FA C T S H E E T
Making Maternal and Child
Health Care a Priority
Helene Stebbins March 2009
As the national debate about health care continues, two things remain
clear about ensuring children’s health:
1) Access to health insurance is not enough. While eligibility for and
enrollment in Medicaid and/or SCHIP is fundamental, children must
get to the doctor at regular intervals for the screening, diagnosis, and
treatment of any special needs or developmental delays they have,
coupled with follow-up referrals to needed services to address them.
2) Healthy children need healthy parents. The health of the mother
– before, during, and after pregnancy – has a direct impact on the
health of the child.
To help inform the national and state-level debate on how to improve
the health care system, this fact sheet takes a closer look at state policy
choices that promote access to high-quality health care for mothers and
children.
What the Research Says About…
…Early Childhood Health …Maternal Health
Improving access to high qual- Biological and neurological sci-
ity health care improves health ences show that the predictors of
and developmental outcomes, healthy child development begin
especially when targeted to low- before pregnancy, with the health
income and minority children.1 of the mother, and continue after
Basic health services – including the birth, with the mother-child
oral health, and vision and hear- relationship. Smoking, substance
ing screening and treatment – are abuse, poor nutrition, maternal
essential to healthy child develop- depression, and perinatal infec-
ment. Improving access to health tions in mothers can harm babies
services, including mental health before birth; and postpartum, can
215 W. 125th Street, 3rd Floor care when needed, is one of the lead to low birth-weight, respira-
New York, NY 10027-4426 most effective policies available tory problems, chronic disease,
Ph. 646-284-9600 for reducing early childhood and even infant death.3 Economic
www.nccp.org health impairments.2 insecurity also increases maternal
stress and impacts both healthy cases, it threatens the developing
births and healthy child develop- brain of the child. 4 To access high
ment. Young children who grow quality health care, parents need
up with parents who have mental health insurance that covers both
health problems face significant physical and mental health, and
threats to their own emotional practitioners who can provide
development, and in extreme accurate diagnoses and referral.
The Current Landscape
Unfortunately, those who need Low-income young children who lack health insurance
high quality health care most are
least likely to receive it. 26%
Low-income: family income below
200% of the federal poverty level,
Low-income young children are 16% or $36,620 for a family of three
more likely to be uninsured. in 2008
Sixteen percent of low-income 5%
young children are uninsured, Colorado U.S. Hawaii
compared to 11% of all young
children. Uninsurance rates 26
of low-income children
range from a high of 26% in
13
Colorado to a low of 5% in
Hawaii.5
Medicaid/SCHIP income eligibility levels for children ages 1-5
0
In most states, low-income chil- Colorado
Income eligibility as a percent U.S.
150-199%
Hawaii
200-249% 250% or more
of the federal poverty level or
dren and pregnant women have $18,310 for26%a family of 3 in 2009
access to public health insurance
(Medicaid/SCHIP) but parents 16%
do not.
While 44 states set the income
5%
eligibility at or above 200 Colorado U.S. Hawaii
percent of the federal poverty
level for young children, only
12 states cover parents at this
same level. More than half of
DC
all states set income eligibil-
ity below the poverty level for
working parents. 6
In most states, the enroll-
ment and eligibility process for
Medicaid and SCHIP can be time
consuming. In some cases, the
re-enrollment process results in
eligible families losing coverage Note: Eligibility levels reflect the highest coverage under the Medicaid, SCHIP, Medicaid waivers, and/or state-financed
for administrative and paperwork programs, as long as enrollment in the program is open.
reasons. Despite state efforts to Source: Donna Cohen Ross and Caryn Marks, Challenges of Providing Health Coverage of Children and Parents in a
Recession: A 50-State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in
streamline the process, there are Medicaid and SCHIP in 2009, Kaiser Commission on Medicaid and the Uninsured, January 2009.
