Plotting a roadmap for success in Pediatric care

Since its inception in 1965, the Medicaid program has evolved, providing health insurance to young children and children with special medical needs. According to research findings by Medicaid.gov child enrollment data for September 2020 represents 49.5% of total Medicaid and the Children’s Health Insurance Program (CHIP) enrollment.

Together, Medicaid and CHIP programs cater to the health care needs of more than 37 million children in the US. These programs play a crucial role in improving children's health and supporting their families for their healthy development. Moreover, the programs include preventive services for the well-being of the country’s youngest residents.

Impact of Medicaid on pediatric care

Medicaid has had a powerful impact on the health of children. It ensures fewer hospitalizations and emergency medical visits, protects children from severe ailments, establishes preventive care and immunizations, and has measurable effects across the lifespan:

• Access to Medicaid coverage during childhood will have a significant impact on health in adulthood.
• Medicaid coverage ensures timely identification and provision for treatments for developmental disabilities in children.

Pathway to ensure success for children in Medicaid

Robust coverage and enrollment

One of the most constructive methods to improve child health is to boost Medicaid coverage and eligibility. Qualifying children should be enrolled in Medicaid and have access to comprehensive pediatric services. The coverage and enrollment process needs to be effective, culturally competent, and linguistically responsive, as Medicaid requires robust outreach to the families to ensure every child is benefitting from the service. Some of the streamlined processes include smoother enrollment and renewal, automatic enrollment, and continuous coverage from birth until the age of five.

Comprehensive primary care

Provision of comprehensive healthcare services like maternal and infant health, diagnostic, and EPSDT— which provides an array of prevention, diagnostic, and treatment services for low-income infants, children, and adolescents under age 21 — can strengthen the care delivery of pediatric services.

Increasing access to pediatric services to the vulnerable population by developing strong networks, addressing social and economic factors responsible for children's overall health, and expanding the grid of telehealth and other virtual care services can also reinforce the quality of Medicaid services.

Enhance quality and outcomes

The pediatric care delivery system should reward high-value care for children. Comprehensive and high-quality measurement approaches can be implemented at the clinical and population levels to drive improvements in healthcare outcomes for roughly one-quarter of the United States population. A significant improvement in the states' performance was observed from Federal Fiscal Year [FFY] 2017 to FFY 2019 on several measures, such as primary care access, preventive care for young children, preventive dental care services, and adolescent care, suggesting progress in the quality of care provided to Medicaid and CHIP beneficiaries.

Value-based payment

Value-based payment models are essential to the Medicaid program’s goal of improving health outcomes for its beneficiaries. However, value-based care is different for children than for adults. Knowing that social determinants of health (SDoH) profoundly affect childhood development, well-designed value-based payment models can provide high-quality care to increase socio-economic productivity and prevent the development of mental and behavioral disorders.

Conclusion

Medicaid coverage has built a robust foundation for comprehensive pediatric health care services. Without Medicaid, the vulnerable young population will not have access to primary, high-quality, and evidence-based care. Over the years, Medicaid and CHIP programs have accommodated many changes to increase their efficiency and effectiveness. However, millions of children still don’t have access to quality healthcare. These programs must ensure quality efforts and outcomes for the nation’s younger population by developing constructive and transparent models to reduce or prevent health complications.

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