As Chief Financial Officer at Connecticut Children’s, part of my role is ensuring that our independent children’s health system has the necessary resources to meet the needs of our patients and their families. Connecticut Children’s is the only health system in Connecticut 100% dedicated to kids. Our team is on a mission to improve access to healthcare from before birth and into adulthood. As we work to provide the high-quality care that our patients and their families deserve, there is one thing I know for certain—Medicaid matters for kids.
The Medicaid program, which we call HUSKY in Connecticut, provides health care coverage for more than one out of every three kids in our state. Here at Connecticut Children’s, more than half of our patients rely on HUSKY and we know that many of their families face disparities including poverty, educational inequalities, food insecurity, poor housing quality and systemic racism.
Connecticut’s Healthcare Safety Net for Children
The Institute of Medicine defines safety net hospitals as those that provide a significant amount of care to patients who rely on Medicaid and experience vulnerabilities. By that definition, Connecticut Children’s is our state’s health care safety net for children. Our safety net role means that Connecticut Children’s devotes significantly more care to patients who rely on Medicaid (56.1%) than the average adult-focused hospital in Connecticut (22.6%).
Unfortunately, the state pays Connecticut Children’s less than other hospitals. Last year, Medicaid payments only covered 57.5% of what it cost Connecticut Children’s to care for our patients who rely on HUSKY. In comparison, adult focused hospitals received payments that covered 62% of costs. Being a safety net for children and receiving lower payments means that Medicaid negatively and dramatically impacts Connecticut Children’s financial bottom line. State leaders need to treat children equitably by prioritizing their unique needs in Medicaid through program design and financial investments. In serving our mission to care for all children regardless of their health care coverage, we struggle and will continue to struggle with the financial impact of Medicaid with the current funding rates.
Why Is Pediatric Medicine Unique?
Children are not little adults. They have unique physical, emotional and developmental needs and they require a health care system that is designed to promote optimal health outcomes. Caring for kids in a hospital setting is predictably more expensive, but this distinction from adult medicine is not intuitively obvious. One driver of costs at Connecticut Children’s is the size range of our patients—we need to stock a wide range of equipment that can meet the needs of a one-pound newborn or a high school football player. Each dose of medicine we provide is also calculated by patient weight.
Another driver is the age range of our patients—50% of the hospital care we provide is for kids under age 1 and about 70% is for kids under age 6. When a toddler requires magnetic resonance imaging (MRI), they can’t be expected to lie still on their own for the procedure. Appropriate care in this situation requires sedation, which involves the services of an anesthesiologist, making each procedure take longer. Caring for very young children requires more staff, more services, and more time—all of which lead to added costs.
Healthy Families and Communities Help Children Thrive
We know that only about 10% of a child’s health results from the health care services they receive, so investments in community health are critical. The Connecticut Children’s Office for Community Child Health works to improve the wide variety of factors that influence a child’s health (often referred to as “the social drivers of health”) such as housing, transportation, food and nutrition, and family support services. Now is the moment the state, healthcare providers and communities must come together and think more holistically about what it means to care for families.
Connecticut Children’s is eager to partner with the state on developing plans that view health services not in isolation, but rather within the context of a comprehensive, integrated system of programs and services that address families’ priorities, concerns, and needs with “all sectors in” and “cross-sector collaboration.” Our ability to participate in such an approach is dependent upon achieving a more solid financial foundation from Medicaid. A more equitable investment in the pediatric safety net is an essential first step toward promoting each child’s optimal healthy development.