Yesterday the House reconfirmed its intent to make massive cuts to Medicaid after the Senate rubber stamped the plan last week. Despite repeated polls – including one from President Trump’s polling firm Fabrizio Ward – showing large majorities of American voters do not want to see Medicaid cut, Congress is moving full steam ahead to do just that as they move into the next phase of the budget reconciliation process.
Those of us focused on early childhood health and development don’t need a poll to show us how popular Medicaid is as we see the results: it connects infants and toddlers to the care they need to arrive at kindergarten ready to learn. Part C of the Individuals with Disabilities Act (IDEA), or early intervention, relies on Medicaid in most states to help pay for an array of therapies, treatments and services for eligible infants and toddlers with disabilities or developmental delays similar to the way Medicaid supports school-aged children and children with disabilities or special health care needs. Part C early intervention is dedicated to infants and toddlers as a school readiness effort. States are required to identify and serve children under age three with developmental needs and engage families as partners in an action plan with their care teams. Early intervention has been shown to minimize or eliminate the need for special education services once children enter kindergarten and can help states save money. Children can be referred to early intervention based on a developmental screening at a check-up with their doctor, or by parents who are concerned about their developmental milestones. Once they have been assessed, they may qualify if they meet the state’s eligibility standards– most based on disability status or level of developmental delay.
If a child enrolled in Part C Early Intervention is also covered by Medicaid, in most states, Medicaid covers eligible services provided by eligible service providers. Based on a child’s needs, early intervention provides services such as physical or occupational therapy, vision, speech/ audiology, nutrition, psychological and social work and service coordination services. Many– if not all –of these services qualify for Medicaid reimbursement when provided to a Medicaid-enrolled child under Medicaid’s pediatric benefit, Early, Periodic, Screening, Diagnostic and Treatment (EPSDT). Read more in our recent brief Medicaid Provides Early Intervention for Infants and Toddlers with Disabilities and Developmental Delays. As states increasingly seek to ensure coverage translates to improved access and care quality for young children, more states have even worked to ensure improved coordination across Medicaid and early intervention, such as Washington and California.
Last week CCF hosted a webinar with our friends at the IDEA Infant & Toddlers Association and ZERO TO THREE to raise awareness about the ways Medicaid and IDEA work together in states. The star of the discussion was Rebecca Amidon, a Michigan parent of two children who received early intervention services. Rebecca explained how Medicaid and Early Start, Michigan’s early intervention program, worked together to help her children in Michigan to get the care they needed that family could not afford without coverage.
Rebecca’s not alone, as a recent NPR story featured a Texas family who also relies on Medicaid and Early intervention. On the webinar, Adriana Kohler from Texans Care for Children shared the ways Medicaid and Early intervention work in Texas, and how state cuts to both programs a number of years back led to decreases in providers that further restrained access to timely care.
What would billions in Medicaid cuts do to families like Rebecca’s? Or state systems of care? While the specific impact would depend on choices made by state lawmakers, cuts of that magnitude would destabilize Medicaid, its providers, and everyone relying on the health program at risk. Cuts would be especially concerning for early intervention by:
Restricting states’ flexibility to serve infants and toddlers through IDEA and Medicaid. States depend on Medicaid’s flexibility to help cover the cost of eligible early intervention services for children who qualify for both programs. Leveraging Medicaid to support early intervention has become even more critical as federal funds for Part C have not kept up with the number of children served.
Jeopardizing the federal guarantee of services under both programs. Two federal laws – IDEA Part C and Medicaid EPSDT – protect the rights of infants and toddlers with disabilities or developmental delays who qualify to receive early intervention services that can support positive development and aid school readiness. Early intervention can help to prevent or lessen disabilities or delays that become more complex and costly to address as they age and enter school– even shown to minimize future special education costs. Medicaid cuts could force states to roll back Medicaid provider payments that may further inhibit access to needed care.
Undermining school readiness efforts. Nearly every state is actively working to make sure children get to school ready to learn. Undermining states’ ability to get children the services they need as early as possible will lead to higher costs as more children arrive at school with delays or challenges that could have been addressed earlier.
The long-term fiscal benefits of Medicaid coverage during childhood have been well-documented and the Congressional Budget Office has estimated that it contributes to our nation’s GDP over the long run. Our country needs healthy and well-educated children to grow into thriving adults and families need a strong Medicaid program to help reach that goal.