Making Maternal and Child Health Care a Priority
times when eligible recipients are consistent with pediatric prac- States where 80 percent or more
need medical care before their tice and can prevent or reduce of the children enrolled in Medicaid
application is approved. future problems. The Early and receive an annual EPSDT health
Thirty states have adopted Periodic Screening, Diagnosis screen
“presumptive eligibility” and Treatment (EPSDT) program
Ages 1-2
policies that provide temporary is Medicaid’s comprehensive child
health benefits package, which Connecticut
coverage to pregnant women, Delaware
but only 14 states have a requires states to periodically
screen children for good health, District of Columbia
similar policy for children.7 Iowa
diagnose any illnesses or delays,
Eighteen states have established Maine
and treat them. To encourage
continuous eligibility provi- Massachusetts
outreach to children who are Rhode Island
sions that ensure coverage for eligible for Medicaid, the federal
one year, without eligibility government sets a benchmark Ages 3-5
redeterminations, and several of 80 percent of enrolled chil-
states have established stream- Delaware
dren receiving at least one health District of Columbia
lined re-enrollment processes screen each year. Iowa
that have virtually eliminated
Only seven states report that Massachusetts
gaps in coverage for adminis-
trative and paperwork reasons.8 more than 80 percent of 1- and
2-year-olds receive at least one
Even when children have health screening. For children ages 3
insurance, they are not getting the to 5, only four states meet the
health and dental screenings that 80 percent benchmark.9
Medicaid income eligibility levels for working parents
Income eligibility as a percent
Less than 150% 150-199% 200-249% 250% or more
of the federal poverty level or
$18,310 for a family of 3 in 2009
DC
Note: Eligibility levels reflect the highest coverage under the Medicaid, SCHIP, Medicaid waivers, and/or state-financed
programs, as long as enrollment in the program is open.
Source: Donna Cohen Ross and Caryn Marks, Challenges of Providing Health Coverage of Children and Parents in a
Recession: A 50-State Update on Eligibility Rules, Enrollment and Renewal Procedures, and Cost-Sharing Practices in
Medicaid and SCHIP in 2009, Kaiser Commission on Medicaid and the Uninsured, January 2009.
What States Can Do
Fully addressing the barriers Provide temporary coverage to
that children and parents face pregnant women and children
in accessing health care requires under Medicaid until eligibility
action at the national and state can be formally determined,
level. But even without federal and provide for continuous
action, there are a number of eligibility with streamlined re-
important steps that states can enrollment processes.
take. These include: Provide incentives and
Set the income eligibility limit supports for pediatric health
for children’s public health practitioners to conduct
insurance (Medicaid/SCHIP) comprehensive well-child visits
at or above 200 percent of the – including health, dental,
federal poverty level. It takes at and vision screenings – with
least twice the poverty level for referrals for needed follow-
a family to ensure that young up services to address child
children have access to even developmental and behavioral
basic necessities.10 issues, and parental depression
Cover children and their concerns.
parents. Healthy children need
healthy parents.
For more information on state policy choices to improve the odds for healthy
early childhood development, see NCCP’s Improving the Odds for Young
Children project at: www.nccp.org/projects/improvingtheodds.html.
Endnotes
1. Shone, L. P.; Dick, A. W.; Klein, J. D.; 5. State data were calculated from the 9. U.S. Department of Health and Human
Zwanziger, J.; Szilagyi, P. G. 2005. Reduc- Annual Social and Economic Supplement Services, Centers for Medicare and Med-
tion in Racial and Ethnic Disparities After (March) of the Current Population Survey icaid Services, EPSDT CMS-416 Data, FY
Enrollment in the State Children’s Health from 2006, 2007, and 2008, representing 2007, updated July, 1, 2008.
Insurance Program. Pediatrics 115(6): information from calendar years 2005,
10. Cauthen, Nancy; Sarah Fass. 2008.
e697-e705. 2006, and 2007. NCCP averaged three
Measuring Poverty in the United States.
years of data because of small sample sizes
2. A Science-based Framework for National Center for Children in Poverty.
in less populated states. The national data
Early Childhood Policy Using Evidence http://nccp.org/publications/pub_825.html.
were calculated from the 2008 data, rep-
to Improve Outcomes for Learning,
resenting information from the previous
Behavior, and Health for Vulnerable
calendar year.
Children. 2007. Center on the Developing
Child at Harvard University. 6. Ross, Donna Cohen; Caryn Marks.
http://www.developingchild.harvard.edu. 2009. Challenges of Providing Health
Coverage of Children and Parents in a
3. Lu, M. C. ; Halfon, N. 2003. Racial and
Recession: A 50-State Update on Eligibility
Ethnic Disparities in Birth Outcomes:
Rules, Enrollment and Renewal Procedures,
A Lifecourse Perspective. Maternal and
and Cost-Sharing Practices in Medicaid
Child Health Journal 7(1):13-30.
and SCHIP in 2009. Kaiser Commission
4. Children’s Emotional Development is on Medicaid and the Uninsured.
Built Into the Architecture of Their Brains. http://www.kff.org/medicaid/7855.cfm
2004. National Scientific Council on the (accessed Feb. 9, 2009).
Developing Child, Working Paper No. 2. The author thanks David Gottesman
7. See endnote 6 (Ross). for his research assistance in writing
http://www.developingchild.net/pubs/
wp.html. 8. See endnote 6 (Ross). this fact sheet.