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Support for LB 1063 – Adopt the Children’s Health and Treatment Act

February 9, 2012

To: Health and Human Services Committee

From: Caitlin Pardue, Policy Associate – Behavioral Health

RE: Support for LB 1063 – Adopt the Children’s Health and Treatment Act

Voices for Children in Nebraska is committed to ensuring that all children have access to the health services they need at the right time.  We are encouraged by the efforts made in recent years to improve Nebraska’s health system and this committee’s commitment to children. LB 1063 would be a further step to ensure children do not fall through the cracks and uphold Nebraska’s obligations under federal law.

Voices for Children continues to be concerned with the lack of access to preventative, “front end” services, specifically within the behavioral health system for children under five.

LB 1063 would clarify Nebraska’s obligation not to discriminate the availability of appropriate and quality services on the basis of age or diagnosis. The bill would preserve family stability and unity, which further protects children’s health and wellbeing. Not only is this good ethical policy, but also wise economic policy.

Clarity on the definition of medical need and young children

Studies show that infants and young children do have mental health needs, which when left untreated often influence long-term developmental problems.[1] Frequently, adolescents receiving mental health services had obvious behavioral and emotional problems at preschool age, but were left untreated until years later.[2]

Numerous providers have approached Voices for Children with concerns that children under five years old are being denying reimbursement for services.

We are concerned that children under five have not been getting the health care they need.  By not providing timely access to appropriate early intervention services, we push children deeper into the system which results in more complicated and more expensive problems in later years and risk the probability of child abuse and neglect in some cases.

LB 1063 shows Nebraska’s willingness to invest in early child interventions in order to address problems when they are easiest to solve.

Cost shifting from Medicaid to Child Welfare and Juvenile Services

When services are denied by Medicaid/Magellan, the costs of these services are shifted to the child welfare and juvenile services system. This costs Nebraska more money because state General Fund dollars do not receive a federal match like Nebraska Medicaid does.

LB 1063 would ensure that children who need services will not be denied coverage. This means that fewer kids will be pushed into Child Welfare and Juvenile Services, and fewer kids will go without treatment. It also means that Nebraska will save money on children who are already wards of the state.

We have learned from Nebraska’s two lead agencies that they have spent over $11 million on services for children who were denied Medicaid coverage. This money comes directly from General Fund dollars.  Redirecting General Fund dollars from other important Child Welfare costs to pay for services that should be paid for by Medicaid seriously jeopardizes the stability and quality of the overall Child Welfare System.  This impacts both current state wards and children who have needs that go unaddressed. When funding for desperately needed services is already stretched, Nebraska simply cannot afford to lose the federal match through Medicaid in order to treat kids in Nebraska who need behavioral health services.  LB 1063 is an important step to stop this kind of cost shifting and ensure kids grow up safe and healthy.

LB 1063 will save the state money in the short term through matching federal funds for Medicaid, and in the longer term the state will save money by treating conditions before they become more complicated and expensive. When physical and mental health problems are identified and treated early on, we avoid much larger, complicated, and more expensive problems developing in later years.[3]

Ensure Nebraska has a transparent and open process

It is important that Nebraska has an open and public process in order to protect the rights of children and their families. When policies are clear and the decision making process is transparent, the system ensures that service providers and government officials are accountable for their actions.[4]  This accountability promotes health and makes Nebraska’s health system stronger.[5]  Creating a public sphere for dialogue and decision making in the health system will result in more reasoned, informed, and public-oriented decisions. As a result of transparent and public processes, the health system becomes more attuned to Nebraska’s health needs and thus more likely to improve health for all Nebraskans.

LB 1063 is a critically important bill that will protect children and families by ensuring no child is denied services who needs them. We urge you to advance it. Thank you.

[1] Osofsky, J.D., Lieberman, A.F. A call for integrating a mental health perspective into systems of care for abused and neglected infants and young children. American Psychologist. 2011; 66: 120-128; Sroufe, L.A., Egeland, B., Carlson, E., Collins, W.A. Attachment and development: A prospective, longitudinal study from birth to adulthood. Attachment & Human Development. 2005; 7: 349-367; Center on the Developing Child at Harvard University. A science based framework for early childhood policy: Using evidence to improve outcomes in learning, behavior, and health for vulnerable children. 2007.

[2] Knapp et al. Feasibility of expanding services for very young children in the public mental health setting. J Am Acad Child Adolesc Psychiatry. 2006; 46: 152-161.

[3] Morrison, M.O., Bratton, S.C. Preliminary investigation of an early mental health intervention for head start programs: Effects of child teacher relationship training on children’s behavior problems. Psychology in the Schools. 2010; 47: 1003-1017; Reynolds, A.J. et al. Effects of a school-based, early childhood intervention on adult health and well-being. Arch Pediatr Adolesc Med. 2007; 161: 730-739.

[4] Laverack G, Labonte R: A planning framework for community empowerment goals within health promotion. Health Policy and Planning 2000, 15(3): 255-262.

[5] Pérez D, Lefèvre P, Romero MI, Sánchez L, De Vos P, Van der Stuyft P: Augmenting frameworks for appraising the practices of community-based health interventions. Health Policy and Planning 2009, 24(5):335-341.


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