A roadmap of Medicaid prevention pathways

The Robert Wood Johnson Foundation awarded Nemours a one-year grant to explore and promote the use of existing Medicaid authority to support prevention. The initiatives described here are intended to sustain approaches that link clinic to community prevention to address chronic disease, including childhood obesity. With 40 examples, this Roadmap is part of a practical resource that includes three case studies and a white paper. Together, these resources bring to light how states have successfully created sustainable financing through Medicaid and the Children’s Health Insurance Program (CHIP) for preventing chronic diseases at both the individual and population levels. The toolkit can help states get started or continue their prevention efforts. These documents can be found at: http://movinghealthcareupstream.org/innovations/pathways-through-medicaid-to-prevention.

The Roadmap illustrates how state Medicaid agencies and their partners can maximize the authority that exists under federal Medicaid and CHIP law to deliver a range of preventive services and strategies at both the individual and population levels. The intent is to promote the use of existing federal Medicaid authority so a state may exercise the options that best align with its unique needs and conditions.

The Roadmap is applicable to a broad array of prevention activities that a state may opt to cover under Medicaid. More specifically, the Roadmap focuses a lens on childhood obesity, a challenge for which prevention is particularly relevant. The American Academy of Pediatrics (AAP) states, “because intervention programs are few, and program costs are high, the most successful intervention for promoting a healthy weight is prevention.” The AAP’s Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents notes that healthy weight has special significance not only because of its importance to childhood and future adult health but also because of “its interrelationships with lifestyle, behavior, the environment, and family life.” 

Since its passage half a century ago, Medicaid has played an essential role in promoting the health and wellbeing of America’s children. Today, 40 percent of children—over 35.5 million—are enrolled in Medicaid or CHIP. Medicaid and CHIP are essential to low income children, and particularly children of color. 

The health policy landscape changed dramatically in recent years with the passage and implementation of the Affordable Care Act (ACA). Federal and state level health policy will continue to evolve in the coming years. This Roadmap will continue to be important to promoting the health and wellbeing of children by showing states how they can accelerate the innovative efforts already underway to strengthen prevention.