Twelve powerful ideas (and lots of tools!) to leverage Medicaid for better outcomes in children’s mental, physical, and emotional health

Part 5 of guidance for advancing action along NC Pathways to Grade-Level Reading

Here is the fifth of our five-part Pathways to Grade-Level Reading Policy and Practice Action Toolkit to provide guidance for how policymakers, advocates, community non-profits, the business community, and other stakeholders can work together to move us closer to the goal of  all North Carolina’s children reading on grade-level by third grade. This Toolkit also highlights organizations and initiatives across the state that are already taking action to move the needle forward. 

Explore Part 1, Part 2, Part 3, and Part 4 of the Toolkit here. Read on to preview the actions that are the focus of each Toolkit. 

In this Pathways toolkit we focus on how Medicaid can be leveraged to support a broad range of services that can strengthen child and family wellbeing. Medicaid holds enormous potential because it touches such a huge number of families: Nearly half of children under age three in the United States get their health insurance through Medicaid and the Children’s Health Insurance Program (CHIP). Further, federal Medicaid law specifically requires that children under the age of 21, who are eligible for Medicaid, receive all medically necessary services through Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) –  regardless of whether those services are included in the North Carolina State Medicaid Plan.

The importance of Medicaid for strengthening the health and wellbeing of children in low-income households cannot be understated: At least three-fourths of children under age 6 in low-income households rely on Medicaid or CHIP for health coverage. Of the general population of children in North Carolina, approximately 33% of African-American and 20% of White children had Medicaid coverage.

Because Medicaid serves families with low or moderate incomes, it is important to think beyond direct provision of health care and address broader social determinants of health. The large number of children that are served, the high number of touch-points that families experience with pediatric care providers over the first three years of life, and the deep level of trust parents often have with their pediatric care provider, all make Medicaid a critical leverage point for promoting children’s on-track development and well-being, beyond the provision of basic healthcare services. 

The Pathways Toolkit part 5 contains a myriad of resources and policy models from other states that illustrate how Medicaid funds can be leveraged to improve young children’s health outcomes, including:

• Improving consistency of care from birth to Kindergarten entry;
• Enabling clinicians to identify the array of childhood and family services that can be billed to Medicaid;  
• Leveraging Medicaid to advance parity in mental health parity reimbursement rates; 
• Leveraging Medicaid to improve parents’ mental health; and
• Leveraging Medicaid to provide infants and children with behavioral and mental health supports.

Addressing Social Determinants of Health

Because Medicaid eligibility is typically determined by low income, families who are eligible for Medicaid are often at higher risk for experiencing a host of challenges that can adversely affect their physical, psychological, and behavioral health. Some of the effects are direct, such as hunger, housing insecurity, and exposure to violence in the community and at home. Some of the effects are indirect, related to caregiver stress and coping with trauma. A substantial amount of research informs us that the best healthcare is only of marginal benefit unless health insurance systems and providers also address the social factors that can have such profound impacts on health. 

Resources and policy models in this Pathways Toolkit part 5 illustrates how North Carolina and other states are using Medicaid to address these impacts by leveraging Medicaid:

1. To address broader social determinants of health;
2. Using a two-generation framework;
3. To advance home visiting;
4. To advance integrated and collaborative care;
5. For school based services;
6. To improve outcomes for children in the Child Welfare system; and
7. To expand access to doula services.

Additional Policy Areas for Strong Early Childhoods

This toolkit also highlights five important actions identified by Pathways stakeholders that can help ensure that parents and their young children can be resilient and thrive, even in the face of adversity. These include:  

• Use data to track community needs and service provision 
• Screen children and families for social determinants of health and connect them to appropriate services;
• Invest in two-generation interventions;
• Expand maternal depression screening and treatment; and
• Include at-risk children in early intervention.

Organizations and initiatives around North Carolina are working hard to implement many of these actions and policy recommendations through innovative programs. Several are profiled in this toolkit, including Book Babies, which partners with families of Medicaid eligible children to develop their child’s early language and literacy skills; Family Connects, which provides universal newborn nurse home visiting program that combines engagement and alignment of community service providers with short-term nurse home visiting; and REACH, which provides case management services with the goal of addressing the social-emotional, behavioral, developmental, and academic needs of children. Learn more about these and other initiatives in the toolkit. 

Download Toolkit Part 5 Here

What is Pathways to Grade-Level Reading?

The Pathways to Grade-Level Reading initiative aims high and is driven by a bold vision:

All North Carolina children, regardless of race, ethnicity or socioeconomic status, are reading on grade-level by the end of third grade, and all children with disabilities achieve expressive and receptive communication skills commensurate with their developmental ages, so that they have the greatest opportunity for life success. 

Toolkit Part 1 (access here) 

• Support Families in Advocating for their Children
• Require Linked Strategies Across Programs to Engage and Learn from Families
• Ensure Assessment Instruments are Culturally and Linguistically Relevant
• Ensure Education Accountability Systems are Culturally Relevant
• Provide Professional Development for Teachers on Cultural Competency/Working with Families
• Support Schools and Child Care Programs to Engage Deeply with Families 

Toolkit Part 2 (access here)

• Recruit and Retain Educators and School Leaders of Color
• Adjust Hiring Practices to Ensure High-Quality Educators
• Invest in School Health and Mental Health Staff and Clinics
• Eliminate or Minimize Suspension and Expulsion

Toolkit Part 3 (access here) 

• Create Family-Friendly Employment Policies
• Ensure Accessible Transportation to Early Care Programs, Schools and Health Services
• Provide Wraparound Services for High Quality Early Care and Education
• Expand Child Care Subsidies for Children; Raise Child Care Subsidy Rates; and Provide Higher Subsidy Rates to Providers in Underserved Communities
• Increase Standards and Compensation of Birth-through-Age-Five Educators

Toolkit Part 4 (access here)  

• Address Barriers in Health Insurance Coverage of IECMH Services to Ensure Adequate Benefits
• Create a Mental Health Professional Development System Focused on Infant and Toddler Clinicians 
• Increase Professional Development in Mental Health Treatment for Pediatricians and Family Physicians 
• Integrate Mental Health Providers with Pediatric and Other Primary Care Practices
• Expand the NC Child Treatment Program

Toolkit Part 5 (current toolkit) 

• Use Data to Track Community Needs and Service Provision 
• Screen Children and Families for Social Determinants of Health and Connect them to Appropriate Services
• Expand Maternal Depression Screening and Treatment
• Invest in Two-Generation Interventions
• Include At-Risk Children in Early Intervention

Keep in Touch with NCECF and Support Our Work

Learn more about the Pathways Action Map and consider adding your work to the map! Share it with others in your network and community, whose work you think should be spotlighted. We want to utilize the Map as a resource to build awareness of innovation, make connections, and identify gaps and opportunities that can help guide policy making, advocacy, funding, and capacity building.

If you have any questions, or would like a guided tour of the Pathways Action Map, please contact us. We’d love to hear your ideas on how to continue to utilize this tool to support the success of all North Carolina children.

Please be sure to subscribe to our biweekly newsletter and consider making a donation today to continue a strong 2024 by helping us transform the lives of North Carolina families, from their earliest days, while also supporting a small growing, family-friendly team. 

The NC Early Childhood Foundation is driven by a bold – and achievable – vision: Each North Carolina child has a strong foundation for life-long health, education, and well-being supported by a comprehensive, equitable birth-to-eight ecosystem. We build understanding, lead collaboration, and advance policies to ensure each North Carolina child is on track for lifelong success by the end of third grade.