How Are States Addressing Mental Health Needs of Infants and Toddlers in Medicaid Policy? New 50-state Report

As lawmakers scramble to address the nation’s worsening mental health crisis among children, few of these efforts have focused on the unique developmental needs of children before they reach kindergarten. It’s hard to imagine an infant or toddler experiencing mental health challenges, but as ZERO TO THREE shows,10-16% of young children experience mental health conditions, including PTSD and anxiety. For low-income infants, the rate is above 20%.

There are many reasons why mental health for the youngest children may be overlooked: lack of broad awareness, important differences in the ways mental health looks for children at the earliest stages of development (even before they can use language to express their needs), and the ways in which the traditional health care system is incentivized and oriented to focus priorities on the more visible and acute needs of adults and older children.

While the mental health needs of young children may look different, they are no less urgent. Strong early emotional development relies on a secure, nurturing relationship between a child and their parent and/or caregiver, a foundational element to early brain development and lifelong health. Because of this, infant-early childhood mental health (IECMH) addresses children’s needs in the context of their parents and caregivers – child and parent mental health is interdependent and relies on the family, community and policy context.

Medicaid’s pediatric benefit, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT), is designed to ensure all children access developmentally-appropriate health services to prevent or lessen health problems, including mental health, even before a formal diagnosis is needed. Where do states stand on working to prevent, mitigate, or address mental health problems for the youngest children through services and supports?

Our new report, Medicaid Policies to Help Young Children Access Key Infant-Early Childhood Mental Health Services: Results from a 50-state Survey, aims to answer this question. We were honored to co-create the report with the National Center for Children in Poverty (NCCP) and Johnson Policy Consulting. This report is a revamped version of NCCP’s 2018 survey, which helped to launch the Medicaid IECMH conversations in many states. Our new survey sought to access more detailed information on state Medicaid payment and processes for specific services, especially those, such as maternal depression screening in well-child visits or parenting programs, that seek to serve the parent-child relationship in the earliest months and years of a child’s life. We are especially thankful for the Medicaid agency staff who took time to respond to the survey during an already-busy time of unwinding.

While we can’t do a direct comparison to the previous survey, our findings do suggest more states are taking steps to formally recognize IECMH in reimbursement policies. One key example is state Medicaid recognition of DC:0-5™: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, a mental health diagnostic system specifically designed to address the developmental needs of children under age 5. In 2018, 19 states allowed use of the  DC:0-5™, with 6 of the states recommending or requiring its use for young children. Today, at least 25 states recognize the DC:0-5, with 15 of those states recommending or requiring its use.

States can use the report findings to identify actionable steps to improve access to services designed to serve early childhood development and early relational health before conditions are more difficult and costly to treat as children age. We recommend state advocates and partners use the findings to set discussion tables with the many systems that serve young children – Part C early intervention, child welfare, early childhood education, home visiting, etc. – to determine the best ways to improve policies that help to spread IECMH services and implement their adoption. Rhode Island just went through this process as part of a legislatively-required IECMH Task Force whose recommendations will be issued later this year.

As the nation grapples with the best way to address the maternal and mental health crises, establishment of a clear Medicaid priority focusing on the mental health needs of perinatal women and young children deserves much greater attention. Watch this space for more resources on state lessons learned in IECMH in the coming weeks and months ahead.

Elisabeth Wright Burak is a Senior Fellow at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.