Research shows that children who are born healthy and have access to reliable, consistent, and timely health services are more likely to be school ready. Children have a better chance of learning math, reading, and other subjects if they have the glasses they need for seeing the whiteboard, the medications they need to return to school when they’re out sick, and the support they need for any disabilities, developmental delays, or mental health challenges. Women’s access to health care before, during, and after pregnancy is also critical for ensuring a healthy pregnancy, a healthy birth, and a healthy baby.
Unfortunately, Texas lags behind the rest of the country in both children’s and women’s access to health insurance, access to critical health services for infants and toddlers, and enrollment in early interventions for addressing developmental challenges. The lack of access contributes to many children not being school ready and falling behind their peers due to unmet needs which can profoundly impact a child’s health and learning for a lifetime.
Addressing children’s health and developmental needs requires a holistic approach, including supporting healthy pregnancies, healthy births, access to affordable health coverage, and early childhood supports for disabilities and developmental delays.
A child born prematurely arrives before the 37th week of pregnancy. Because premature birth occurs before full-term pregnancy when important development is still occurring, premature babies are born at risk of more health problems. Premature births can result in low birthweights and increases the risk of challenges in breathing, feeding, vision, and hearing, and long-term intellectual and developmental disabilities. To boost the number of children who are school ready, policymakers need to support healthy pregnancies that lead to fewer birth complications and healthier newborns.
Unfortunately, more than 1 in 10 Texas babies are born preterm. Furthermore, Black babies are much more likely to be born preterm compared to White babies.
Health insurance plays a critical role in ensuring children can attend regular check-ups, identify disabilities or developmental delays and receive early interventions, address mental health challenges, and get healthy and back to school when they’re out sick.
Unfortunately, Texas ranks among the worst states in the country (more than twice the national average of 5.7 percent) in the percentage of children under age six who are uninsured yet eligible for Medicaid.
While the state’s income eligibility policies for Medicaid exclude most adults below the poverty line, Texas children in families with low incomes typically are eligible for insurance either through Medicaid or Children’s Health Insurance Program (CHIP) if they are U.S. citizens or lawfully present in the U.S.
However, inadequate health coverage outreach efforts, unintended bureaucratic barriers and delays that families encounter when they attempt to apply or remain enrolled, and other systemic barriers keep eligible children out of health coverage.
A healthy childhood starts with a healthy mother and a healthy pregnancy and continues with access to postpartum care and early childhood supports for parents and infants. Multiple factors contribute to maternal and infant health, but health insurance coverage is a critical piece of the puzzle. If a woman has limited access to health care before or during her pregnancy, she may not be able to address conditions like heart disease or diabetes that can lead to pre-term births, low birth weight births, birth defects, infant mortality, and maternal death. Also, with limited access to mental health care, new parents suffering from postpartum depression may not receive help, which increases safety risks for babies, interferes with parent-child bonding, and can contribute to language delays and behavior challenges in a child. In fact, research shows that increased access to health coverage for low-income women before, during, and after pregnancy is associated with lowered rates of maternal and infant mortality – particularly for Black women and babies – improved utilization of preventive care and health counseling before pregnancy, and higher birth weights for infants.
While most states offer Medicaid to low-income adults, under Texas policy, uninsured low-income women typically are only eligible for insurance through Medicaid while pregnant and for two months after the pregnancy. Pregnancy complications – such as postpartum depression, cardiac arrest, dangerous blood clots, and infections, remain a serious concern in Texas and can arise months after childbirth. One-third of maternal deaths in Texas occur between 43 days and one year after pregnancy, and the vast majority of maternal deaths are preventable.
Unfortunately, Texas is by far the worst in the country when it comes to low-income women accessing health insurance. Nearly half (48 percent) of low-income Texas women of childbearing age do not have health insurance – which is more than twice the national average (23.4 percent). Texas is an outlier in the region too, with low-income women in Texas much more likely to be uninsured compared to southern and neighboring states.
It is critical for school readiness that infants who are sick can receive the medication and health services they require. It is also essential that they visit their pediatricians routinely so they can offer immunizations that help prevent illness, track growth and development, identify potential disabilities or developmental delays early, address any concerns that parents have, and establish a trusting relationship between a child and their parent.
