By: Dennis Walto, CEO Children’s Health Fund
Health insurance is a critical component of children’s well-being; without it, they will have extraordinary difficulty realizing their potential. This is especially true for children living in poverty — but with all the talk of “Medicare for All” dominating the news, it’s important to recognize that healthcare access is not singularly defined by insurance coverage. It takes a braid of payment mechanism, provider availability, and platform of service delivery — the “3Ps” — to truly make healthcare real for kids.
As an organization predicated on increasing kids’ access to healthcare, Children’s Health Fund unequivocally embraces the idea of holistic care and we implore child health advocates to look broadly at how to define and ensure a child’s ability to thrive.
The Payment Mechanism
With the expansion of health insurance coverage through the Affordable Care Act, more children than ever before now have health insurance. In fact, statistics showed that in 2017 over 95 percent of kids in the United States were insured, however recent reports show a worrisome decline. According to newly released Medicaid and CHIP enrollment data for 2018, there is an overall decrease of about 920,000 children covered by these insurance providers nationwide.
We know that access to healthcare for children is greatly enhanced by a way to pay for those services through an affordable vehicle. That’s why we cannot let up on our efforts to connect families with insurance and why we are alarmed at the recent decrease in enrollment.
Medicaid, for example, is the single largest insurance payer of healthcare services for children and families in the country, especially low-income families. There are currently more than 37 million children covered by this payment plan. The Affordable Care Act greatly increased access to Medicaid by giving states the option of extending eligibility for families living at or near the poverty line. Similarly, CHIP was designed for children whose families live above poverty thresholds but still cannot afford commercial health insurance and some 9.4 million children, as of 2017, are covered under this program.
At Children’s Health Fund, when our mobile clinics are out in communities, we see children regardless of their ability to pay; but in every instance, if children are not registered for Medicaid, or have access to commercial insurance, we work with their parents or caretakers to get them registered, ensuring payment does not continue to be a barrier.
Advocating to protect the guarantees provided for children through Medicaid is one of our highest priorities. Child health providers like ours who serve poor and medically underserved children are deeply concerned about mounting pressure to reduce Medicaid spending and weaken the nation’s single most important child health program.
Clearly, having an affordable way to pay for medical, behavioral and oral healthcare services on an ongoing basis is a fundamental and essential component of increasing access to care — but there is more.
Medical professionals, including doctors, dentists, nurse practitioners, nurses, physician assistants and licensed clinical social workers, are the majority frontline healthcare providers for all children and families; unfortunately, neither they nor their expertise are evenly distributed. There are more than 7,000 health professional shortage areas or HPSAs across the country representing geographic areas where the medical provider/population ratio is less than 1:3500. To put this into perspective, we would need nearly 15,000 additional health care providers to meet the current need and nearly 80 million children and families live in HPSAs right now.
HPSAs represent densely populated urban communities in the South Bronx and rural mountain valleys in West Virginia. They are almost always areas of high poverty where the barrier to healthcare is not how to pay for the services, it’s the human touch or the lack of a medical professional to provide the service. Federal programs like the National Health Service Corps (NHSC) are designed to provide incentives to young medical professionals to work in HPSAs, offering increased capacity to provide medical services closer to where they may live. The NHSC is also a fundamental program in completing the healthcare access equation.
Exposing healthcare providers to community-based care is another way to ensure that the pipeline of medical professionals considers the option of working in resource-poor settings. Part of the Children’s Health Fund program model is to partner with medical schools and set up residency rotations for newly trained pediatricians and other healthcare workers. In fact, in 2018 alone, our programs hosted more than 350 medical, dental, nursing, social work, psychology and pharmacy students for a combined 30,000 hours of service. Many of Children’s Health Fund’s medical directors once rotated through a mobile clinic site and were captivated by our mission and our programs’ work with underserved children.
Figuring out how a child can receive the services they need is also vitally important, especially for those who face barriers to care and this is the third P — the platform. Whether it’s helping children get to a public or private clinic, or bringing the services directly to the child, innovative service platforms are needed to break down transportation barriers and bring care to where children live, learn and play. This can be public housing sites, homeless shelters, schools, and/or community centers; the underlying factor is that it’s important to deliver mobile services to where children are, and not wait for them to come to us. Increasingly, the use of telehealth technology is on the rise to bring services where children and families are and reduce the burden of taking time off from work and school or other factors that may impede an appointment from happening.
Federal support is also critical to making sure service provision platforms are maintained and increased.
Programs like the Community Health Center grants provide government funds to Federally Qualified Health Centers to ensure that rural access points remain open.
We support new mobile health research requests being made in the House of Representatives that call for Health and Human Services to update its research on mobile health clinics as a platform for service delivery that focuses on where children live, learn and play, breaking down transportation barriers.
Increased support for school health clinics is proven to increase access to care — especially by minority and hard-to-reach children by having healthcare providers go to where children are most days. And, new telehealth and tele-mental health programs open up avenues for funding and more innovative platforms that also reduce barriers to accessing healthcare, ensuring that providers can reach children who need to receive care at home or from specialty physicians not in their regions.
In 1987, Children’s Health Fund was the vanguard of using mobile clinics to provide medical care to children and families living in poverty. Today, our mobile clinics provide quality healthcare services at more than 330 locations across 16 states, Washington, DC and Puerto Rico. Our mobile and fixed-site medical and dental clinic sites include more than 225 schools and Head Start Centers, more than 20 homeless shelters, and numerous public housing sites and WIC centers. Notably, 31 percent of Children’s Health Fund programs use telehealth to bridge the access gap.
Through our advocacy, we go even further. We are urging legislators to support language in the FY 2020 Appropriations bill that would block an attempt to eliminate Medicaid non-emergency transportation (NEMT). While our vision is to bring healthcare to all children where they are, we also need funds to get children and their families to needed preventative care when they need it.
Providing full access to healthcare for children living in poverty isn’t easy, but it is achievable. And it’s important that we continue to bolster insurance but also eliminate other barriers children and their families face. At Children’s Health Fund, our thirty years of breaking down access barriers point toward the integration of the “3Ps” — affordable payment mechanisms, accessible providers and platforms to truly meet the needs of underserved children. When working in unison, children will be afforded access to care that will allow them to realize their full potential. They can’t thrive on anything less.