Many young children have health, developmental or behavioral problems that are not identified before entering kindergarten, preventing them from receiving early intervention services. Large gaps in early identification exist in Medicaid, the nation’s largest health insurance program for children, in which eligible children are entitled to regular screenings. This brief breaks down the shortfalls in receipt of developmental screenings into: not all eligible children are enrolled in Medicaid/CHIP; not all enrollees see a health care provider; and not all providers have the appropriate skills. To address these problems, states can take a number of steps within the Medicaid/CHIP policy environment.
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Many young children have health, developmental or
behavioral problems that are not identified before
entering kindergarten, preventing them from receiving
such services as medical care, early intervention services,
or simple equipment like eyeglasses or hearing aids. Yet
as health care providers and early childhood providers
alike recognize, ensuring that children get the right
treatment or services early on can maximize their
developmental outcomes, while failing to identify and
treat these problems may compromise children's ability to
perform to their potential in school and lead to more
costly special education and/or health care interventions
later. For these reasons, the importance of screening is
reflected in both the American Academy of Pediatrics'
Bright Futures guidelines and the Head Start
Yet large gaps in early identification exist in Medicaid,
the nation's largest health insurance program for children,
in which eligible children are entitled under federal law to
get regular health and developmental screenings. In
Medicaid, practical implementation challenges result in
missed screening and treatment services; CHIP benefits
vary by state and do not always offer coverage for these
services. Together, Medicaid and CHIP cover half of
low-income children and an even larger share of lowincome
young children. Increasing developmental
surveillance and screening rates in Medicaid and CHIP
could greatly increase how often developmental delays
are correctly identified in this population.
This brief breaks down the shortfalls in receipt of
developmental screenings among low-income children
into the following components: not all eligible children
are enrolled in Medicaid/CHIP; not all those who are
enrolled see a health care provider for well-child visits,
and many do not have a regular provider who tracks their
care over time; and even when children visit health care
providers, not all providers have the appropriate tools or
skills to carry out effective developmental screenings.
Together, these problems undercut the intent of the law
that all Medicaid-covered children should receive
To address these problems, states can take a number
of steps within the Medicaid/CHIP policy environment.
To track both gaps and progress in this area, states will
need to invest in data systems that allow them to evaluate
how rates of Medicaid and CHIP participation, screening,
assessments, and referrals are changing. Progress in this
area will require investments in health information
systems and technology, quality measurement, and public
End of excerpt. The entire brief is available in PDF format.
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