Leveraging Medicaid to Promote ERH and Lifelong Mental Well-Being | |
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Science tells us that relationships are foundational for future health and well-being, with early relational health (ERH) where it begins. The CSSP National ERH Initiative seeks to promote and protect the social-emotional well-being of children and families, beginning at birth. More can be done using Medicaid to promote ERH and improve health, mental health, and lifelong well-being. That is why we were heartened to see the August 18, 2022 Information Bulletin from the federal Centers for Medicare and Medicaid Services (CMS), which focuses on how to leverage Medicaid to deliver mental health services for children and youth. (Available here).
Children (birth to 21) enrolled in Medicaid are entitled to services under the Early Periodic Screening Diagnostic and Treatment (EPSDT) benefit. A prime purpose of EPSDT is to correct or ameliorate both physical and mental conditions. States’ obligation to finance all medically necessary care under EPSDT—whether or not such services are covered for adults in Medicaid—extends to promotion, prevention, screening, diagnostic assessment, and treatment related to mental health. Medical necessity determinations are made by the state under broad federal guidelines; they must take into account the individual child’s needs and information from the child’s health providers. CMS emphasizes that: “The goal of the EPSDT benefit is to ensure that individual children get the health care they need in the right place when they need it.”
Medicaid financing for a continuum of age-appropriate and family-centered health services is central to promotion of ERH and social emotional development. The CMS informational bulletin emphasizes the role of EPSDT and states’ responsibilities and opportunities. For example, opportunities include: improved rates of screening for mothers and young children, financing models that promote and intervene early for developmental and ERH concerns, paying for parent-child dyadic services, and integrating effective models into high performing medical homes. For a fuller list of policy opportunities for states that builds upon the CMS recommendations to states, click here.
We also note that about half of states have adopted the option provided under the American Rescue Plan Act (ARPA) to expand Medicaid coverage for pregnant women from 60 days to 12 months postpartum. “This provides major new opportunities to promote maternal health and early relational health,” said consultant Kay Johnson. “If all states adopted, this extended postpartum coverage following a Medicaid financed birth could reach as many as 2 million mother-infant pairs nationwide.” With this policy change, the opportunities to finance mother-child, dyadic interventions have grown dramatically.
The mental health impacts can begin at birth. “One in seven people experience postpartum depression, which is among the most common pregnancy complication and a leading cause of maternal death in the United States, yet it often is left untreated,” said consultant Karen Howard. “Parents with mental health problems are less able to support their children’s healthy growth and development, and they are less able to manage the responsibilities that come with the critical roles within their families.” Medicaid coverage is key to addressing this challenge.
Read the longer version of this article here.
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Question: What does it mean for some young woman to know that they will have medical insurance coverage (Medicaid) for their baby, themselves and for the wellbeing of their relationship for the next 12 months after birth? Or what might it mean, if that was not there?
ERH Family Network Collaborative Collective Response: "When a family knows they have insurance for both the mother and baby for the first year of life, it allows them to feel more peaceful. Not having insurance after the baby is born could impact your family finances and potentially your child's access to medical care, adding additional stress for the family. Relationships shouldn’t depend on having insurance, but the impact can affect their well-being."
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Schor, E. L., & Johnson, K. Child health inequities among state Medicaid programs. JAMA pediatrics, 175(8), 775-776. June 2021. Read Here.
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Fuentes-Afflick, E., Perrin, J. M., Moley, K. H., Díaz, Á., McCormick, M. C., & Lu, M. C. Optimizing Health And Well-Being For Women And Children: Commentary highlights interventions and recommends key improvements in programs and policies to optimize health and well-being among women and children in the United States. Health Affairs, 40(2), 212-218. January 2021. Read Here.
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Early Relational Health Initiative Vision:
Harness the Power of Early Relationships
for the Flourishing of All.
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The mission of the National Early Relational Health Initiative 3.0 is to ensure that all infants, young children, and their families benefit from supports and social connections that advance early relational health and its contribution to lifelong well-being and thriving.
Parents know that positive connections with their children matter, regardless of their circumstances. However, social, racial, cultural, and economic injustices and challenges can overload families and communities, often taking a toll on parents, young children, and their relational health. Because of barriers created by lacking family policies, families do not have access to supports that are responsive to their needs.
To promote Early Relational Health in every community, we need to first listen to parents to understand the challenges they are facing and what supports and services work best for them. We must then work together with families to create a shared vision to transform our communities, systems, programs, and policies, so each and every family can experience the emotional well-being and joy that come from those first days, months, and years of connecting and nurturing.
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Center for the Study of Social Policy
1575 Eye Street, NW, Suite 500
Washington, DC 20005
ERH@cssp.org
202.371.1565
www.cssp.org
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