Should health plans do more to support parents in raising stable families?

That’s the recommendation from a coalition of child health researchers who are calling for an overhaul of part of the state’s Medi-Cal program. Medi-Cal is California’s low-income health program that covers 40 percent of children in the state.

The recommendations are included in a report, from the First 5 Center for Children’s Policy and a group of child health experts that calls for Medi-Cal to better address the needs of entire families and emphasize preventive care.

Young children’s mental wellbeing cannot be separated from the family and community context in which they’re living, the researchers argue. If California policymakers want children to be healthy, they need to make sure parents are healthy too, the report states.

The goal of the report, said Sarah Crow, managing director of the First 5 Center for Children’s Policy, is to help policymakers who are “re-envisioning how Medi-Cal can better serve children and their families.”

The paper proposes a “hub and spoke” model for delivering early and preventive behavioral health services to families with young children, and connecting them with social supports. Kids and parents would be screened at a central location in their communities, such as a clinic, and providers would work with them to develop a family care plan.

Families who need help would receive services on site, if available, such as parent-child therapy or child-parent bonding classes. They could also be referred to local “spoke” organizations for needs such as substance abuse treatment, affordable housing or support groups.

Implementing this model would require existing providers to receive extensive training. The state would also need to develop a new workforce of people who can deliver the various supports families need, the report states.

California would also need to change how it funds Medi-Cal. As it’s currently structured, Medi-Cal only pays providers to address the behavioral health needs of enrolled children, not the entire family. But that’s misguided, researchers argue, because challenges such as domestic violence, economic instability and parental mental illness can impact children’s wellbeing.

Also, reimbursement rules discourage preventive behavioral health interventions in young children, according to the paper. Under the current system, children must be diagnosed with an illness in order to get treatment. That’s hard to do when children are too young to express themselves, said Alex Briscoe, principal for the California Children’s Trust, which collaborated on the report.  

The paper proposes funding behavioral health care for young children in the same way as physical health services, where agencies receive a set amount of funding per patient, regardless of diagnosis.  

“The Medi-Cal model of mental health is pathology-based and it’s reimbursed in California per minute, and only via diagnosis for an identified patient,” Briscoe said. The system, he said, has “created structural impediments for delivering care that we know works.”

Supporting children’s mental health early in life increases their chances of developing into healthy teenagers and adults, Crow said.

“Often when people are thinking about mental illness or mental health care they aren’t thinking about little kids,” Crow said. But that’s when “neuro-connections are developing at the greatest rate in a person’s lifetime.”

Ted Lempert, president of the children’s advocacy group Children Now, said the idea of prioritizing early intervention makes sense.

“The bottom line is Medi-Cal has to be reformed,” he said. “Kids need to be prioritized more in Medi-Cal, and screenings and interventions required by federal law need to be occurring.

“This brief adds to the push to really ensure kids are getting the services they’re entitled to.”