An under-recognized, under-reported threat to our most vulnerable children – and the innovations that are helping them – is winding its way through Congress. Part of legislation to “repeal and replace” Obamacare is an enormous decrease in federal funding for Medicaid and a significant restructuring of the program that will directly impact millions of American children. Much has rightfully been made about the potential impact such changes would have on the 6 million seniors and the 15 million people with disabilities who depend on Medicaid. But the proposed changes to Medicaid would also undermine innovative work in communities across the country to make sure children have a healthy start in life and can grow up to reach their full potential.
One of those innovations is taking place in Portland, Oregon. For children at the Faubion School, where over 80% of children are eligible for free or reduced priced lunch, Ms. Claire is a person they run to, quite literally, when something traumatic occurs. Ms. Claire is a member of a team of mental and behavioral health professionals from Trillium Family Services embedded in the Faubion School – available every day, all day, no appointment needed. Faubion’s elementary school students seek her out first thing in the morning after witnessing violence in their neighborhood or sometimes in their homes. Some of Faubion’s students often struggle to focus in class and need comfort after a restless night due to systemic challenges around housing, food security and racially targeted violence. With a “trauma-informed” approach, Ms. Claire knows how to calm a burdened, stressed, and overwhelmed child, and fosters the coping skills that help students calm and heal. Across the state of Oregon, Medicaid supports Trilliummental health professionals in nearly 100 schools to provide direct services to students where and when they need them. These supports are working. This past school year, Faubion increased its reading scores by 7% over the previous year. Suspensions dropped to 2% this past school year, with 30 fewer students excluded compared to the 2013 – ’14 school year, and attendance rates were up by 7% for 3rd – 5th graders this past school year compared to the previous year.
Through a novel partnership with Kaiser Permanente – and the knowledge that academic and social-emotional outcomes are intimately tied to health, Faubion is expanding its support services further still. In the fall, a primary care health clinic will open inside the school to ensure that students receive timely health care, allowing them to continue to thrive academically.
These services cannot be sustained and expanded without Medicaid. Private and state funds were pulled together to pilot the initial program at Faubion. But Ms. Claire’s work will be expanded this fall through an additional Medicaid-funded therapist and by health care provided through the new Medicaid funded clinic at the school. Without Medicaid support, the students – and whole families – who have been helped by these extraordinary services could be left exposed, unprotected, and unsafe. Importantly, they would not have the network of supports that buffer them from the significant adversities in their lives and community.
In Cincinnati, staff at the Mayerson Center for Safe and Healthy Children at Cincinnati Children’s Hospital Medical Center (CCHMC) have adapted an innovative tool to screen children and families for risk factors for child maltreatment. In addition, they not only identifythe problem but offer solutions, including targeted parenting interventions and connecting families to community services and resources. This work helps to address underlying factors, such as substance abuse or food insecurity, and hopefully prevent expensive medical interventions later in a child’s life. The children served at the Mayerson Center and CCHMC are overwhelmingly covered by Medicaid, which means the hospital has the financial leeway to engage in this innovative work.
Deep cuts to Medicaid will force states to cut coverage for children, people with disabilities, low-income adults, and seniors. Fewer children with health insurance will mean less innovation at places like the Mayerson Center. The American Health Care Act (AHCA), the legislative vehicle to repeal and replace Obamacare, has already passed in the House of Representatives and is under consideration in the Senate and includes steep cuts to Medicaid. Under the AHCA states would need to increase spending by 37% to make up for the lost federal support.
Local communities are engaged in efforts like those in Portland and Cincinnati because twenty years of brain science research demonstrates a direct link between adverse childhood experiences (such as witnessing violence or having a parent addicted to drugs) and chronic diseases and adverse social outcomes later in life. Limiting the amount of trauma in a child’s life and providing supportive buffers (like stable adult relationships or mental health interventions) helps children grow up healthier. The Faubion school and the Mayerson Center are members of the Building Community Resilience (BCR) collaborative at the Redstone Global Center for Prevention and Wellness at the George Washington School of Public Health. BCR is designed to align community support systems for children and families to develop the resilience necessary for positive health, educational, and life outcomes. An ounce of prevention early in childhood is worth a pound of cure later in life.
According to the Congressional Budget Office, the AHCA would cut $834 billion from Medicaid over the next 10 years resulting in 14 million fewer individuals being covered by Medicaid. Currently, about one-third of all children in this country are covered by Medicaid, about 30 million in all, most of whom are living in poverty. Therefore, any cuts to Medicaid would disproportionally impact our most vulnerable children. That’s why the Children’s Hospital Association has said the AHCA, “would be disastrous for our nation’s children.”
These cuts set up our children for failure. Cincinnati, Portland, and other communities demonstrate that when we support children they can thrive, even in the face of trauma and adversity. Congress should not limit children’s growth, or the future of our nation by slashing Medicaid.