Healthcare in New York is poised to go beyond the clinical setting by targeting social determinants to improve the health of the community starting with its littlest residents – babies. Called the First 1000 Days on Medicaid, the initiative will focus on children ages 0-3 to improve outcomes and access to services for children to instill healthy lifestyle habits in them at an early age. It will become part of the state’s robust Medicaid reform initiatives in 2018 (New York Health Plan Analysis).
New York State Medicaid Director Jason A. Helgerson announced the First 1000 Days on Medicaid initiative in July 2017 at the United Hospital Fund’s Medicaid in New York: Innovating in an Era of Uncertainty conference. The state has an opportunity to be a change agent to ensure the development of children preventssuper-utilizerss of the healthcare system in the future, he said. Addressing social determinants such as poverty, unequal access to healthcare, poor environmental conditions and educational inequities, specifically Kindergarten readiness, is essential to improving the health of children at this critical stage of their lives.
“If we do a better job of trying to influence the lives of our youngest children, we can prevent so much cost, so much misery, so many problems in the future,” Helgerson said.
Support for the program is evident, however, it begged the question: “Do we need another Medicaid initiative in New York?” The state’s Medicaid Redesign Team has done yeoman’s work improving the health of Medicaid recipients through a variety of targeted initiatives that are seeing positive outcomes. However, critics say there is too much project overlap, outcomes are difficult to meet, and funds aren’t utilized efficiently.
Nearly six months later, that sentiment still may be true. However, a 200-person state-wide stakeholder group, led by State University of New York Chancellor Nancy Zimpher, fulfilled its obligation and designed and presented the state’s 10-point agenda for the program in December 2017. Its priorities focus on access to early childhood health and development of children age 0-3, intervention with high-risk, low-income families to boost kindergarten readiness and reduce long-term health and social services for federal, state, and local governments, and securing partnerships with Medicaid stakeholders and early childhood development leaders. Many of the initiatives have an evidence-based and value-based component, which is a critical part of the state’s overall Medicaid overhaul strategy. For example, using evidence-based metrics, pediatricians will be paid more when children under their care start Kindergarten ready.
There may be plenty of Medicaid initiatives, but the statistics for New York children are alarming: 59 percent of children ages 0–3 are covered by Medicaid, 51 percent of all births are covered by Medicaid and 48 percent of children 0-18 are covered by Medicaid. Research indicates children on Medicaid are healthier and have better outcomes, including education, employment, and a reduction in welfare dependency.
The 10 initial projects for the First 1000 Days initiative are expected to improve the outcomes and statistics for these children. They are: Create a Preventive Pediatric Care Clinical Advisory Group, Promote Early Literacy through Local Strategies, Expand Centering Pregnancy, New York State Developmental Inventory Upon Kindergarten Entry, Statewide Home Visiting, Require Managed Care Plans to have a Kids Quality Agenda, Data system development for cross-sector referrals, Braided funding for Early Childhood Mental Health Consultations, Parent/Caregiver Diagnosis as Eligible Criteria For Dyadic Therapy, and Pilot and Evaluate Peer Family Navigators in Multiple Settings.
During a recent Facebook Live update, Helgerson said with the 10 programs in place, they can now move forward with implementation. While some of the initiatives are administrative in nature and will be implemented in 2018, several have a budgetary impact. Support at the state level is unclear at this time because New York already has numerous Medicaid-focused programs that are quite costly and often overlap services.
According to the Center for Health Care Strategies, New York is one of six states they approached through a grant from the David and Lucile Packard Foundation and the Robert Wood Johnson Foundation, to identify new ways to support infants and young children - in their first 1,000 days - on Medicaid through initiatives that support high-risk, low-income families, improve life chances, and address social determinants and education. Other states expected to launch similar programs are Connecticut, Maryland, Minnesota, Oregon, and Washington.
Despite ongoing rhetoric in Washington, New York hasn’t been shy about implementing Medicaid initiatives to help improve the health of its most vulnerable residents, and this initiative is no different. Its expansive initiatives have resulted in a 26 percent increase in Medicaid enrollment, and its per-recipient spending is at its lowest rate in more than a decade. While progress has been made and some goals met, many challenges loom at the state and federal level. The successful statewide transition to value-based contracting through these types of initiatives is the state’s end game, and that will be the most challenging to attain of all.