Health care funding for low-income families is a major political issue in Florida. At risk is the health of nearly a million people, including several hundred thousand children. The Florida House’s stunning decision on April 28 to adjourn early without coming to an agreement on this issue may have enormous implications for public health. Failure to accept federal funding to expand Medicaid will have far-reaching ripple effects that will increase societal costs and jeopardize the health of many thousands of children in Florida, as well as their parents.
Approximately 20 percent of children have significant mental health issues and about 15-20 percent have significant chronic health conditions. There is overlap among these so that children with health conditions who also have significant mental health issues are at increased risk for poor disease management, resulting in higher health care utilization and costs. Poor health outcomes occur when medical treatment regimens are not followed; poor psychosocial functioning is associated with non-adherence to regimens. Research has shown that behavioral interventions addressing psychosocial barriers improve regimen adherence and health. Yet in clinical practice, such interventions are typically not implemented due to policy constraints.
Research studies indicate that one-third of children are overweight or obese, increasing their risk for psychological and eventual health disorders. Poor children, who are more likely to be of ethnic minority status, have even higher rates of health conditions such as obesity, asthma and type 2 diabetes. Ten percent of low-income, ethnic minority children have asthma, the leading cause of school absences and hospitalizations among children. These children do not typically receive evidence-based, behavioral interventions to improve their health conditions. Many of these children are currently eligible for Medicaid, and there are many more without health insurance who would become eligible for Medicaid if Florida expanded Medicaid eligibility.
Medicaid expansion is important because it is part of the Affordable Care Act (ACA) that proposes to do many things to improve population health. Chief among the ACA’s programs is the emphasis on prevention and integrated care. Integrated health care means that both physical and mental health issues can be addressed together in the same setting. That is why the Low Income Pool is being phased out and Medicaid expansion is proposed — it makes sense to link the LIP phase-out with Medicaid expansion. With preventive, integrative health care, low-income children’s health can be promoted and emergency department and inpatient hospitalizations will be reduced, resulting in significant health cost savings.
There is a substantial research base indicating that psychosocial and behavioral factors are integral to health promotion and effective disease management. Behavioral and mental health professionals, such as pediatric psychologists, have the expertise to help children and their families manage chronic health conditions. However, the current Medicaid system in Florida does not recognize licensed psychologists as independent providers, and only about one-third of states nationwide recognize psychologists in Medicaid. Psychosocial treatment for these children can be obtained, but in separate settings such as community mental health centers where treatment is often difficult to receive due to long wait lists and psychologists generally do not provide direct clinical services. Thus, the current system provides a disintegrated approach to health care for poor children.
A recent pilot program in Oregon demonstrated significant cost savings for children enrolled in Medicaid. The program focused on the small percentage of kids who had the greatest health care use and cost the most due to repeated hospitalizations for poor control of conditions such as diabetes and asthma. Psychosocial treatments were given to these children and their families, addressing the many barriers they face for optimal disease management. Regimen adherence was improved with these psychologically-based interventions. Costs were compared for the year before treatment and the year in which treatment was delivered. The results showed very significant cost savings relative both to the year before psychosocial treatment and to comparison regions in the state not providing these additional services.
It’s time to take the politics out of health care for children and make effective policy rather than continue ideological arguments. Expand Medicaid in Florida in order to provide health care for poor children and their families. Recognize psychologists as independent providers who can work alongside physician colleagues and other health professionals. With sensible health care policy, it is possible to achieve integrated health care focused on optimal disease management and prevention of health problems. This approach will improve the quality of life for low-income children and their families, and reduce health care costs to society.
Alan Delamater, Ph.D., is a professor of pediatrics and psychology and Director of Clinical Psychology in the Department of Pediatrics at the University of Miami Miller School of Medicine. UHealth – University of Miami Health System is nationally and internationally acclaimed for education, research, patient care and biomedical innovation. For more information, visit UHealthSystem.com/patients/pediatrics.