Improving the Lives of Young Children: Meeting Parents' Health and Mental Health Needs through Medicaid and CHIP So Children Can Thrive

Abstract

Many young children have developmental or behavioral problems that could be addressed or prevented with the right early response but that are not identified or treated, compromising children’s ability to perform up to their potential in school and leading to more costly interventions later. Because the quality of parenting is so critical to children’s development, parental or family difficulties—including maternal depression—can endanger children’s development. Yet, parents often do not receive needed medical or mental health care.  This brief discusses state Medicaid and CHIP choices that can enhance delivery of medical, mental health, and related services to parents.

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Executive Summary

Many young children have developmental or behavioral problems that could be addressed or even prevented with the right early response but that are not identified or treated before entering kindergarten, compromising children’s ability to perform up to their potential in school and leading to more costly health and special education interventions later. Because the quality of parenting is so critical to young children’s development, parental or family difficulties— including maternal depression and other parental mental health and medical problems—can endanger children’s development. In these situations, treating parents may be crucial to getting children’s development back on track. Yet, for many reasons, parents often do not receive needed medical or mental health care or other supportive services.

This brief discusses state Medicaid and CHIP choices that can enhance delivery to parents and families of the medical, mental health, and related services needed to support young children’s development. A range of physical and mental health problems affects parenting (for example, parents’ chronic pain and general health), but the evidence for the role of two-generational services is greatest for parental mental health problems. Among these problems, research attention has focused especially on maternal depression, which is widespread among lowincome mothers, particularly damaging to young children’s development if left untreated, yet very treatable (NRC and IOM 2009). Therefore, after initially identifying possible two-generational issues a state could consider, we focus largely on barriers and solutions to helping parents receive treatment for depression.

Other briefs in this series address children’s screening for developmental delays, referral and follow-up treatment, and case management/care coordination for young children (Hanlon 2010; Kenney and Pelletier 2010; Pelletier and Kenney 2010). This brief is more exploratory and less definitive than the other three because a more challenging policy environment has meant less program experience on which to base firm recommendations. Policy and service approaches that consider parents and children together cut against the grain of most federal and state funding streams and service systems; while there are important exceptions, many health, human services, and early childhood programs are organized to support either services to the child or services to the parent but not both. For Medicaid, the central focus of these briefs, the key distinction is that Medicaid eligibility and benefits are more restrictive for parents than children. However, even with these constraints, there are important policy opportunities for states to explore, and health reform will considerably expand those opportunities.

After addressing the reasons that two-generational services matter, the Medicaid policy framework, and the changes that health reform will bring, the brief focuses on three policy opportunities for states: increasing Medicaid coverage among eligible parents of young children, increasing service receipt among parents, and increasing receipt of family-based services when children are Medicaid-eligible but their parents are not.

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