New York State changes have hurt health care for kids

Less than four months after New York State made changes to the way it evaluates the need for care management services for children with complex medical or behavioral health needs, there’s worry the budget may further cut payments for these services, potentially harming vulnerable children in need of quality care.

The ripple effect, an estimated statewide $20 million cut to family and children care management services, heightens concerns about reduced access to care for vulnerable children and families. Care coordinators help families navigate health care, including arranging visits to doctors, helping find transportation, and connecting with the school to arrange an individualized education plan.

As a pediatrician on Long Island deeply entrenched in patient care, I’ve seen the profound effect of these revisions.

The changes modified the Child and Adolescent Needs and Strengths Assessment (CANS) rating system operated by the state Department of Health. Using a patient’s history in functioning, medical health, development needs, trauma, and health and cultural factors, the system delivers an “acuity level,” a measurement of the severity of the child’s problems, which decides the time care managers can spend with the child and family and how much a provider would be paid for administering care.

These mundane adjustments have had major impacts because fewer children are being cleared for the services they need.

This assessment is a mandatory tool for determining acuity in all children under New York’s Health Home Serving Children program, the state case management program designed specifically for children with complex and chronic medical and/or behavioral conditions who are Medicaid beneficiaries.

Since COVID-19, it’s evident that there are health care barriers for socioeconomically disadvantaged communities and people of color, intensifying the urgency to invest in children’s health care. Unfortunately, these revisions seem to heighten barriers to access, further strain an already challenged workforce, and threaten the very essence of Health Home Serving Children programs, designed to shift health care management from crisis and acute care settings to patient homes and physician offices. This could compromise quality hospital-to-home transitions of care, creating gaps in preventive and chronic care and disrupting overall care coordination.

Northwell Health, which serves 1,600 children with complex chronic medical and behavioral needs, has seen a drastic change in acuity under the new model. Recently, we had twins reevaluated on the CANS 2.0. The children have significant medical complexities that require care coordination for early intervention services and 12 specialty providers, as well as support services for various social determinants of health, including housing instability. The care manager averaged 15 encounters on behalf of the twins every month. Yet, the twins’ acuity rating moved from high to medium under the new CANS rating system.

Their benefits changed even if their needs didn’t — and they’re not alone. We’ve seen benefits reduced for infants born with chronic lung disease, using oxygen and feeding tubes, requiring multiple visits with pediatric specialists and intensive therapy visits — because their acuity level changed.

We must reevaluate the unintended consequences of these revisions to ensure a resilient and responsive health care system for vulnerable children. This is essential to allow children and families to continue getting the services they need.

The future of health care for New York’s children and families depends on policy decisions that prioritize their well-being over administrative expediency.