Start: February 2019

Funder: Robert Wood Johnson Foundation


The health care system is often the first social sector to connect with the at-risk population of infants in low-income families. With Medicaid covering more than half of all births in many states, and 40 percent of children nationwide, state Medicaid leadership is particularly well-positioned to spur innovations that can improve outcomes for young children and their parents. However, in most states the connection between the health care and early childhood sectors is, at best, tenuous, and Medicaid’s potential to support early childhood and family services is largely untapped. Advancing greater alignment between Medicaid and early childhood-serving agencies is critical to identifying upstream opportunities that reduce adverse childhood experiences. Intervening during the first 1,000 days of life can potentially generate long-term payoffs for young children, as well as the social systems that will serve them into adolescence and adulthood.

Aligning Early Childhood and Medicaid, a national initiative made possible by the Robert Wood Johnson Foundation, will seek to enhance alignment across Medicaid and state agencies responsible for early childhood programs with the goal of improving the health and social outcomes of low-income infants, young children, and families. This multi-state learning group, led by the Center for Health Care Strategies (CHCS) in partnership with the National Association of Medicaid Directors and ZERO TO THREE, is bringing together Medicaid and state agencies responsible for a wide range of early childhood programs including, but not limited to, child welfare; the nutrition program for Women, Infants, and Children; Title V Maternal and Child Health; home visiting; early intervention; child care; preschool education; perinatal health care; and early childhood mental health. The 20-month initiative will support opportunities to develop and test:

  1. Align state programs and investments between Medicaid and other early childhood systems to drive more strategic, evidence-based investments for infants and toddlers in low-income families; and
  2. Demonstrate the value of early childhood cross-sector alignment, for improving near- and long-term health and social outcomes.

The Aligning Early Childhood and Medicaid initiative includes eight states with a demonstrated commitment to improving the health and social outcomes of low-income infants, young children, and families. Each of the state teams include Medicaid agency representatives and delegates from a child-serving agency, as follows:

  • Colorado Department of Health Care Policy and Financing (Medicaid) and the Office of Early Childhood;
  • Minnesota Department of Human Services (Medicaid) and Children and Family Services Administration;
  • New Jersey Department of Human Services, Division of Medical Assistance and Health Services (Medicaid) and Department of Children and Families;
  • New York Department of Health (Medicaid) and the Division of Family Health at the New York State Department of Health;
  • Oregon Health Authority (Medicaid) and the Early Learning Division of the Oregon Department of Education;
  • Rhode Island Executive Office of Health & Human Services (Medicaid) and the Department of Human Services;
  • Vermont Department of Health Access (Medicaid) and the Division of Maternal and Child Health at the Department of Health, and the Department for Children and Families; and
  • Washington Health Care Authority (Medicaid) and the Department of Social & Health Services, Economic Services Administrations.

This initiative builds on lessons from the Medicaid Early Childhood Innovation Lab, an earlier CHCS-led program that brought together state Medicaid agencies and regional health systems to promote optimal conditions for early childhood development. Participating states will receive tailored technical assistance and participate in peer learning opportunities to exchange and accelerate solutions across states. CHCS will distill lessons from the states’ early childhood cross-sector efforts and share emerging best practices nationally.

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