Each week, another heartbreaking story comes out that shows us that the nation’s children are not okay. Mental health and wellbeing are suffering. A recent study showed that the number of children 3-17 who experienced anxiety or depression grew by over 25% from 2016 to 2020.
If we dig deeper into these stories and the data, we quickly find a group of children who are struggling most: children and youth with the most complex mental health and behavioral needs. They are getting bounced around a system that wasn’t designed for them. In fact, sometimes the system is non-existent. Providers are ill-equipped to care for them, and often refuse to take on the most complex kids. Caregivers and families struggle to keep them safe at home, and they often end up in group homes or institutional settings.
These children are often covered by Medicaid, and while Medicaid leaders have always been challenged to meet the needs of this population, they are increasingly concerned about what they are seeing. Earlier this year, NAMD brought together Medicaid leaders to take on this challenge. We talked about where the program could make a difference for these children and their caregivers, and identified three places where Medicaid could play a leading role:
- Preventing crises by providing care and supports. As the primary source of health insurance for these children, Medicaid can make sure these children and their caregivers are well-supported and can access behavioral health care. For example, West Virginia is making it simpler for families to access available support regardless of the state funding source (Medicaid, the mental health authority, or child welfare agency). There is a single point of entry for families that is clear and simple, rather than multiple programs that families have to cobble together themselves. Other states, like Massachusetts, are making sure caregivers can access crisis care that reflects the needs of their children. Crisis responders can tap into experts who understand the unique needs of children with intellectual and developmental disabilities who are in a mental health crisis.
- Improving specialized inpatient psychiatric care. Medicaid leaders’ top priority is to help children live and thrive in the community. The data tells us that’s where kids do best. But some children do need specialized, inpatient psychiatric care. Medicaid programs want to ensure safety, quality of care, and smooth and speedy transitions back into the community. One way that states are advancing these goals is through transparency and oversight. For example, Iowa has a cross-agency quality review panel that examines cases where a child has been in group care over a certain time period. This helps to ensure they are being served in the most appropriate setting. Other states, like Virginia, use payment levers to make sure children who need one-on-one support get it while in a group setting.
- Supporting the return to the community. Getting children back into the community and stabilizing them there is important. Medicaid programs are looking at levers to support this transition. Arizona, for example, requires caregivers to be involved in discharge planning for all out-of-home placements. Other states, like Arkansas, are adding a step-down level of care to help children transition back into the community. In the step-down level of care, children participate in community life during the day (like going to school) but return to the facility in the evenings.
Improving the system for children with the most complex behavioral health needs won’t happen overnight. And Medicaid can’t go it alone. Systemic change will require many players at the table, like child welfare, health plans, providers, schools, and others. But Medicaid can, and is, being proactive in using the levers it can use to make a difference. There is much work to be done. The health and wellbeing of our nation’s children is what is at stake, and we cannot afford to wait.
Want to Learn More? Check out NAMD’s Journey Map for Children and Youth Experiencing Crisis. NAMD members can also check out this issue brief, State Medicaid Options to Address Children and Youth Experiencing Crisis (NAMD login required).