By Kate Breslin, Schuyler Center President & CEO
As children around the state return to school – the first nearly-normal return to school since 2019 – there is fresh attention on how to best support our children after an extended period of disruptions.
In the two and half years since the onset of the COVID-19 pandemic, researchers and government agencies have been exploring what we know about education, child health, and mental health – and questioning traditional approaches, especially when it comes to children and families with access to fewer resources. Recent bulletins published by the federal Center for Medicaid and CHIP Services focus on strengthening mental health care and access and expanding care in schools.
Bringing Services to Children: Increasing Equity Through School-Based Health Programs
In August 2022, the Center for Medicaid and CHIP Services released two important bulletins with information about how states can improve child health. One brief focuses on school-based health services and the other on opportunities to leverage Medicaid and the Children’s Health Insurance Program (CHIP) to improve children’s mental health in the context of the nation’s child and youth mental health crisis.
Nationally, use of health care services among children declined during the public health emergency. Data show 2% fewer vaccinations, 6% fewer child screening services, 24% fewer outpatient mental health services, and 24% fewer dental services. Even before the pandemic, as many as one in six US children between the ages of 6 and 17 had a mental health disorder and in December 2021, the US Surgeon General issued an advisory calling youth mental health a crisis that has been exacerbated during the pandemic, saying that “even before the pandemic, an alarming number of young people struggled with feelings of helplessness, depression, and thoughts of suicide — and rates have increased.”
The “Information on School-Based Services in Medicaid: Funding, Documentation and Expanding Services” bulletin (8/18/22) articulates support for school-based health programs and notes that the school setting provides a unique opportunity to enroll eligible children in Medicaid and CHIP and furnish Medicaid-covered services, including mental health and substance use disorder services. It goes on to say that schools are uniquely positioned to increase health equity and help ensure that all children have access to necessary health care services, including services provided through a formal Individualized Education Program (IEP) and Individualized Family Service Plan (IFSP). The bulletin summarizes existing guidance and strategies for states to consider in developing proposals to implement, maintain, and expand school-based health services. The bulletin includes information about existing state flexibilities and best practices for maximizing Medicaid coverage for services furnished to beneficiaries in schools.
Screening, Diagnosis, and Treatment
The “Leveraging Medicaid, CHIP, and Other Federal Programs in the Delivery of Behavioral Health Services for Children and Youth” bulletin (8/18/22) aims to prevent the potentially lifelong consequences of unaddressed Adverse Childhood Experiences (ACEs) and other problems by providing information about EPSDT requirements and other authorities available to states to deliver effective prevention and interventions, including treatment, through their Medicaid and CHIP programs. EPSDT is a part of federal Medicaid law that requires the provision of screening, diagnosis, and treatment to correct or ameliorate physical and mental illness and other conditions. It is inclusive of vision, dental, hearing and other concerns. EPSDT is a mandatory benefit for all children and youth covered by Medicaid and, while not a federally required benefit for CHIP enrollees, New York recently elected to provide the EPSDT benefit under its CHIP state plan.
Healthy Families, Strong Communities
Schuyler Center prioritizes policies that strengthen New York families and communities, with a special focus on disenfranchised populations, by ensuring a strong and healthy start for all, regardless of income, race, and ethnicity, and by promoting robust and sustainable public systems that generate positive results for New York children and families. With 78% of low-income children in New York covered by Medicaid and CHIP, it is critical that the state use these resources to ensure that children have access to critically needed services and care. These recent bulletins and recommendations provide examples of how to do so.
Further Reading:
- A recent National Institutes of Health study that appears in The Lancet Regional Health – Americas suggests poverty combined with other types of adversity in early childhood, is associated with greater chances of premature death in adulthood.
- Adversity and Opportunity—The Pandemic’s Paradoxical Effect on Child Health and Well-being – JAMA Pediatrics, March 2022
- CMCS Informational Bulletin on EPSDT and behavioral health (August 18)
- CMCS Informational Bulletin on School-Based Services in Medicaid (August 18)
- Proposed rule on Medicaid and CHIP Core Set measures (August 18, comments due October 21)
- CMCS Informational Bulletin on USDA demonstration to evaluate using Medicaid eligibility information to directly certify children for free and reduced price school meals (August 18, state applications due September 30)
- Proposed rule on streamlining eligibility, enrollment, and renewals in Medicaid, CHIP, and the Basic Health Program (August 31, comments due November 7)
- Proposed Eligibility Rule Simplifies Medicaid and CHIP Enrollment Process for Children – Georgetown University Health Policy Institute
- Child Health Policy resources from Schuyler Center
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