AAP Voices Blog

Medicaid’s Vital Role in Wellness 

As a general pediatrician who cares specifically for children with complex chronic medical conditions, wellness to my patients means living with their family and being included in their community. Pediatricians take a whole-child view to optimize both health and wellbeing. One way to achieve this for my patients is prescribing home health care services or, as I refer to it, “prescribing wellness”. 

I think of Audrey, a 3-year-old patient with congenital heart disease and a gastrostomy tube who spent so much of her young life in the hospital for heart surgeries and feeding intolerance. Wellness to her means being home and having optimized treatment plans so less time is spent on daily medical care. To support her wellness, I prescribed home health care. 

Home health care services most often refer to care delivered by nurses, therapists, home health aides, and certified nursing assistants in the comfort of a patient’s home. Whether patients can receive this care depends on home health care being covered by insurance. While employer-provided insurance often covers some of this care, most do not cover home health care adequately or affordably for the extended periods that are required by children with chronic medical conditions.

Except for Medicaid. 

Medicaid is first and foremost a children’s health program. It is a lifeline for patients like mine and covers the vast majority of pediatric home health costs in the United States. Medicaid is one of the few insurance options available that recognizes how optimizing wellness means extending care beyond the walls of a hospital or clinic and into the home.

But, right now, the future of Medicaid – and the health of children with complex medical needs – is at risk as Congress considers significant cuts to the program. 

More than half of children with functional limitations from chronic conditions rely on public insurance. Without Medicaid, many of my patients would be unable to afford the appropriate home care services they need to thrive. Children who have home health care have shorter hospital stays and lower costs and are less likely to be readmitted. Plus, home health care benefits all children, as children without complex chronic conditions account for 64% of home health care use. 

Loss of home health care not only impacts a child’s wellness, but also family wellness. Providing their own home health care for their child can impact a family’s financial status and have negative impacts on parental mental and physical health. I think of Jessica, a mother of an 18-month-old born prematurely with oxygen dependence from bronchopulmonary dysplasia (BPD), who stopped me in the hallway in tears when she found out her son lost his Medicaid coverage. Medicaid covered home health care that supported his medical needs so that she could play with her active toddler and just be his mother for a few hours a day, not his parent and his nurse. 
When I meet with families who have children with unique health needs, I find it important to start conversations about their insurance so that they're aware that many of the benefits they depend on are unique to Medicaid. As pediatricians, we can highlight to families how critical Medicaid is not only for most children’s ambulatory and inpatient services, but also the services that keep children in their homes and communities.

Medicaid’s role in supporting access to home health care services is just one aspect of this critical program. As pediatricians, we know first-hand how Medicaid is a lifeline for the patients we see every day, allowing them to access the health care they need to grow up healthy and thrive.   

For all of these reasons, I am seriously concerned by what cuts to this vital program would mean for children and families across the country. To put it plainly: if Congress passes the significant Medicaid cuts that are under consideration, children’s health will suffer. For me, I think of my patients with complex health needs and how the vital support they receive through home health care will be in jeopardy. 

Please join me in urging Congress to reject cuts to Medicaid by highlighting the importance of the program to the patients you see. Right now, negotiations are taking place in the Senate, and so it’s important that senators hear from pediatricians about the impact of cuts. AAP members can visit federaladvocacy.aap.org (AAP login required) to contact your senators via email.

You can also call the U.S. Capitol Switchboard at (202) 224-3121 or click here to find your senators’ DC office phone numbers. 

Medicaid is so much more than just health insurance; it’s a foundation for wellness and a program that sets children and families up to thrive – it’s the reason my patients can get the lifeline care they need in the comfort of their own homes. Together, we can tell our lawmakers why Medicaid must be protected. 

*The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.