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The Children’s Defense Fund’s New York office opened in 1992 as a health policy organization, advocating for New York children’s right to a healthy start in life. CDF-NY has accomplished this goal by serving as the liaison between the Facilitated Enrollment program and the State Department of Health, empowering low-income communities by providing them with a voice heard by state and local decision-makers. Over the past 20 years, the office has made significant progress in bringing health coverage to all children. We were the driving force behind raising the Child Health Plus eligibility level to 400% of the Federal Poverty Level, and are responsible for streamlining the Medicaid application process, making public health insurance options more accessible to thousands of children and families in New York State.
School-Based Health Centers (SBHCs) provide healthcare services in schools, making them available to children who normally have limited access due to financial and geographic barriers. These centers provide comprehensive primary care services at no out-of-pocket cost to the patient, and have been proven to increase access to health care for minority youth, improve school attendance and performance, reduce emergency room visits, prevent unnecessary hospitalizations, and lower the total annual Medicaid expenditures3.
We know that SBHCs are an access point for all children’s mental, emotional, and physical health services. Therefore, as we work through upcoming changes in New York’s Medicaid funding reimbursement, we must take care to ensure that these centers are not left behind. As a result, CDF-NY has made SBHC funding a priority, and will be releasing a report in the upcoming months that communicates the fiscal sustainability of these SBHCs, showing why they should receive the continued support of Medicaid.
The Children’s Defense Fund – NY seeks to preserve access to comprehensive medical, dental, mental health and other services for New York’s school aged children, while sustaining the financial viability of SBHC providers. If the Medicaid carve-out for SBHCs cannot be maintained, we offer recommendations for the positive inclusion of SBHCs into Medicaid managed care, based on findings compiled in our report: School-based Health Centers in New York State: Ensuring Sustainability & Establishing Opportunities for Growth.
Despite these gains, however, there are still 180,0191 children statewide without health insurance, which puts New York in sixth place in terms of states with the highest number of uninsured children2. Historically, most of these children have been eligible for coverage through either Medicaid or Child Health Plus, but are not enrolled due to either a lack of awareness or insurmountable bureaucratic and administrative barriers2. The following are examples of everyday obstacles people face:
Children of immigrant parents may not receive care for which they are eligible due to a language difference between their parents and the healthcare provider
Foster children are automatically dropped from their health insurance plan once they turn 18, leaving them without coverage.
Through the implementation of the Affordable Care Act in 2014, New York hopes to eliminate these barriers and aims to make health insurance more accessible for all children. CDF-NY works towards this goal by helping New York’s uninsured children obtain health coverage and ensuring that the care they receive is comprehensive, of optimal quality, and child-specific.
CDF-NY has adopted a holistic health agenda by advocating for healthcare services that meet both the physical and mental health needs of children. However, mental health services are not always accessible. In New York City, only 16,000 of an estimated 360,000 children with a diagnosable mental health condition are receiving services in the City’s mental health system4. Even when mental health care can be obtained, the services might not provide the child with the comprehensive care they need. For example, with the implementation of managed care plans, especially through public insurance policies such as Medicaid, mental health providers are only reimbursed for certain services and for a fixed amount of services per person, which leaves little room to account for and tend to individual patient needs5.
Such gaps in mental health care are especially detrimental to children from lower income areas, who are more susceptible to behavioral or emotional issues and whose families have more difficulty finding local providers that offer comprehensive, quality services6. In order to close this gap, CDF-NY has partnered with New York Lawyers for the Public Interest’s Health Justice Program in order to research mental health services in areas serving vulnerable children. In addition, we are internally coordinating with our Juvenile Justice and Education departments to analyze the intersection between mental health services and the Cradle to Prison Pipeline.
On October 30, 2014, experts on child and adolescent behavioral health joined CDF-NY for a webinar entitled “Unaccompanied Minors and Behavioral Health Services.” The webinar walked children’s health stakeholders through the behavioral health consequences associated with arrival and placement in the United States as an unaccompanied immigrant child. Experts offered descriptions of common symptoms, demonstrated best practices and identified helpful resources for social service providers working with this population. Presentations from the webinar can accessed below:
In January of 2014, the Children’s Defense Fund – NY teamed up with SAMHSA Region II to offer an important webinar on the Affordable Care Act and its effect on access to behavioral health care. Andrew Leonard of CDF-NY provided an explanation of behavioral health parity as it relates to the Affordable Care Act and access to coverage. Dennis Romero, Region II Adminsitrator for SAMHSA, presented on the changing health care landscape, the importance of behavioral health, and the important efforts SAMHSA is leading to address health disparities and promote access to care. Both presentations are available here: