The Children’s Health Insurance Program, which covers low-income children across the country, turns 25 in August, but Pennsylvania has had its own “CHIP” even longer, and was used as a model for the federal program.
CHIP launched in Pennsylvania five years before the national program. CHIP allows states to cover children when parents cannot afford private health insurance.
Today, said Antoinette Kraus, executive director of the nonprofit organization Pennsylvania Health Access NetworkAbout 136,000 children in the Commonwealth are enrolled in CHIP, which is a slight decrease from previous years.
“We think that’s because, right now, we’re still under a public health emergency,” he said, “so a lot of kids are enrolled in Medicaid with their families and they can’t be taken off coverage during this period. So, we hope that when the public health emergency is over, many children will transition from Medicaid to CHIP.”
That’s because in Pennsylvania, CHIP can cover any uninsured child who isn’t eligible for the state’s Medical Assistance program or Medicaid. The current end date for the public health emergency is October 13, although there is a chance it could be extended.
Pennsylvania Health Access Network helps families find health services that fit their budget. Kraus said a persistent barrier they see is that parents don’t always know the income eligibility requirements for CHIP and assume they can’t afford it.
“But really,” he said, “for very low-income parents, if you make between $21,000 and $28,000, and you have a child under the age of five, or if you make between $18,000 and $28,000 and your child is between six and 18 – CHIP is free for them.”
Kraus added that Pennsylvania is experiencing one of the lowest rates of uninsured residents in its history, for both adults and children. He credited a combination of the Affordable Care Act, Medicaid and CHIP. Nevertheless, a 2019 report showed that 4.6% of children in the state were still uninsured.
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Connecticut is among the top 10 states in offering access to mental health services for its young population, according to the latest report from Mental Health America, but advocates said more could be done.
The Children’s Hospital Association said that in 2020, at the start of the pandemic, there was a 24% increase in mental health emergency department visits for children ages 5 to 11.
Bob Duncan, chief operating officer of the Connecticut Children’s Health System and Medical Center, said that investment in Medicaid mental health needs to be strengthened and that the nation needs more providers in the pediatric mental health system.
“We don’t have enough psychologists and psychiatrists to meet the necessary demand,” Duncan observed. “Currently, there are 10 child psychiatrists for every 100,000 children. It is estimated that we need 47 for every 100,000 children.”
He shared his findings as part of a coalition meeting this month with members of Congress and the Secretary of Health and Human Services. However, Duncan believes the divisive political landscape could stand in the way of promptly addressing these challenges and agreeing on dollar amounts to fund system improvements.
Duncan wants to expand telehealth services as a way to reach children in different parts of the state. In the meantime, he added that there are ways adults can help the children in their lives.
He recommended that parents develop a relationship with their pediatrician and seek out a psychologist, if necessary. And he pointed out that the first and most important step for parents has been available all along: talking to their children.
“Families have the opportunity to take time out and spend time at home with their children, and they can see some of the things that their children may have been struggling with, in a typical environment, when the children were in school, I haven’t seen,” Duncan said. “Take the time and create an atmosphere where children can talk to their parents to express what they feel.”
She remains hopeful that the overall picture of children’s mental health will improve over time, but acknowledged that stigma persists and prevents people of all ages from speaking openly about mental health.
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The pandemic has had a significant impact on the mental health of young children and due to long-standing treatment disparities, mental and emotional recovery for children of color may be more difficult than for their white counterparts.
A report of Mental Health America (MHA) found that white children with depression were more likely to receive specific mental health counseling. Meanwhile, students of color generally do not receive counseling or “non-specialized mental health services.”
Dr. Asha Patton-Smith, a child/adolescent psychiatrist at Mid-Atlantic Permanent Medical Group, said it’s up to parents and caregivers to start the conversation about mental health with their children.
“Really open-ended questions are what I like,” Patton-Smith suggested. “He was just like, ‘Hey, you know, I noticed you seem a little more isolated than usual. Tell me what’s going on’. The more open, the more response you’ll get.”
The Centers for Disease Control and Prevention advises building community connections as a way to combat mental health issues. The Center also recommends that schools connect students to mental health services, integrate social and emotional learning, and review discipline policies to ensure equitable treatment.
The MHA report noted that depression rates are highest among multiracial youth, about 4% higher than average. Patton-Smith said allowing treatment disparities to persist and leaving mental health problems untreated can have lasting impacts.
“It increases the likelihood that other mental health disorders will develop,” Patton-Smith said. “Untreated depression, anxiety, bipolar disorder, post-traumatic stress disorder. May increase likelihood of suicidal ideation or death by suicide.”
According to the Centers for Disease Control and Prevention, more than a third of all high school students reported persistent feelings of sadness or hopelessness in 2019, a pre-pandemic statistic that had already increased 40% since 2009. Patton-Smith added that black children and young adults of color may also face stigma social roots around mental health.
“In the African-American community and the Latinx community, we still have a long way to go,” Patton-Smith said. “There are still challenges in understanding that depression, anxiety and mood issues are not character flaws, they are not personal weaknesses.”
He added that combating stigma starts with mental health conversations in churches and schools, where having a person of color involved in the conversation as a counselor or mental health expert is critical.
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CORRECTION: This story has been updated to include the correct link to register for Medicaid in Virginia. (9:40 p.m. ET, July 11, 2022)
FIX: The website where Virginians can sign up for Medicaid has been corrected. (8:45 p.m. MST, July 11, 2022)
New mothers in Virginia are now eligible for up to a year of Medicaid support. It is a great expansion of the program.and advocates hope it will help reduce maternal mortality rates.
The new version of Virginia’s Medicaid program has been in the works for years and was first approved by state lawmakers in 2020.
Previously, most new mothers could only get Medicaid benefits for two months after the birth of their child. But Sara Cariano, a senior health policy analyst at the Virginia Poverty Law Center, said many postpartum problems take more than 60 days to show up.
“This will really improve the care that the mother can receive and ensure that if she needs any kind of physical help, behavioral health, even dental health, she doesn’t have interrupted care,” Cariano said. “She can continue with the same provider that she had during her pregnancy.”
According to a 2020 report from the Virginia Department of Medical Assistance Services, more than 60% of maternal deaths among women with a chronic health problem occur after 43 days. The maternal mortality rate for black mothers in Virginia is more than double the rate for their white counterparts.
People can sign up for Medicaid Online at commonhelp.virginia.gov.
Cariano said people who are already enrolled in Medicaid and become pregnant are automatically enrolled in the 12-month pregnancy support program, and new mothers who left the 60-day version of the program but are still within the range of a year, they can reapply for benefits
She said Enroll Virginia, a coalition of community organizations, can help people navigate the process.
“If someone has applied and has a problem with an application, we also provide a lot of help with the case,” said Cariano. “We help people a lot to navigate what can be a bit of a complicated process to sign up.”
As long as they meet the income restrictions, all non-citizens legally residing in Virginia are also eligible for the program. Cariano said that all mothers, regardless of their immigration status, are eligible for coverage during pregnancy and up to sixty days after the birth of their child.
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