Summary

New York State has drafted a proposal that will be submitted to the US Department of Health and Human Services, requesting flexibility in how it uses Medicaid funds. Known as a “Medicaid waiver,” the proposal includes a request for $13.52 billion to be used over five years. The intent is to design innovative ways of using Medicaid funds that will promote health equity and address health disparities.

Despite the fact this waiver is focused on equity, the investments in the current proposal are not aligned with the needs of the poorest and most diverse population of New Yorkers who rely on Medicaid: children. In New York, Medicaid covers 50% of births each year, 60% of children ages 0 – 3 years, and 40% of children ages 0 – 18 years, but the proposal fails to address the racial and ethnic disparities in maternal and infant morbidity and mortality, glaring disparities in early childhood health, or the overwhelming crisis New York is facing in youth mental health.

Without an explicit and specific focus on children in the waiver, New York will fail to achieve its four proposed goals. We call on the New York State Department of Health to amend its proposal to explicitly prioritize incentives and payment methodologies in seven areas:

Goal: Build a resilient, flexible and integrated delivery system to reduce health disparities

1. Mental health needs of youth: Build stronger partnerships with schools, including expanding primary care and mental health clinics in schools, funding more school-based mental health providers, and providing universal screening for anxiety and depression to school-age children.
2. Two-generation approaches: Place behavioral health specialists in pediatric and primary care practices to address emerging mental health needs of both mothers and young children.
3. Maternal health: Provide tobacco cessation interventions during pregnancy, early screening and treatment of maternal anxiety and depression, post-partum long-acting reversible contraception to reduce short inter-pregnancy intervals, and increased referral to parent support programs, including home visitation.

 Goal: Redesign and strengthen system capabilities to advance health equity

4. Continuous Medicaid coverage: Guarantee coverage for children and their mothers from birth to age 3 years.
5. Universal home visitation: Cover universal, nurse-provided home visitation for parents of all newborns to reduce maternal and infant mortality and morbidity.
6. Developmental screenings: Cover comprehensive early childhood developmental and social-emotional screenings in partnership with community partners and provided in community settings.

 Goal: Create statewide digital health and telehealth infrastructure

7. Internet service and equipment: Cover service and equipment for households to facilitate parents’ access to telehealth, especially for families with young children.

We urge the Department of Health to reverse New York’s historic under-investment in children. Healthy growth and development of children today will bring long-term value to Medicaid and other public systems, including but not limited to education, child welfare, and juvenile justice.