Achieving Health Equity In New York: Supporting Healthy Child Development For Babies And Toddlers Through State And Community Partnerships With Medicaid
This BUILD Initiative blog post by George L. Askew, MD, FAAP, Deputy Commissioner of Health, Division of Family and Child Health, NYC Department of Health and Mental Hygiene explores how New York State has taken steps toward meeting its health equity goals by ensuring that its Medicaid program is working with health, education, and other system stakeholders to maximize outcomes and deliver results for the children they serve.
By George L. Askew, MD, FAAP, Deputy Commissioner of Health, Division of Family and Child Health, NYC Department of Health and Mental Hygiene
We know that the first 1,000 days of children’s lives are the most crucial to their development. Evidence also tells us that children on Medicaid have better health and life outcomes. With health equity as a goal, New York State has taken steps to ensure that its Medicaid program is working with health, education, and other system stakeholders to maximize outcomes and deliver results for the children we serve.
Cross-Sector Workgroup
During 2017, New York State Medicaid brought together a cross-section of over 200 stakeholders from education, child development, child welfare, pediatrics, and mental health to develop recommendations for how Medicaid could improve outcomes for the youngest New Yorkers, from their birth to age three, nearly sixty percent of whom are covered by Medicaid. The workgroup developed The First 1,000 Days on Medicaid, a set of ten innovative initiatives to promote cross-sector collaboration to maximize health and development outcomes in infants and toddlers, focused on minimizing disparities. As a member of this workgroup representing New York City, our work at the New York City Department of Health and Mental Hygiene (DOHMH) has focused on a few of these initiatives. Two of note:
1. Home Visiting
Studies have shown that certain home visiting models are most effective at improving maternal and child outcomes and yielding strong returns on investment for states. As the funder of over half of all births in New York, and 59% of kids aged 0–3, Medicaid has a significant interest in promoting and spreading evidence–based home visiting programs. New York Medicaid will take several significant steps to ensure the sustainability of home visiting in New York so every child and pregnant woman who is eligible for and wants the services receives them. This initiative will support the following:
- Continuum of Care: Support mothers with pregnancy (pre-birth) and continues to support babies once they are born.
- Nurse-Family Partnerships and Newborn Home Visiting Program: This evidenced-based, home-visiting program for high-need communities features nurse visits to women in their homes every one-to-two weeks during pregnancy and throughout the child’s first two years of life. The nurses offer guidance on breastfeeding, child development, parenting skills, pregnancy planning, preventive health practices, and strategies to attain economic self-sufficiency.
- Newborn Home Visiting Program: This program supports mothers and their newborns the first few weeks after birth. A public health professional visits the mother and baby to help with breastfeeding, offers health and safety tips, and connects the family with community resources.
- Pediatric Bundle: The Pediatric Bundle toolkit supports pediatric primary care providers in addressing early childhood health and development and, ultimately, pediatric primary care through clinical practice innovations and policy (Medicaid) reform.
2. Centering Pregnancy
DOHMH has supported CenteringPregnancy(CP) – group prenatal care that brings women due at the same time out of exam rooms and into a comfortable group setting – through its Healthy Start Brooklyn site, which provided funds to start three new CP sites. Evidence suggests that the program improves birth outcomes, particularly among disadvantaged populations such as low-income black and Hispanic women. Participants are more likely to receive adequate prenatal care than non-participating peers.
Due to continued interest from providers and patients, DOHMH has partnered with the Centering Healthcare Institute to expand CP to five new sites in areas of high need based on maternal and infant health outcomes. Selected sites will be announced in Jan 2019.
Moving Towards Health Equity
Achieving health equity—starting before birth—requires coordinated activities across the Health Department’s divisions, in partnership with government agencies, healthcare systems, and community partners. We are committed to leading with communities and healthcare systems to ignite sustainable change.
Explore More
Bridging the Divide between Child Welfare and Home Visiting Systems to Address the Needs of Pregnant and Parenting Youth in Care
Article February 21, 2025
This article presents findings from an implementation study of a pilot project that connected pregnant and parenting youth in care with home visiting services. It draws primarily on semistructured interviews conducted with the practitioners who delivered those services and the parents who received them. We find that home visiting services can be delivered successfully to pregnant and parenting youth in care and that both practitioners and parents reported that parents benefit from those services. We also find that engaging and delivering services to pregnant and parenting youth in care presents substantial challenges and that home visiting programs sometimes deviated from their standard practices in response. The study has implications for future efforts to provide home visiting services to pregnant and parenting youth in care or to other families involved in the child welfare system.
Dear Child Welfare Colleague Letter from ACF
Report February 21, 2025
The Children's Bureau (CB) within the Administration for Children and Families (ACF) is committed to fostering a child welfare system that is focused on supporting families. The Family First Prevention Services Act (FFPSA) and its title IV-E prevention program provides a watershed opportunity to create more equitable outcomes for children, youth, and families before they face the tumult and devastating consequences of maltreatment and separation. The ACF has worked diligently to support jurisdictions as they develop, submit, revise, and implement prevention plans, and we are continuously examining how to streamline processes and improve supports. This letter includes resources to aid jurisdictions as they develop their plans, including links to prevention plans that have been approved, sample program plans, resources for tribes, and responses to policy questions.
Accelerating the Expansion of Home Visiting Services Under the Family First Prevention Services Act
Report February 21, 2025
The Family First Prevention Services Act of 2018 (Family First) was intended to redirect a portion of federal child welfare funding to early intervention and prevention. Six years later, multiple barriers still stand in the way of expanding families’ access to support services such as voluntary home visiting. Key challenges include building cross-agency agreements, navigating administrative practices, and aligning funding streams. The goal of this paper is to expedite the expansion of home visiting services under Family First by elevating strategies developed by states to address financing system misalignment between child welfare and home visiting. In many cases, use of Family First resources to support home visiting requires braiding funds to cover start-up costs, adapting child welfare vendor contracts and payment approaches to account for variability in services and cover the full cost of providing home visits, and collaboration between agencies that may not be accustomed to communicating with each other and working together. We hope this paper enables additional states to expand home visiting more rapidly to more families, promoting safer, happier, and healthier lives together