As a pediatrician and Executive Vice President for the Office for Community Child Health at Connecticut Children’s, I’ve spent much of my career focusing on improving child health services. In my various roles—including Project Director for North Hartford Ascend and Founding Director of the Help Me Grow National Center—I have seen firsthand the critical need for a more integrated, comprehensive system of care for children and families.
Medicaid matters for kids. It plays a vital role in supporting families, but there is still much more we can do to ensure it addresses the full range of needs that impact children’s health and well-being. These needs extend far beyond healthcare—social, environmental, and behavioral factors all play a significant role in shaping health outcomes. Health services alone are not enough. We must bring together all sectors that support families and communities, creating a holistic, community-driven system that recognizes the interconnectedness of healthcare, education, housing, and other critical factors.
A New Vision for Medicaid
When considering how to redesign Medicaid, we must look beyond simply improving health services. The focus should be on well-being—not just health—as a means to an end. This includes physical, mental, and emotional health, social engagement, and family stability. Achieving these outcomes requires collaboration and coordination between healthcare providers, community organizations, and, most importantly, the families we aim to serve.
Here are some key ideas to guide the transformation of Medicaid:
• Social Determinants of Health Matter: We know that social and environmental factors often outweigh healthcare in determining long-term health outcomes. Programs that address these factors—such as economic stability, housing, and access to food—must be a part of Medicaid reform. This is particularly true for vulnerable children and families who face multiple, intersecting challenges.
• Collaboration is Key: To achieve meaningful outcomes, Medicaid redesign must encourage collaboration between health providers and community organizations from all sectors. Healthcare alone cannot solve the problems families face. We need cross-sector partnerships that bring together education, social services, public health, and the community itself.
• Community Engagement: The people most affected by these policies—the families—must have a voice. We must ensure that any changes are led by those who will benefit from them and that families have ownership in the process. This ensures that Medicaid services are acceptable and effective for those who need them most.
• Addressing Health Inequities: Medicaid must also tackle the root causes of health inequities. Historically marginalized communities, especially those of color, face significant barriers to accessing care and achieving positive health outcomes. Transformative change requires focused efforts to close these gaps.
• Value-Based Payment Models: To incentivize meaningful change, Medicaid should focus on reimbursing providers for outcomes that matter. This means supporting practices that lead to tangible improvements in health, such as early intervention for developmental delays, mental health support, and family wellness.
Key Recommendations for Medicaid Reform
Through our work, we’ve identified several strategies that can enhance Connecticut’s Medicaid program, especially for children. Here are some specific recommendations:
• Incorporate Effective, Holistic Child Health Services: Expand services like Reach Out and Read, Healthy Steps, Help Me Grow, pediatric integrated behavioral health, and medical-legal partnerships. These programs go beyond medical care, addressing the needs of children in a more comprehensive way.
• Focus on Key Outcomes: Medicaid should aim to improve children's developmental milestones, academic performance, and social-emotional health. This includes ensuring families have access to basic needs like diapers and promoting loving, supportive relationships between parents and children.
• Use Data to Drive Results: Establish clear performance measures, such as early detection of developmental delays, and referrals to services like maternal depression support, SNAP/WIC benefits, or early dental care. Tracking these outcomes will help ensure that Medicaid investments lead to real improvements.
• Integrate Funding Streams: To make these programs sustainable, we need to blend local, state, and federal funding in a way that supports integrated care models. This can be done by creating centralized, comprehensive systems of care and replicating successful models, such as a children's cabinet that includes leaders of state agencies serving families and communities.
• Reinvest in Successful Programs: We must build a system that enables cost savings from successful interventions to be reinvested in expanding these services. This requires state-funded technical assistance to demonstrate the return on investment and long-term cost benefits of these programs.
Building an Integrated System of Care
At the heart of Medicaid reform is the need for an integrated system of care. Programs like Help Me Grow and North Hartford Ascend are great examples of this approach. Help Me Grow enables healthcare providers to connect families with community-based services, ensuring children receive early, comprehensive support for healthy development. North Hartford Ascend, a cradle-to-career initiative, works within three North Hartford Promise Zone neighborhoods to integrate care coordination with schools and community-based organizations, strengthening families’ ability to access local programs and services to support children and youth from early childhood through to career readiness. By bringing together all sectors that impact families’ lives, these programs create a more efficient system, reduce redundancy, and improve outcomes for families.
The lessons from programs like Help Me Grow and our work with North Hartford Ascend demonstrate that cross-sector collaboration and community-driven approaches can yield meaningful, sustainable change. These models work because they don’t isolate healthcare but place it within the broader context of family and community support.
A Community-Driven Approach to Medicaid Reform
The current Medicaid system has great potential to better support families, promote well-being, and reduce health disparities. However, this transformation requires a shift in thinking. Health care should not be seen in isolation but as part of a broader, integrated system that addresses all of a family’s needs. Strengthening Medicaid to expand services to focus on health promotion and prevention can be achieved through a value-based healthcare plan that employs effective performance measures, optimizes financial resources, and supports sustainability through reinvestment. Such an approach strengthens population health outcomes, reduces redundancy, and achieves cost savings. Connecticut has the resources to build such a system for the benefit of all families.
We have the expertise and resources to make this happen. With community input and collaboration, we can create a system that truly supports the health, development, and well-being of all Connecticut children and families. I look forward to working with policymakers, healthcare providers, and the community to make this vision a reality.