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  • Writer's pictureJorge Petit

Improving Children’s Behavioral Health through Medicaid and CHIP

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I recently came across 3 newsworthy (and encouraging) announcements that I wanted to share and elaborate on as it relates to improving children's behavioral health. The reason these are so important is that there are a number of worrisome trends concerning children's behavioral health, including the rising prevalence of behavioral health disorders and the impact of digital media.

Since the COVID-19 pandemic we have seen a steady increase in mental health issues among children and adolescents—anxiety, depression, and overdose deaths—exacerbated by remote learning, increased social/peer isolation, disruption of routines, dysfunctional family dynamics and general stress. These concerning trends are more common among LGBTQ+ students, female students, and students across racial and ethnic groups. Consequently, we have seen a significant number of children who have experienced the fallout of the pandemic with parents/caregivers that have been sick or died due to COVID or have become food insecure, unstably housed or homeless. Alarmingly, we have also seen an increase in suicide rates among young people, making it a leading cause of death in certain age groups; underscoring the need for more effective suicide prevention strategies and mental health support services.

A number of recent reports and the U.S. Surgeon General’s 2023 Advisory: Social Media and Youth Mental Health clearly demonstrate that the increasing use of digital media and technology is affecting our children’s mental health. We know all too well that excessive screen time has been linked to issues like reduced attention spans, sleep disturbances, altered body image, cyber-bullying, and increased risk of depression and anxiety.

There has been a growing movement toward more holistic approaches that consider the physical, emotional, social, and environmental factors affecting children's mental health. This includes integrating mental health care with primary health care and creating a more seamless continuum of community-based support for children as well as parents/caregivers. There is also a renewed focus on better coordination across systems of care and sectors, such as foster care, education, mental health, substance use treatment, etc. We are also seeing the growth of telehealth services usage for behavioral health, especially during the pandemic, which has continued due to its convenience and ability to reach underserved populations, although concerns about effectiveness and equity in access remain.

We all know that Social Determinant of Health (SDoH)—considered nonmedical factors and conditions in where people are born, live, learn, work that affect a wide range of health, functioning, and quality-of-life outcomes and risks. These have an outsized impact on children and adolescent’s wellbeing, directly and indirectly. Acknowledging these and potentially exerting some effect on more upstream interventions aimed at parent/caregiver supports and services, such as educational, vocational, housing, and food security supports are critical and potentially impactful in the long run.

The federal government’s growing recognition and focus on policy and funding changes/ flexibilities, through Medicaid and the Children's Health Insurance Program (CHIP), are critical at this junction given the glaring need for increased and flexible funding for early intervention and prevention, coordination of behavioral and physical health services, increased school-based mental health programs, and initiatives aimed at addressing these SDoH impacts.

Recently, the Domestic Policy Council Office of Science and Technology Policy published the U.S. Playbook To Address Social Determinants Of Health calling out the need to “address the social circumstances and related environmental hazards and exposures that impact health outcomes” as a core tenant. Also this month, the Center for Medicaid and CHIP Services posted an informational bulletin that laid out guidance to states about opportunities available under Medicaid and CHIP to cover clinically appropriate and evidence-based services and supports that address health-related social needs (HRSN) especially vulnerable populations like children. Through different methods (state plan amendment, in lieu of services (ILOS), 1115 demonstration waivers) states can take advantage of these new flexibilities that cover certain evidence-based housing and nutritional services designed to mitigate the negative SDoH impacts that are known to disproportionately impact children.

For example, research shows that in 2021 about 1 in 8 U.S. households with children experienced food insecurity (1) and food insecurity has been associated with twice the odds of having behavioral issues in children (2). As I wrote in my prior BH: Matters Blog: An Unseen Crisis: Youth Homelessness in the United States, on any given night (2022) youth homelessness estimates are close to 30,000 unaccompanied youth—91% were between the ages of 18 to 24 and 9% under the age of 18. Additionally it is estimated that 1 in 30 youth experience homelessness each year, which translates into over 4 million youth experiencing homelessness at some point in their lives.

The flexibility to allow for funding for housing supports and transitions/navigation services or caregiver respite or home delivered meals or pantry stocking are game changers that will reap long term benefits to children, their family, and the community.

Another useful resource for our sector was the announcement earlier this month that Health Management Associates (HMA) partnered with the National Association of State Mental Health Program Directors (NASMHPD) Technical Assistance Coalition to produce a series of briefs that characterize the opportunities to improve coordination of services for children.

Finally there seems to be a growing consensus that we need to address children’s mental health more holistically and find new ways to fund a system of care that is coordinated and integrated, high-quality and accessible, and emphasizing the need for more upstream and preventative interventions that will have long-term and meaningful outcomes. We also need to address the importance of family/caregiver’s wellbeing, support and stability as key elements of a child’s ultimate success and develop more tailored interventions.

Lastly, New York is closer to securing approval for the 1115 Waiver amendment proposal with the Centers for Medicare & Medicaid Services. This 5 year waiver, as intended, will address the many health disparities in our healthcare delivery system and focus on interventions that target specific populations (such as individuals with serious mental illnesses, those struggling with substance use disorders, children with serious emotional disturbances, those with intellectual and developmental disabilities) as well as allow more flexibilities such as the ones listed above that can better integrate health, behavioral health and social care into a more seamless, person-centered and integrated continuum of supports, services and treatments that will produce better outcomes and a healthier community.



  1. USDA ERS - Key Statistics & Graphs. (2023, June).

  2. Whitaker, R. C., Phillips, S. M., & Orzol, S. M. (2006). Food insecurity and the risks of depression and anxiety in mothers and behavior problems in their preschool-aged children. Pediatrics, 118(3), e859–e868.

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