Progress and Opportunity for California’s Infants and Toddlers

California’s new, historically large state budget offers many important investments that will benefit infants and toddlers and their families. After so much stress, turmoil, illness and grief, we are glad to see our state taking seriously the health and well-being of young children, as well as the adults and communities around them.

We have been particularly tracking new investments in care for children enrolled in Medi-Cal. One critical new policy is the creation of a dyadic care benefit. As we describe in a recent blog post, dyadic care is a form of treatment that serves parents or caregivers and children together, targeting family well-being as a mechanism to support healthy child development and mental health. The new benefit was highlighted in a recent LA Times article, in which Dr. Kathryn Margolis of Zuckerberg San Francisco General Hospital & Trauma Center notes the vital connection between caregiver and child for mutual health: “A baby is not showing up by themselves to the pediatrician’s office. The caregiver is coming in with their own strengths and stressors.” Dr. Margolis describes how dyadic care works at UCSF, as well as UCSF’s new Innovative Pediatric Technical Assistance Initiative, in this recent blog post.

Another important service for children on Medi-Cal is developmental screening. New pre-pandemic data show only 25% of infants and toddlers with Medi-Cal insurance receive timely developmental screenings. Focused on this problem, First 5 San Mateo recently released an environmental scan of early identification and intervention services, which found only 20% of young children receive screenings in that county. Moreover, it found large gaps between the number of children who are found to have delays and the number who actually receive services. In LA County, the First Connections program is continuing efforts to improve screening and referral practices with a new series of free toolkits to help agencies implement or refine their approach to embedding screening and referral in their work. Learn more about the kits, which include steps for forming an implementation team, setting goals, training staff, identifying resources, and more, by reading this post.

A key reason young children with delays don’t receive adequate services is that families are not offered the care coordination they are entitled to––and desperately need given the complexity of the systems. This was underscored by multiple stakeholders in their comments to DHCS about its RFP for new Medi-Cal managed care plans. Concerns include that the draft RFP and model contract do not reflect adequate accountability strategies to change course from the plans’ current poor performance in areas of child health. And they don’t establish criteria and requirements for plans to show progress in narrowing the state’s equity gap. California has an opportunity to make truly meaningful change for children and families with these plans—but must be bold and seize it.

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