Remarks given by Vikki Wachino, a senior advisor at Third Horizon Strategies, at the National Association of Medicaid Directors Fall Conference on November 15, 2021.
When we picture childhood, we like to picture joy, laughter and learning. We envision young kids happily heading off to school, gleeful on swingsets, or enjoying games on playgrounds. We picture teens enjoying friendships, planning social events, and building toward adulthood. 
Kids are asking for our help, and we need to deliver. Doing right for kids’ mental health means two things. First, we must prevent as many kids as possible from experiencing mental health problems. This means spreading and scaling prevention and early intervention strategies that have been proven effective.
Second, we need to expand access to services to children when they do face mental health and or substance use issues. Before the pandemic, only half of American children who needed mental health services got them. Children of color are even more likely to go without needed treatment, and the gap between black and white is widening. The pandemic has destabilized access to services nationally. Building back better requires building mental health and addiction services – and to prioritize building services in communities, where kids can access services early in their illness, not in facilities, where they get access late in their illness. We need to act as soon as possible.
Doing right by kids is a job for Medicaid. Medicaid is the leading insurer of children in the United States: It along, with CHIP, covers nearly half of children in America. So when we strengthen Medicaid, we strengthen kids. Medicaid’s comprehensive kids benefit, the Early and Periodic Screening, Diagnostic, and Treatment program, provides the foundation. Its complex name can overshadow its straightforward commitment to children and youth: that their needs, both health and developmental, will be met, and start with screening and primary care. This commitment lays the foundation for expanding access to behavioral health services, and for advancing prevention and early intervention for kids. And Medicaid covers one out of five parents of young children, making it a platform for whole family-approaches.
Medicaid’s impact is greatest when we work together toward a common goal. More than 20 years ago, federal and state policy makers, providers, philanthropies, research and advocacy organizations came together to commit to expanding access to health coverage for children. We made kids coverage a priority and invested in it. This collaboration fostered coverage expansions and dismantled barriers for kids. The gains in coverage were dramatic: by 2016, the rate at which kids were uninsured reached the lowest levels in our nation’s history, half of what they had been a few years earlier. Working together with common purpose, we delivered for America’s children.
America’s kids and youth need us to deliver for them again. And they need it us to do it now. They need state, federal and local public officials, health plans and providers, community organizations, advocates, and philanthropies to join together around a big idea: launching large scale state and national initiatives to both prevent kids from experiencing mental health and substance use problems and building access to services in communities to help when they do. They need us to commit to turning things around, and for us to commit today to working in every community and every state, and to collaborating to bridge sectors and silos.
Here’s what the work could look like. To expand prevention, we could spread and scale interventions that have been proven effective in helping to promote children’s development. We can build kids’ social skills and address the impact of trauma. Teaching children and families relationship-building and emotional coping skills can promote healthy brain development and avoid behavior problems. We can put our shoulder behind the wheel of increasing access in communities by expanding Medicaid-covered behavioral health services in schools and linking pediatric primary care to behavioral health services. As we do this work, we must engage families and people who have experienced mental health challenges in designing services that work for them. And building access for children and families of color should be our first priority.
And although this is a job for Medicaid, it not only a job for Medicaid. Commercial insurance also needs to commit to expanding access to effective services to improve kids’ health and well-being.
Kids can’t wait. In some places, the work has already begun. California is adopting whole family behavioral health screening and intervention. Ohio is integrating care and expanding services for children with complex behavioral health needs, and Michigan has expanded its school Medicaid program, increasing the school behavioral health workforce by more than 1000. But these efforts are just the start of delivering for kids.
The results of a successful initiative focusing on services, prevention, and early intervention could be dramatic. It would reduce use of emergency rooms and costly inpatient services. It would reduce the number of kids in the juvenile justice system and strengthen the child welfare system. And it would build a stronger society – and a stronger health system — by strengthening the next generation, because children who experience mental health challenges are more likely to experience mental illness, addiction, and other chronic physical health conditions as adults. These interventions are relatively low cost and high-yield. The investments we make may reverberate for generations.
We can make it easier for kids to go to school, play and grow into healthy adults. And reduce the stress that millions of children and families face. Let’s deliver for America’s kids. Let’s give them childhood back. And let’s start now.
Vikki Wachino is a visionary leader who has spent her career leading and inspiring organizations that make a difference for people most in need. As Principal of Viaduct Consulting LLC, Vikki advises mission-driven healthcare organizations on policy, strategy, and implementation of groundbreaking approaches to advance the health of people and communities. She also recently held a concurrent role as CEO of the nonprofit Community Oriented Correctional Health Services, where she expanded organizational vision and influence through new advocacy, programs, and partnerships. Vikki twice served the Centers for Medicare and Medicaid Services, first as Director of the Children and Adults Health Programs Group, then as Director/Deputy Administrator of the Center for Medicaid and CHIP Services. In both roles she managed vast programs with enormous budgets and immediate impact on the lives of millions of people.