Op-Ed: California can’t leave our children behind on missing medical care


Eli Kirshbaum


The kids are not all right. The more dangerous Delta COVID variant is far from the only health crisis our children are facing. Reports are showing that children are struggling with mental health, food insecurity, and obesity and backsliding on routine vaccinations. In California, we likely don’t know today the full extent of the pediatric health crisis because so many children haven’t accessed the healthcare they need, and their records are incomplete.


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Our state entered the pandemic already with fewer than half of Medi-Cal-enrolled children accessing preventive care between 2013 and 2019. In fact, California ranks 40th for all states in providing preventive health services to children, including well-child exams, developmental screenings, mental health screenings, and blood tests for lead exposure. The pandemic accelerated these gaps, resulting in more children missing their well-child visits, vaccinations, and sick care.

In a recent report on healthcare utilization during COVID, data from California’s statewide health data network indicated that the declines in medical office visit volumes for adolescents (25%) and children over five years old (36%) were much larger than for adults (20%) in 2020 compared to 2019. These drops are concerning, given the critical role that regular well-child visits, prevention screenings, and primary care provide in supporting the physical, development, preventive, and mental health of children.

The good news is that this is a powerful moment, one where technology, policy, and a renewed focus on equity are converging to create new opportunities to dramatically improve children’s health — particularly for children covered by Medi-Cal, California’s Medicaid program. With more than half of all children in California covered by Medi-Cal, improvements at this one program can create systemic healthcare transformation for our children.

There has already been one major area of progress this summer, with state leaders making a $4.4 billion investment in the Children and Youth Behavioral Health Initiative to expand access to mental health care. This is a bold step and one we’d like to see replicated for general health and prevention, but there is more work ahead. As leaders in children’s health and data-driven health improvement in California, we have five recommendations. California should:

  1. Make Medi-Cal coverage easier for parents. Support parents in navigating what can be a difficult healthcare landscape, starting with making annual Medi-Cal renewal as easy as employer-sponsored coverage. Keep the youngest children enrolled continuously to ensure that they can connect with the multiple well-child visits and screenings in the first years of life when 90% of brain development occurs.
  2. Promote family-centered health homes. Pediatric practices need to be supported by an integrated team approach to best serve families. The state and health plans should invest and assist in building quality family-centered health homes where children can receive well-care visits and screenings, with family information and engagement in care, as well as care coordination and connection to health-related social-emotional support services.
  3. Put data to work. Give care teams easy-to-use tools to identify which children have not yet received needed preventive services. A medical chart is of limited utility if it doesn’t reflect care delivered from all clinics and child-centered settings serving a child. Health information networks bring together patients’ records from across all their providers, including school-based care, allowing care teams to rapidly and accurately identify gaps — including missing preventive services. Many providers and health plans are not yet connected to California’s networks, but a new state law will require proactive sharing of medical records by 2024.
  4. Utilize a trusted community health workforce. As part of the state’s preventive services state plan amendment, California should create a dedicated community health worker (or “promotores de salud” in Spanish) benefit that is specific and available to all children enrolled in Medi-Cal. This must include these workers being paid a living wage and empowered as an essential part of our healthcare ecosystem. These are health advocates who share lived experiences with the communities they serve and understand their unique needs, and they are often the first line of trusted information for children and their families.
  5. Link performance to health plan payments. Nearly all children on Medi-Cal are enrolled in managed care plans, which are paid a flat fee per person for the year. While Medi-Cal health plans have performance standards, these standards have not yielded improvements in children’s preventive care and care coordination, and many children are not receiving the care they need. While contracts also specify health plan responsibilities in delivering required well-child care and care coordination, these requirements are not proving to be enough to ensure children are receiving preventive care. We recommend tying health plan payments to children’s preventive services through “minimum spend” requirements to more effectively ensure children are getting the care they need. The upcoming Medi-Cal managed care re-procurement and contracts related to rate setting are an important opportunity to get this right.

Investing in our children’s health is an investment in the future of our state. California was already behind before the pandemic, and COVID only accelerated the gaps in preventive services for children. It is time for our state to put health data, proactive care coordination, and outcome-based payments to work for California’s children.

Claudia Williams, CEO of Manifest MedEx, California’s nonprofit health data network, and former Senior Advisor, Health Innovation and Technology at the White House. Kristen Golden Testa, Director of the California Health Program at The Children’s Partnership, where she works to expand and improve health coverage and enrollment for children, focusing on Medi-Cal, the Children’s Health Insurance Program (CHIP), and Covered California.