappling with unprecedented economic impacts and grave fiscal pressures as a result of COVID-19; efforts to ensure additional federal support for Medicaid and CHIP through enhanced federal matching funds are essential to facilitating a robust Medicaid and CHIP response.

Policy and financing strategies that states could pursue in the near-term include:

  • Submitting “second round” requests to CMS for flexibility: All states have submitted and been approved for various flexibilities under expedited disaster Medicaid and CHIP authorities. States could now look to a next wave of priority needs to be addressed, including issuing directed payments to pediatric primary care providers and funding telehealth investments.
  • Leveraging Medicaid IT funding and emergency expedited approval authority: Longstanding federal rules authorize enhanced federal funding for Medicaid IT activities and CMS has signaled new appetite for flexibility in light of COVID-19. States could explore investments with CMS for solutions to enhance and scale telehealth, facilitate health data exchange, and enable referrals to social services for pediatric providers.
  • Submitting a CHIP Health Service Initiatives (HSI): States could continue to take advantage of the flexibility of HSIs with a COVID lens and also benefit from a further enhanced FMAP from the Families First Act. Examples could include expanding behavioral health capacity, nutrition services, or other social supports.
  • Moving eligibility and enrollment resources to where families still go: The conditions for receiving enhanced federal Medicaid funds under the Families First Act will help facilitate retention of coverage by children and families currently covered by Medicaid. However, states will want to continue to maximize access to health coverage for the uninsured and it will be important to focus resources on online options, unemployment agencies, and food banks.

Increasingly, we are hearing reports about declining pediatric primary care visits and a concurrent drop in children’s immunizations. A combination of the federal funding opportunities and Medicaid and CHIP strategies could be leveraged to provide personal protective equipment (PPE) to pediatric practices to operate safely,  support pediatric practice reconfiguration and provider training to safely complete visits,  conduct outreach to reassure families that they are able to safely visit their pediatric provider and vaccinate their children, and re-engineer service delivery.

We’ve focused on strategies that may be leveraged for near-term support and relief. However, continued attention and significant additional federal resources—in the form of additional funds better directed to pediatric providers, greater state fiscal relief through a larger and longer term increase in the federal Medicaid matching rate, and other support—will be needed to ensure the sustainability of a high-performing pediatric primary care delivery system to support children and families, and a likely increase in social and emotional health needs emerging from the COVID-19 pandemic.

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