Opportunities to Support Optimal Health for Children in Medicaid Beyond the COVID-19 Pandemic.

SDOH inequities prevent some children from accessing the opportunities necessary to achieve optimal health, and many of these influences are compounded during the pandemic 1 We assessed the impact of the intersection of stay-at-home and shelter-in-place orders, economic downturn, and school disruptions in five key SDOH areas 6 Economic Stability Factors that create economic instability for children and families-including lack of employment opportunities, job loss, food insecurity, unstable housing, and poverty-are exacerbated by the pandemic 7 Five months into the pandemic, the Bureau of Labor Statistics reported that communities of color were disproportionately affected byjob loss 8 Current predictions estimate that almost six million children will become newly eligible for Medicaid by 2021 through job loss 7 Along with the racial wealth gap, food and housing insecurity are expected to increase, disproportionately affecting Black, Indigenous, and Latinx children through the accumulated effects of inequity and racial discrimination 1,2,7 Social and Community Context During the COVID-19 pandemic, social and community factors associated with worse health outcomes are exacerbated, including exposure to the effects of systemic racism, a key driver of health inequities for children in Medicaid 9 There are higher rates of COVID-19 infections and deaths in communities of color, partially because of higher rates of employment in service industries, lower pay, and decreased ability to work remotely, increasing potential exposure to COVID-19 2 The culminating effects of nationwide protests highlighting the history of marginalization and systemic racism against Black Americans, and decades of collective intergenerational trauma and chronic stress, are compounded by communal distress from the pandemic 10 Neighborhood and Built Environment Over half of low-income individuals live in high-poverty neighborhoods in highdensity metropolitan areas, limiting their ability to socially distance 11 Marginalization and structural racism contribute to higher rates of residence in high-poverty neighborhoods among Black (70%) and Latinx (63%) populations relative to Asian (40%) and White (40%) populations 11 A child's neighborhood influences their access to multiple determinants, including health care and high-quality education In-person schooling allows staff to observe and report suspected child abuse or neglect, which appears to be on the rise 1 Whether online or in-person, disruptions in schooling are predicted to cause declines in learning and development, especially for students who were behind before the pandemic 13 Health Care Access and Quality Access to health care, an important determinant of overall health, affects children enrolled in Medicaid, who receive well-child visits and ageappropriate vaccinations from their primary care providers AAP's policy statement provides recommendations for how pediatricians can address and ameliorate the effects of racism on children and adolescents-by optimizing clinical practice, bolstering workforce development and professional education, and supporting community engagement, advocacy, and public policy 9 Improve Access to Health Care Increased flexibility to cover and deliver care The registry could be created through public-private partnership or in coordination with school-based health centers focused on children with chronic illnesses, special health care needs, and physical or developmental delays