Welcome to the first of a three-part blog series about a critical health care issue for children: Medicaid. As Senior Director of Government Relations and External Affairs, I spend a lot of time thinking about the Medicaid program because it plays a huge role at Connecticut Children’s and it impacts a majority of our patients and their families. As the Connecticut General Assembly enters its 2025 legislative session, the elected officials who represent you and me will be writing a new two-year state budget and Medicaid will be part of those conversations. Understanding Medicaid is important because it plays a critical role in ensuring children get the care they need.
In this blog post, we’ll break down Medicaid, explain its importance to children and children’s hospitals, and consider how it will play a role in state legislative budget conversations this year. In part two of this series, Connecticut Children’s Chief Financial Officer, Bridgett Feagin, will explain how Medicaid impacts our health system financially and influences our ability to address the factors that drive children’s health. In part three, Dr. Paul Dworkin, a developmental pediatrician and founder of Connecticut Children’s Office for Community Child Health, will describe how opportunities to invest in the neighborhoods where families live can help each child to grow, learn and succeed.
What Is Medicaid?
Medicaid is a government-funded health insurance program that helps people with limited income or resources access essential healthcare services. It was established in 1965 as a medical care extension of federally funded programs providing cash income assistance, with an emphasis on dependent children and their mothers. It is jointly funded by the federal government and individual states. Today, Medicaid is a key source of health care coverage for low-income families, pregnant women, people with disabilities and children. According to the Kaiser Family Foundation, nearly 80 million Americans rely on Medicaid and the related Children’s Health Insurance Program (CHIP), including 37 million children. In Connecticut, more than one out of every three children and nearly 40% of all births rely on Medicaid and CHIP, which we call HUSKY A and HUSKY B. For children, Medicaid is a lifeline. It ensures they have access to preventive care, doctor visits, hospital stays, and treatments for chronic or serious illnesses—all at little to no cost to their families.
Why Does Medicaid Matter for Kids?
Nearly half of all people covered by Medicaid are children and its importance lies in its ability to:
Ensure Access to Care: Children from low-income families often face barriers to accessing medical care, such as high costs or a lack of insurance. Medicaid removes these barriers, ensuring kids can visit doctors, get vaccinations, and receive necessary treatments without financial strain on their families.
Cover Specialized Services: Medicaid covers services that are especially important for children, including early and periodic screenings, diagnostic tests, and treatments for developmental delays, disabilities, or chronic conditions like asthma and diabetes.
Uniquely Impact Children’s Hospitals: Children’s health systems like ours rely on Medicaid to fund the specialized care they provide. Like other children’s hospitals across the country, Connecticut Children’s treats a much larger share of patients covered by Medicaid than adult-focused hospitals. This fact, coupled with the reality that Medicaid payments are quite low, means that Connecticut Children’s struggles with the financial impact of Medicaid, and this challenges our ability to offer the advanced treatments and programs that children need.
Promote Long-Term Health: Access to healthcare during childhood can prevent long-term health problems. By covering preventive care and addressing issues early, Medicaid helps children grow into healthy adults, reducing healthcare costs down the road.
What’s the Difference Between Medicaid and Medicare?
Medicaid and Medicare are both government healthcare programs, but they serve different populations and have distinct purposes:
Who It’s for: While Medicaid primarily serves low-income individuals and families, Medicare covers people aged 65 and older, along with certain younger people with disabilities.
Funding: Medicaid is jointly funded by the state and federal governments while Medicare is fully funded with federal dollars.
Covered Services: Medicaid has broad coverage including preventive care for kids while Medicare focuses more narrowly on hospital care, medical care and prescriptions.
How Will Medicaid Show Up in State Legislative Conversations in 2025?
Legislative Committees: Two committees in the Connecticut General Assembly have direct roles to play in Medicaid. The Human Services Committee has responsibility for all matters relating to the Department of Social Services, which runs the Medicaid program. The Appropriations Committee must write a new state budget that covers the two-year period starting on July 1, 2025 and Medicaid is one of the largest components of state spending each year.
Medicaid Landscape Analysis: Last year, the State reviewed the Medicaid program to assess the need for changes to the way it provides coverage. The report concluded that Medicaid should explore opportunities to better manage the care needs of those who rely on the program, particularly for people with chronic medical and mental health conditions. Legislators will likely use this analysis as a resource when they consider if there should be changes to the way Medicaid works.
Medicaid Rate Study: In 2023, legislators asked the State to conduct a study to assess how adequately the program pays its providers like hospitals and doctors. The final component of the study was released earlier this month and it will serve as a resource to elected officials as they consider how and where to make financial investments in the Medicaid program.
The Road Ahead for Medicaid
Since we now know more about how Medicaid works and why it’s important, stay tuned for the rest of this blog series so you can learn some insights about how changes to the program can better serve the needs of vulnerable kids and families who rely on it.