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.
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.
Report September 16, 2021
A new report from the Georgetown Center for Children and Families shows that a state’s decision on whether to expand Medicaid has a profound impact on women of childbearing age (18-44). In 2019, across all racial and ethnic groups, women in non-expansion states were more likely to be uninsured than women in states that had expanded Medicaid. Research shows that expanding Medicaid health coverage helps to lower maternal mortality rates and increases access and use of health care among women of childbearing age. Closing the coverage gap is a critical first step to combatting the maternal health crisis in our country and addressing persistent racial and ethnic health inequities.
Report September 9, 2021
How we talk about child health and obesity matters. Growing evidence shows that where we live and what we earn shapes the options available to us in terms of food and activity.
Archived Webinar September 1, 2021
The Center of Excellence for Infant and Early Childhood Mental Health Consultation offers virtual training webinars from experts on key topics in the field of infant & early childhood mental health, followed by meaningful discussion. Webinar 2, accessed on this webpage, examines issues of racialized inequities and bias on the early care and education experiences for Tribal Communities, explores traditional practices and their role in healing and resilience, examines the commonalities of IECMHC and traditional practices; and identifies practices and policies to strengthen cultural responsiveness in IECMHC for tribal communities, in order to reduce disparities and support children’s healthy development.