Supporting Florida’s Children On Pathways For Success

7/1/2024

This article first appeared as a column in the 2024 July issue of South Florida Hospital News

By Mary Mayhew, FHA President and CEO

One of the single most effective ways to build a healthy future for Florida’s children is to support a strong foundation from the beginning that contributes to great health and educational success. Parents and families are largely responsible for this foundation and pathway. However, there are many government and nonprofit resources that have been established to complement and support our shared vision for healthy, happy, and thriving children.

While there are many factors that contribute to a child’s healthy and happy future, timely access to high-quality healthcare, developmental and mental health services from birth is essential. It is well understood that children should be kindergarten ready by age 5 and reading proficiently by the end of third grade to support future educational success. Educational success is one of the most effective pathways to reducing poverty, to creating successful independent adults and supporting strong and stable families and thriving communities.

We also fundamentally understand that the love, nurture and support a child receives from birth are essential components to achieving our shared goals for children in our country and state. In Florida, 66% of all children receive their healthcare through the state’s Medicaid program and the Children’s Health Insurance Program. Medicaid covers most of these children, making Medicaid a significant factor in children’s and adolescents’ physical and mental health. Medicaid also covers more than 43 percent of all births in the state.

A healthy child is a learning child. And a learning child is significantly more likely to perform better academically, finish high school, go on to higher education, and maximize economic opportunities.

From well-child visits, preventive care, management of chronic illnesses, such as asthma and diabetes, to early intervention and treatment of mental health needs, Medicaid has a significant responsibility to ensure our children can access timely medical and behavioral health care services. Children do not always have mental health crisis between the hours of 8 a.m. to 5 p.m., so the system needs to be financially supported to meet their needs 24/7. Even though many children have a Medicaid coverage card, if physicians, dental offices, or other providers do not accept that coverage because reimbursement rates are extremely low then we aren’t supporting the goals of timely access to these critical healthcare access and improved health outcomes.

Achieving that timely access requires:

• Ensuring comprehensive provider networks by Medicaid Managed Care Plans
• Driving accountability of the role of private Medicaid insurance companies to support vital wrap around services that recognize the need for case management, social workers and other social services that support improved health outcomes
• Fair payments to physicians and other healthcare providers
• Reasonable administrative procedures and reporting requirements that do not create undue burden and cost for providers
• Maximizing available federal funding for Medicaid-covered services

Progress is being made on several of these fronts. During the last legislative session, lawmakers appropriated significant funds to enhance Medicaid provider payments, including $134 million to increase Medicaid payments to support moms and babies during labor and delivery and an additional $86.2 million to support pediatric behavioral health care services ($43.1) and pediatric physicians ($43.1) caring for children in Medicaid.

Lawmakers also amended the state budget to add language requiring increased transparency for the private insurance companies that have contracts to administer the state’s $34 billion Medicaid program that, as of May 2024, supports 4,423,280 Floridians, including 2,268,824 (just over 50%) children. This transparency is intended to drive greater focus on evaluating whether the Medicaid program and the insurance companies are structuring networks of providers, incentivizing models of care, and providing reimbursements that support the best possible outcomes for those vulnerable individuals who depend on Medicaid for timely access to healthcare services.

Additionally, the state legislature authorized reimbursement for collaborative care models for behavioral health services that support integrated care of primary and behavioral health services. This is vitally important for families who need access to community-based pediatricians and other pediatric specialists, including behavioral health, to meet their children’s needs.

Looking forward, to build on this progress, the state should also take advantage of available federal Medicaid funding for behavioral health services to support the increasing number of children and adolescents who are struggling with behavioral, psychological, and emotional challenges, hindering their ability to maximize their potential, live their life to the fullest, and embrace their opportunities.

The statistics tell a powerful story. Half of all lifetime cases of mental illness begin by age 14. Children with serious mental illness could have their lifespans shortened by 25 years. There are over 400,000 Florida children and youth with emotional, behavioral, and developmental issues, but only about half can access services.

We can and should do more. And, given Medicaid’s integral financing role in health care for such a large number of Florida’s children and adolescents, it needs to have a leading role. Supporting Medicaid reimbursement of certified community behavioral health centers and continuing to support the integration of behavioral health services in primary care settings with appropriate Medicaid reimbursement will significantly improve access, long-term health outcomes, and reduce the economic burden on the families and providers.

Medicaid is a partner for many Florida families in ensuring their children and adolescents have the care and support they need. The state can strengthen this partnership by holding managed care plans accountable, ensuring fair payment, and seeking Medicaid reimbursement for established behavioral health models of care. Our children deserve nothing less.