How Can States Improve Child 

Development Services?

State Medicaid agencies are positioned to promote high quality, comprehensive, and well 

coordinated preventive and developmental services that can help assure the healthy devel 

opment of young children.

The Assuring Better Child Health and Development (ABCD) initiative,

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coordinated by the

National Academy for State Health Policy and funded by The Commonwealth Fund, seeks

to enhance the capacity of state Medicaid programs to deliver and

finance health care that promotes children's development. In the first

phase of ABCD (2000 2003), four states   North Carolina, Utah,

Vermont, and Washington   developed strategies to improve deliv 

ery and financing of child development services. In the second phase

of ACBD, which started in early 2004, five states  California, Illinois,

Iowa, Minnesota, and Utah   are working to improve health care that

supports children's healthy mental development. Below are some

examples from the first round of ABCD.

The North Carolina project developed a  best practices  model for

integrating child health and development services into local health

care delivery systems, targeting children from birth to five years of

age. The model includes standardized developmental screening, referral, service coordina 

tion, and the provision of educational materials and resources for parents and clinicians serv 

ing Medicaid children.  Since 2000, the screening rate has increased from less than 20 per 

cent to more than 85 percent in areas using the ABCD model. Seven percent of these chil 

dren were referred for additional services, compared to the 2002 statewide average of 2.9

percent.

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Surveys have found widespread support for the ABCD model among healthcare

providers.

21

In July 2004, this project's success led to revisions in Medicaid policy to mandate

the use of evidence based, standardized developmental screening tools in North Carolina.

Washington state's Medicaid agency developed a new well child care encounter form to

standardize the delivery of developmental services for low income children during EPSDT

visits and to enhance the state's capacity to review patient records for quality. The encounter

forms provide guidance and information to both physicians and parents and address age 

specific issues in development. For practitioners who serve children in foster care, use of the

forms is required to claim a significantly enhanced fee for EPSDT exams. 

In Vermont, several home visiting services were underutilized due to limited referrals.  The

state sought to strengthen and expand the delivery of child developmental services to

Medicaid eligible families by integrating home visiting programs; streamlining referral paper 

work; and expanding eligibility from 12 months to five years. Additional services developed

include home visiting with case management, phone consultation, targeted educational

materials that highlight child development, and group education for parents and caregivers.

Through these modifications, Vermont increased the number of families accepting home vis 

its from 43 percent to 50 percent.

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More information on the Assuring Better Child Health and Development initiative can be found at www.nashp.org.

20

Pelletier, op. cit.

21

The Commonwealth Fund,  North Carolina is Assuring Better Health and Development,  September 2005, 

http://www.cmwf.org/publications/publications_show.htm?doc_id=294570#north (27 September 2005).

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