All kids, especially those who are most vulnerable, deserve a healthy start
By Mike Odeh
November 11, 2019
The first three years of a child’s life are a time of rapid growth and development – babies and toddlers learn to smile, talk, play and walk (or run!). These years are both exhilarating and exhausting to a parent or caregiver, as they watching their little ones grow, and wonder if they are meeting key developmental milestones. Parents know the critical role that pediatricians play during this time – they are the ones they can count on to identify delays or alleviate concerns – and access to routine screenings can make all the difference.
The American Academy of Pediatrics recommends that all children under the age of three be screened routinely to monitor their development and identify potential delays. Screening is the first step to connecting children with the supports they need for healthy development, and is especially critical to helping identify children with or at risk of developmental delays, so that they can be connected with early intervention services.
However, based on 2015 data, fewer than one in three infants and toddlers with Medi-Cal were receiving timely developmental screenings. Developmental screenings are an important preventive care service, which like check-ups and immunizations, children are entitled to through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit, and is required by federal law.
The promising change is, in response to the unacceptably low rates of developmental screenings for young kids, this year California approved the use of tobacco tax funds to reimburse Medi-Cal providers for developmental and trauma screenings. This investment aims to improve screening rates and highlight the need for better cross-sector health and early childhood collaboration, shared data, and parent and provider education and outreach to ensure that kids receive screenings and get connected to early intervention services.
Additionally, Governor Newsom signed Assembly Bill 1004: Developmental Screening Services, to ensure California’s babies and toddlers, birth to age three, receive crucial developmental screenings through Medi-Cal. In addition to clarifying the current law, AB 1004 requires that California use the developmental screenings data they are collecting for compliance purposes, which in short, will support enforcement of existing contracts and ensure Medi-Cal providers are delivering on the EPSDT entitlement. This bill complements the $50 million budget investment made in developmental screenings earlier this year (for reimbursement to Medi-Cal providers) and it will make annual reporting more meaningful, as well as actionable.
Yet, budget investments alone will not help California achieve higher rates of developmental screening. The state will need to make this an ongoing priority, and incorporate financial support, technical assistance, and enforcement to ensure Medi-Cal plans and providers remain accountable for developmental screenings. Without the funding for screenings, the support and infrastructure providers need to appropriately refer children to early intervention services, and the right oversight from the Department of Health Care Services, it will be challenging to see a demonstrable improvement in screening rates.
The state needs to start holding Medi-Cal health plans accountable for ensuring that infants and toddlers are receiving their developmental screenings. Starting in 2020, California will begin to publicly report on developmental screenings in Medi-Cal health plans. In doing so, we will join 25 other states that reported these rates in their Medicaid and/or Children’s Health Insurance Programs (CHIP). The 2018 data – referred to as the Child Core Set – put out by the federal government show that higher screening rates are possible: 11 diverse states reported developmental screening rates of more than 50 percent. For more information about California’s scores on the 2018 Child Core Set quality measures, see this factsheet and a snapshot on young children’s preventive care.
Furthermore, additional work needs to be done to ensure families receive appropriate referrals and access to early intervention services following developmental screenings. Recent research shows that nearly 18 percent of U.S. children have a developmental disability, and a higher Medi-Cal screening rate would mean better identification of children with developmental disabilities. To learn more about the impacts of developmental screenings and early intervention, please read this blog post.
In an ideal world, all California children would receive the needed developmental and early preventive health screenings they’re entitled to, so that they can grow up healthy and thrive. California policymakers must do their part to ensure this becomes a reality, and invest in robust referral and early intervention systems to connect kids with services they may need for supporting their healthy growth and development.