The American Academy of Pediatrics (AAP) developed a set of comprehensive health guidelines for well-child visits known as the “periodicity schedule.” The schedule recommends eight well-child visits within the first 15 months of life.
Unfortunately, too many infants are not receiving these critical well-child check-ups. The numbers worsened during the COVID-19 pandemic: Nearly half (42 percent) of Texas infants enrolled in Medicaid did not receive the recommended six or more well-child visits in the first 15 months of life. This rate trails behind the national average of 37 percent for infants in Medicaid.
Well-child visits are also critically important for a toddler’s health and school readiness. The American Academy of Pediatrics recommends well-child visits every six months from age 18 months to 3 years old.
One in four (23.8 percent) Texas toddlers enrolled in Medicaid did not receive the recommended two or more well-child check-ups between ages 15 and 30 months, which is better than the national average of 29 percent.
We often think of a child’s growth as height and weight, but a child under age six should also reach milestones in how they play, learn, speak, act, and move. For some young children, healthy development may not be a clear path. Developmental delays or disabilities can take many forms, including medical conditions such as Down Syndrome and hearing or vision impairments; delays in language or speech; trouble interacting with others; cognitive issues that affect learning, problem-solving, or reasoning; and delays in motor development that can impact walking, eating, and writing.
In addition, children in low-income households are at greater risk of health concerns and developmental delays. This is, in part, because low-income children may face more risks, such as poor housing conditions, contributing to problems such as lead poisoning or asthma, nutritional deficiencies, or parental depression that affects parent-child attachment and impacts a baby’s brain development.
Developmental delays can range in severity and scope, but it is clear that early identification and intervention are key to optimizing a child’s health and educational success. Developmental screenings during regular checkups help families and health professionals recognize milestones and identify possible social, behavioral, and developmental delays that can be addressed with early interventions. When children have delays or disabilities, providing Early Childhood Intervention (ECI) services or other support while they are still infants or toddlers is more effective than waiting until they are older.
The screening process also creates an opportunity for health professionals to help families understand age-appropriate expectations and learn ways they can guide their children to school readiness and effectively address challenges that may arise.
The American Academy of Pediatrics recommends developmental screenings using a standardized tool for children at 9 months, 18 months, and 30 months, or if a caregiver expresses a concern with their child. In Texas, over half (53 percent) of children under age three enrolled in Medicaid did not receive a developmental screening in the 12 months before their last birthday – which is better than the national average of 58.7 percent for children under age three in Medicaid. While it is encouraging to see that Texas is doing better than the national average, there are opportunities to make sure more young children are screened early before challenges get worse.
Early identification of disabilities or developmental delays — partnered with a strong system of support to infants toddlers, and caregivers– can prevent early challenges from having lasting effects and give children a greater opportunity to meet developmental and learning goals. Texas Early Childhood Intervention (ECI) is an effective federal-state program that contracts with community organizations to provide life-changing therapies and services to children under age three with autism, speech delays, Down syndrome, and other disabilities and developmental delays. The state is required by federal law to provide these services to all eligible children under age three.
Working with caregivers, ECI helps children learn to walk, communicate with their families, and meet other developmental goals. ECI services prevent further delays, reduce the need for costly special education services, and help children develop independent living skills in the long term. In fact, a national study that tracked children from states’ early intervention programs as they entered elementary school found that only 58 percent were receiving special education services when they entered school. Thirty-two percent of children were considered to no longer have a disability or developmental delay, while ten percent had a disability or delay but did not receive special education services.
Unfortunately, Texas is much worse than the national average in children’s access to ECI. According to years of research, the prevalence of children under age three with disabilities and delays whose development could improve with ECI services is between 13 and 20 percent. However, only 2.5 percent of Texas children under age three are enrolled in ECI services, trailing behind the national average of 3.9 percent. Additionally, only 1.7 percent of Black children under age three in Texas are enrolled in ECI services, underscoring that Black children are likely under-enrolled and less likely to receive ECI services in the state.
Policymakers can ensure more babies are born healthy, mothers have the health care they need before, during, and after pregnancy, and all eligible children have health coverage and early interventions to get them off on a strong start. Learn more about the Dashboard’s policy recommendations to enhance good health and development in the first five years of life here.