Achieving Health Equity In New York: Supporting Healthy Child Development For Babies And Toddlers Through State And Community Partnerships With Medicaid

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.