While California children have been spared, for the most part, from contracting COVID-19, children’s health is being greatly impacted by missed preventive and routine care as a result of the pandemic. The American Academy of Pediatrics found that 70 to 80 percent of kids are not currently seeing their pediatrician. The unavailability of preventive care is exacerbating health disparities that existed long before the pandemic – the State Auditor released a report last year on children’s access to preventive health care in Medi-Cal which showed that fewer than half of children in Medi-Cal had an annual health check-up, despite a legal guarantee to timely preventive services and health screenings. The fact that children are now missing out on critical preventive and routine health care is extremely problematic and has far-reaching impacts, including:

• Missed well-child visits and developmental check-ups, as receiving routine well-child visits and screenings in order to identify developmental issues and refer children for early intervention services are critical to healthy development;
• A reduction in immunization rates, as pediatricians prioritize vaccinations for children under age two, but the threat of an increase in vaccine-preventable illnesses and communicable diseases, such as measles, mumps, rubella, pertussis, and meningitis, for example, is very real;
• Heightened mental health needs, as children and families are experiencing increased anxiety and stress due to the abrupt change in schedule and overall uncertainty in their environment, and some kids may be living in unsafe homes;
• Missed dental visits, including cleanings and routine exams, allowing children’s oral health problems to develop or worsen and creating a backlog of needed care;
• New and/or greater access challenges for children with special health care needs, as these children and their families are likely to face additional barriers above and beyond what other families are dealing with during this crisis, including trouble getting vital equipment (e.g., ventilators, gloves, etc.) and missing specialist visits, some of which can’t be replaced by telehealth services.

As we emerge from this crisis, it is critical that we prioritize children’s health care needs. Pediatric practices, medical and dental clinics, and children’s hospitals are an essential part of our state’s public health and health care infrastructure, and the current crisis threatens the continued viability of pediatric providers and children’s access to care. Children must stay connected to regular care so that they are not delaying or forgoing non-emergent visits or forced to seek care in overburdened emergency departments; and they must also be able to access pediatric subspecialists and children’s hospitals, especially if they have special health care needs, so they can continue to receive the specialty care that keeps them healthy or addresses their chronic, acute, and complex medical needs.

In the short-term, some providers have taken on new approaches to health care, such as incorporating telehealth services into their practice, separating well-child visits from sick visits (e.g., by time, designating morning versus afternoon appointments and/or by physicality, like using different entrances), asking patients to wait in their cars, rather than in waiting rooms, and even delivering some services, such as vaccinations, to patients in their cars. Health plans and insurers have also stepped up to support providers during this critical time and adjust to new approaches in serving patients – for example, HealthNet has committed $13.4 million in grants to Medi-Cal providers to implement and expand telehealth services, and Blue Shield of California has arranged up to $200 million in provider relief for advance payments and contract restructuring.

These efforts are helpful in the immediate and short-term, but longer-term solutions are required to ensure children’s health care needs are fully met as soon as it is safely possible. Some specific areas that state policymakers should consider so that the health care system can meet the needs of children include:

• Supporting provider retention and stability activities so they can keep doors open, continue to pay their staff, stock vaccines, etc.;
• Ensuring that all providers and their staff have personal protective equipment so that they can remain safe while treating kids;
• Expanding the child-serving health workforce to include more community health workers, promotors, and peer-to-peer supports to address the health needs of children and families;
• Providing clarity and support around reimbursement for telehealth services and policies and
• Doubling down on the promotion, monitoring, oversight, and accountability of children’s preventive care services in Medi-Cal, including making a commitment to address health disparities.

While the health care system is first and foremost focused on responding to the needs of COVID-19 patients, as it should, we cannot scale back important pre-pandemic activities that support and promote children’s health and prevention. Activities like family outreach and education, health plan monitoring, and strengthening Medi-Cal accountability are ever more important. And at the same time, California must preserve its critical network of child-serving practices in order to protect access to care for the millions of children who need routine and preventive care, and to retain the bandwidth to work through the backlog of children’s medical and dental care created by the COVID-19 pandemic.

 

Resources

If you are a parent or caregiver, don’t hesitate to call your child’s pediatrician if you have any health-related questions. Pediatricians can help determine whether your health concern can be addressed virtually, or if your child needs to be seen in-person. Read more about resuming California’s deferred and preventive health care during the COVID-19 pandemic from the California Department of Public Health.

If your family includes a child with special health care needs, this can be an increasingly difficult time with new and unique challenges. The California Department of Public Health provides some tips and resources here and Family Voices of California also has useful information available on their site.

Lastly, we encourage you to educate yourself about the preventive care services that your child is entitled to in Medi-Cal, which include well-child visits, dental, vision, hearing and trauma screenings and vaccinations; timely access to and coordination with language-appropriate care; and any treatments needed for a physical or mental condition.