Financing Early Childhood Systems:

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• Financing Early Childhood Systems
• Lessons from the Past and
• Challenges for the Future
• Kay Johnson, Project Director Project THRIVE at
  NCCP
• Association of Maternal and Child Health Programs
  
• (AMCHP) Annual Conference
• March 7, 2006

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• Supported through a cooperative agreement with
  the Maternal and Child Health Bureau, HRSA-DHHS.

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A Framework for Spending Smarter in State and
Local ECCS Initiatives
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How are we doing in terms of financing early
childhood services?
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Percentage of Children Less than Six Years Old,
By State, 2003-04
gt 40 37 - 39 34 36 32 - 33
Source US Current Population Survey, National
Center for Children in Poverty
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Percentage of Young Children in Poverty, By
State, 2004
gt 40 37 - 39 34 36 30 - 33
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Infant EPSDT Screens Referrals, Selected
States, FY 2003
Percent of infant who had at least one EPSDT
screen or a subsequent referral. Source Center
for Medicare and Medicaid Services www.cms.gov
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EPSDT Participation Ratios, Children Ages 1 to
3, US, FY 2003
No data lt 60 70 69 80 79 gt80
Percent of one and two year olds who had at
least one EPSDT screen. Source Center for
Medicare and Medicaid Services www.cms.gov
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EPSDT Referral Ratios, Children Ages 1 to 3, US,
FY 2003
No data lt 1 1-10 11-20 20-50 50-69 gt70
Percent of one and two year olds who had a
referral subsequent to EPSDT screen. Source
Center for Medicare and Medicaid Services
www.cms.gov
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Financing for Child Development Services in
Medicaid Managed Care Plans, 1999
Source Berry, Butler, Budetti. Ambulatory
Child Health, 2001.
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National HEDIS Results for Measure Well-Child
Visits in the First 5 Years of Life, 2004
Source NCQA 2000 HEDIS and HEDIS/CAHPS
www.ncqa.org
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Medicaid Pays for Services to At-risk Children
with Social-Emotional Delay but no Diagnosis,
State Reporting, 2005
Yes (MDC 16 ) No (MDC 10) Dont know (MDC 6) Data
not available
Source Rosenthal and Kaye. State Approaches to
Promoting Young Childrens Healthy Mental
Development. NASHP/CMWF, 2005.
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Percent of Infants Served by State Title V
Programs with Medicaid Coverage, FY 2002
No data lt 25 25-34 35-44 45-54 55-64 65-74 gt
75
Source Title V Data System www.mchb.hrsa.gov
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Primary Child Care Arrangements of Children lt Age
5 in Low-Income FamiliesParents working,
resident, high school education, income lt200 FPL
Source Capizzano, Adams, Ost. Caring for
Children of Color, Urban Institute, 2006.
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Percentage of Infants and Toddlers Served in Part
C Early Intervention, By State, FY 04
lt 1.50 1.50 - 1.76 1.75 2.49 2.50
2.99 3.00 - 4.99 gt 5.0
Sources NECTAS, NCCIC, OSEP.
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Percentage 3 4 Year Olds Enrolled in School, By
State, 2003
gt 60 50 59 40 44 45 49 gt40
Source Kids Count. www.aecf.org
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Moving Ahead in Finance and Policy to Support
Comprehensive Early Childhood Systems
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Spending Smarter A Funding Guide for
Policymakers to Promote Social and Emotional
Health and School Readiness Kay Johnson and Jane
Knitzer. National Center for Children in
Poverty, December 2005. Spending Smarter in
ECCS Kay Johnson and Jane Knitzer. Project
THRIVE Issue Brief 1. National Center for
Children in Poverty, February 2006.
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Common Challenges linked to Financing

• Restrictions on eligibility and benefits.
• Failure to screen for and identify risks.
• Lack of reimbursement for early intervention
  services without a diagnosed condition.
• Services not accessible to uninsured parents.
• Too few providers.
• Gaps between systems.

Sources Johnson and Knitzer, 2005. Johnson and
Kaye, 2003 Johnson and Knitzer, 2002.
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Maximize Medicaid/EPSDT

• Recommend age appropriate screening and
  diagnostic tools in EPSDT.
• Cover services delivered in a range of settings.
• Separate billing for development screening and
  diagnostic evaluation.
• Reimburse for parent-child (family) therapy.
• Match funds for child care MH consultation.
• Use appropriate diagnostic codes.

Source Spending Smarter. Johnson and Knitzer.
NCCP. 2005. www.nccp.org
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Deficit Reduction Act of 2005

• Eligibility
• Premiums and cost-sharing
• Benchmark coverage
• Targeted case management

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Title V MCH Block Grant

• Use ECCS planning to assess fiscal resources.
• Include children with developmental, behavioral,
  or emotional challenges in definition of special
  needs (CSHCN).
• Spend on services not covered by Medicaid.
• Include social-emotional services in medical
  home initiatives.

