New York has begun its ambitious project to re-engineer health care for low-income children. In a new report, Building Health Homes for Kids: New York’s Reforms for Children on Medicaid Finally Take Shape, the Center for New York City Affairs looks at the opportunities and challenges presented by the State’s first major step toward reform.
The Health Homes Serving Children program offers a kind of broad-spectrum care management, designed for kids with a combination of complex health conditions and chaotic life circumstances. Care managers work with children and families intensively and up-close, helping them navigate what can be a baffling maze, not only of doctor’s appointments but therapists, special-education evaluations, public benefit applications, and so on — all in the name of keeping kids out of emergency rooms and hospital beds.
While planning children’s Health Homes, the Department of Health estimated that nearly 174,000 children and adolescents, from birth to age 21, were potentially eligible for the program—the majority of them because of mental health disorders. The hope was that community-based care management would skew the system toward prevention, catching kids early and steering them into services that might change the trajectories of their lives.
However, a year and a half after the program’s 2016 launch, many providers are struggling just to keep their care management services running. Enrollment is a small fraction of what was anticipated; the program is hobbled by a lack of investment in technology that would help community-based providers operate in the big-budget world of health care; and many of the nonprofits offering frontline services are unable to cover their overhead costs.
Beyond their operational challenges, the potential of children’s Health Homes to succeed — to meaningfully impact kids with serious needs — depends on the State’s larger commitment to expanding access to children’s behavioral health care, a field notorious for funding problems, waitlists, and shortages of staff and capacity. Care management can only add so much value, after all, if there isn’t enough care to manage.
Building Health Homes for Kids draws on program observations and interviews with stakeholders, from policymakers to frontline providers to families using Health Homes services. We offer promising practices as well as policy recommendations, developed in collaboration with experts in the field and intended to support the State in its work toward better care for vulnerable kids.
This project was made possible by grants from the Altman Foundation, the Child Welfare Fund, Ira W. DeCamp Foundation, and The Sirus Fund. Design by: Milan Gary Photo by: hrScene . For the full report click here.
