The first 1,000 days of a child’s life are a critical window for cognitive, physical, and social development. Exposure to adverse experiences during this period and beyond in early childhood dramatically increases the potential for lifelong poor health and social outcomes. This in turn can result in substantially increased health care costs across an individual’s life span. Adverse childhood experiences (ACEs) — including neglect, abuse, exposure to violence, family dysfunction, etc. — also drive negative social outcomes, such as poor school performance and involvement in the juvenile justice system, often leading to poor health consequences later in life.
Medicaid covers almost half of babies born in the United States and 40 percent of children. As such, intervening via Medicaid offers a prime opportunity to increase the odds that children (ages 0-3) get a good start in life. Indeed, before age three, the health care system is the social institution most likely to have regular contact with young children (e.g., a recommended schedule of 12 well-child visits before age three). Medicaid provides comprehensive benefits for children including guaranteed access to developmental screenings and treatment services. In short, Medicaid is uniquely positioned to serve as a platform for identifying problems and connecting at-risk infants, young children, and their families with needed health, developmental, and social services.
Capitalizing on the Window of Opportunity
Even though the pay-off for prevention is a long-term venture, more and more Medicaid stakeholders and policymakers are recognizing the importance of exploring Medicaid-driven strategies to generate system-wide investments in upstream prevention. These approaches will necessarily involve going beyond Medicaid and working with other state and local health and social service agencies. The financial incentives for such Medicaid investments will be clearest for stakeholders that will potentially bear the fiscal responsibilities as children grow into adulthood (e.g., states, regional health plans, accountable care organizations, etc.).
Through a planning grant from the David and Lucile Packard Foundation, the Center for Health Care Strategies (CHCS) convened Medicaid agencies and health plans in six states — Connecticut, Maryland, Minnesota, New York, Oregon, and Washington — to identify new strategies to support high-risk, low-income families, prevent ACEs, and improve the life chances, social determinants, and educational prospects of infants and young children. Through our conversations, a number of topics have emerged as key to this work:
- Integrating cross-sector data;
- Using data analytics and predictive modeling to target interventions to the highest risk infants, families, and neighborhoods;
- Identifying assessment tools and shared metrics (e.g., kindergarten readiness);
- Building state and community level cross-agency partnerships (e.g., across health, early childhood, child welfare, housing etc.); and
- Creating new clinical models and community linkages to medical practices.
With additional support from the Robert Wood Johnson Foundation and the David and Lucile Packard Foundation, CHCS is launching the Medicaid Early Childhood Innovation Lab to continue its work within the identified early innovator states, and create new partnerships with other states and plans. A learning group will be formed to design, implement, and spread strategies for: (a) creating the conditions for optimal early childhood (ages 0-3) health and development of all children; (b) intervening with higher risk low-income families to prevent childhood trauma/ACEs, boost kindergarten readiness, and reduce long-term health and social services costs for federal, state, and local governments; and (c) generating connections between Medicaid stakeholders and innovators in early childhood development. Lessons from the participating teams will be shared broadly with stakeholders across the country.