Source Spending Smarter. Johnson and Knitzer.
NCCP. 2005. www.nccp.org
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Other Health Mental Health Programs

• Coverage mental health in SCHIP.
• Explicitly include Community Health Centers.
• Use childrens mental health grants.
• Use community mental health centers as a hub for
  early childhood mental health consultation.

Source Spending Smarter. Johnson and Knitzer.
NCCP. 2005. www.nccp.org
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Child Care

• Blend child care quality funds to finance early
  childhood mental health consultation (e.g.,
  quality set aside)
• Use CCDF to support training on social-emotional
  and school readiness.
• Target funding to ensure highest risk get
  high-quality child care.

Source Spending Smarter. Johnson and Knitzer.
NCCP. 2005. www.nccp.org
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Head Start Early Head Start

• Support mental health consultation.
• Finance training to enhance the skills of
  parent-involvement coordinators, parent
  educators, etc.
• Fund additional support services and referral for
  vulnerable children and their families.

Source Spending Smarter. Johnson and Knitzer.
NCCP. 2005. www.nccp.org
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IDEA Special Education Programs

• Assure appropriate social-emotional screening,
  evaluation, and services in Part C.
• Extend Part C eligibility to infants and toddlers
  with social-emotional conditions and risks.
• Build a continuum of services from 0-5, focusing
  state expenditures.

Source Spending Smarter. Johnson and Knitzer.
NCCP. 2005. www.nccp.org
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Use Programs Serving Young Children and Families
At High Risk

• Develop and fund a systematic approach for
  referral and assessment of young children who
  have experienced abuse or neglect and/or
  witnessed domestic violence. (CAPTA)
• Use TANF for family counseling, coordination,
  substance abuse treatment, and family support.
• Transfer TANF funds to the CCDF or the SSBG to
  fund activities in child care and family support.

Source Spending Smarter. Johnson and Knitzer.
NCCP. 2005. www.nccp.org
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Top Ten Things To Do Now

• Review current funding.
• Maintain and/or improve current programs.
• Support strategies with interagency plans and
  agreements.
• Mobilize resources to serve at-risk.
• Blend dollars for cross-training professionals.
  
• Use flexibility of smaller federal grant
  programs.
• Clarify eligibility and payment mechanisms among
  Medicaid, Part C, Title V, mental health, etc.
• Adopt billing mechanisms for developmental
  services.
• Target one high-risk population.
• Finance parent-child interventions.

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Together we can build coordinated systems of
care to help our youngest children be ready to
THRIVE.
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For more information or questions, contact us at
Project THRIVE
646-284-9644 ext. 6456 Thrive_at_nccp.org
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Websites of Interest

• Commonwealth Fund -- www.cmwf.org
• National Academy for State Health Policy --
  www.nashp.org
• National Center for Children in Poverty --
  www.nccp.org
• State Early Childhood Policy Technical Assistance
  Network -- www.finebynine.org
• School Readiness Indicators Initiative --
  www.gettingready.org

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Selected References

• American Academy of Pediatrics, Committee on
  Children and Disabilities. Developmental
  surveillance and screening for infants and young
  children. Pediatrics. 2001108(1)192-6.
• Bruner C, Floyd S, and Copeman A. (2003). State
  Early Childhood Policy Technical Assistance
  Network - Financing School Readiness Strategies
  An Annotated Bibliography. Des Moines, IA Child
  and Family Policy Center.
• Institute of Medicine/National Research Council.
  From Neurons to Neighborhoods The Science of
  Early Childhood Development. Shonkoff and
  Phillips, (eds), Washington, DC National Academy
  Press, 2000.
• Johnson and Kaye, Using Medicaid to Support Young
  Childrens Healthy Mental Development, National
  Academy for State Health Policy, Portland, ME,
  2003.
• Johnson, Knitzer, and Kaufmann. Making Dollars
  Follow Sense Financing Early Childhood Mentla
  Health Services to Promote Healthy Social and
  Emotional Development in Young Children. New
  York NCCP, 2002.
• Johnson and Knitzer. Spending Smarter A funding
  guide for policymakers and advocates to promote
  social and emotional health and school readiness.
  New York NCCP, 2005.
• Kauffman Early Education Exchange. Set for
  Success Building a strong foundation for school
  readiness based on the social-emotional
  development of young children. Kansas City The
  Ewing Marion Kauffman Foundation, 2002.
• Knitzer. Building Services and Systems to
  Support the Healthy Emotional Development of
  Young Children An action guide for policymakers.
  New York NCCP, 2002.
• Markus A, Rosenbaum S, Stewart A, and Cox M. How
  Medical Claims Simplification can Impede Delivery
  of Child Development Services. New York
  Commonwealth Fund. 2005.
• Perkins, J. Olson, K. (1999). Medicaid Early
  and Periodic Screening, Diagnosis and Treatment
  as a Source of Funding Early Developmental
  Services. National Health Law Program.
• VanLandeghem K, Curtis D, and Abrams M. (2002).
  Reasons and Strategies for Strengthening
  Childhood Development Services in the Healthcare
  System. Portland, ME National Academy for State
  Health Policy.