Health Equity and Young Children

1. Health Equity and Young Children State Context May 30, 2013 BUILD Initiative Meeting Carrie Hanlon, Program Manager National Academy for State Health Policy (NASHP)

2. NASHP • Non-profit, non-partisan • Work with state agencies and branches of state government to advance workable health policy solutions • Identify best practices • Disseminate lessons nationally • Guided by Academy Members • www.nashp.org

3. Related Work • Healthy child development • Assuring Better Child Health and Development (ABCD) • 25+ states (CO, MI, MN, OH) • Health equity/disparities • Aetna Health Equity Learning Collaborative • 7 states (MN, OH) • AHRQ HCUP Race/Ethnicity Workgroup • State collection and use of race/ethnicity data • Other (oral health, primary care transformation)

4. Dual challenges • Emphasis on immediate (health care) savings—adults, chronically ill populations • Desire to simplify, “one size fits most”, resistance to or lack of understanding about importance of addressing inequities

5. A Golden Opportunity • Health care delivery reform—care teams, accountable care initiatives • Increasing focus on community partners/ linkages, social determinants of health and population health • A way to bring in partners with expertise in early care/education, child health and health equity

6. State Roles • Purchase health care services • Define benefits • Regulate professionals and facilities • Collect and report data • Set standards and measure performance • Inform consumers • Educate and train healthcare professionals • Convene stakeholders

7. Medicaid, Medicaid, Medicaid, (and CHIP) • 1 in 3 children under the age of 6qualifies for Medicaid (Urban Institute-UI) • Medicaid (and CHIP) covered over half of all Hispanic and black children in 2010 (UI) • Compared to higher-income peers, children from low-income families or on Medicaid • Lag behind developmentally from as early as nine months of age (Halle et al., 2009) • Experience Adverse Childhood Experiences at higher rate (WI Children’s Trust Fund, 2010) • Have nearly twice the rate of untreated tooth decay (GAO, 2008)

8. Regulatory, Purchasing Strategies • Set cultural and linguistic requirements for managed care plans (CA) • Require health care providers to complete cultural competence training (NJ) • Develop Medicaid managed care pediatric performance improvement projects (IL, OR)

9. Regulatory, Purchasing Strategies, continued • Provide Medicaid reimbursement for: • Maternal depression screening (IL) • Care coordination (OR) • Preventive oral health services by mid-level dental providers or PCPs • Screening for trauma or adverse childhood experiences?

10. Data and Measurement • Create a standardized race/ethnicity data collection policy (CT) • Inventory state agency collection of race/ethnicity/language data (MN) • Establish Medicaid pay for performance incentive measures: • Developmental screening (OK) • Disparities reduction (MA)

11. Delivery Reform Initiatives • Overarching focus on children/equity: • Children: RI Health Home SPA, CO medical homes • Equity: OH medical homes, OR CCOs • Pediatric medical home qualification and recertification standards • Pediatric learning collaboratives • Education for community-based programs (Head Start, home visiting) • Child health and development data • Expectations for community partnerships, linkages and engagement

12. Cross-systems Strategies • Educate policy makers about health equity (CT, MN) • Align education, early care, health care • Tailored positions • Cabinet-level child health director (OR) • Health equity? (OH Commission) • Shared goals/outcome measures • Kindergarten readiness (OR) • Social determinants of health approaches • Breathe Easy at Home (RI, Boston) • Medicaid outreach and enrollment using public health data, GIS, spatial analysis (VA)

13. Some Takeaways • Optional vs. required, general vs. specific • Include examples/expectations in guidance • State “template” with local flexibility • Who is at the table matters • Cross-pollinate early learning, health equity, and health reform councils • Convene pediatric advisory groups or include pediatric providers in existing committees • Establish and leverage family-centeredness and community partnership expectations

14. Links • NASHP website: www.nashp.org • Adverse Childhood Experiences in Wisconsin: Findings from the 2010 Behavioral Risk Factor Survey. (Wisconsin Children’s Trust Fund) http://wichildrenstrustfund.org/files/WisconsinACEs.pdf • C. Coyer and G. Kenney, The Composition of Children Enrolled in Medicaid and CHIP: Variation over Time and By Race and Ethnicity (Urban Institute, 2013) http://www.urban.org/publications/412783.html • T. Halle, et al., Disparities in Early Learning and Development: Lessons from the Early Childhood Longitudinal Study—Birth Cohort (The Council of Chief State School Officers and Child Trends, 2009). • U.S. Government Accountability Office, Extent of Dental Disease in Children Has Not Decreased, and Millions are Estimated to Have Untreated Tooth Decay (Washington, D.C.: GAO, 2008). http://www.gao.gov/new.items/d081121.pdf