Well-Child Care

Well-child visits, referred to in statute as screening services, are the foundation of EPSDT coverage and are a crucial entry point to support the delivery of immunizations, screenings, physical assessments, referrals, caregiver education, and ongoing health care needs management. The American Academy of Pediatrics and Bright Futures recommends eleven well-child visits through the first 30 months of life and then annually starting at age 3.ⁱ  When children receive recommended well-child visits and preventive care, they are more likely to be up-to-date on immunizations, have developmental concerns recognized and addressed, and are less likely to visit the emergency department.^{ii,iii,iv,v,vi,vii}  Despite these benefits, many children do not receive the recommended number of well-child visits and preventive health services, and disparities exist across race, ethnicity, income level, and geography.^viii  Well-child visit attendance among children ages 0 to 30 months eligible for Medicaid and Children’s Health Insurance Program (CHIP) is more than 20 percentage points lower compared to children with private insurance.^ix  Caregivers and providers cite a range of barriers to families’ attending well-child visits, including lack of transportation, work responsibilities, lack of childcare, and other social needs.^x 

What’s New: Improving Preventive Care in Early Childhood

The Centers for Medicare & Medicaid Services (CMS) is pleased to launch new well-child care TA opportunities for state Medicaid and CHIP programs focused on improving preventive care in early childhood. These opportunities build on CMS’ previous infant well-child TA efforts, shifting the focus from initial enrollment and engagement challenges to enhancing attendance of well-child visits and utilization of preventive care.  

Well-child visits play a critical role in identifying concerns that require follow-up care and, in early childhood, include essential preventive services such as immunizations, developmental and lead screening, and early oral health interventions. A webinar series launching in January 2025, will showcase state strategies for improving the delivery of preventive care in early childhood. Participants will gain insights from CMS, states, and subject matter experts on actionable approaches that Medicaid and CHIP programs can implement to support improvement in this area. Following the webinar series, a project-oriented affinity group will offer states the opportunity to undertake a self-defined QI project and learn from interactive workshops, one-on-one coaching, and peer state teams.

Webinar Series

CMS invites all interested staff from state Medicaid and CHIP programs, along with pediatric providers, Medicaid and CHIP managed care plans, public health agencies, and other quality improvement (QI) partners, to participate in the preventive care in early childhood webinar series. Register for the webinar series here.

Webinar: Promoting Preventive Care through Well-Child Visits in Early Childhood 
Monday, January 6, 2025
Recording (coming soon).

Well-child visits in early childhood include important preventive care services such as immunizations, developmental and lead screenings, oral health assessments, and early oral health interventions. However, not all children enrolled in Medicaid and CHIP receive the recommended number of well-child visits, which can lead to delayed immunizations and missed opportunities to identify developmental delays and elevated blood lead levels. In this webinar, experts from the CMS and Mathematica will discuss strategies for Medicaid and CHIP programs to increase the delivery of preventive care during early childhood. The webinar will also discuss the upcoming Improving Preventive Care in Early Childhood Affinity Group available to state teams in Spring 2025.

Webinar: State Medicaid and CHIP Experiences Promoting Preventive Care through Well-Child Visits in Early Childhood
Rescheduled to Monday, May 5, 2025, at 2-3 PM ET
Register for this webinar here.

This webinar will continue discussing strategies for state Medicaid and CHIP programs to promote well-child visit attendance and preventive care in early childhood. State Medicaid and CHIP teams will present their approaches to increasing developmental assessments, lead screenings, and immunizations provided during early childhood well-child visits.

Webinar: Addressing Barriers to Well-Child Visits and Preventive Care:  Promising Approaches to Transportation in Medicaid and CHIP Programs
Rescheduled to Monday, June 16, 2025, at 3-4 PM ET
Register for this webinar here.

Access to well-child visits, and the preventive care that is provided at those visits, is essential for keeping children healthy and thriving, yet transportation challenges often prevent families from attending these visits. This webinar will discuss a common barrier to well-child visits and preventive care – transportation – and share lessons learned from state Medicaid and CHIP programs implementing innovative approaches to address this barrier.

Affinity Group

Beginning in Spring 2025, CMS will convene an affinity group focused on improving the utilization of preventive services in early childhood. State QI teams, led by Medicaid or CHIP staff, will meet monthly for one-on-one TA sessions with QI coaches and subject matter experts, receiving tailored guidance and support on their QI project. States will also come together for periodic group-learning sessions focused on skill building and peer sharing related to advancing preventive care through well-child visits.

The affinity group is scheduled to run for 21 months:

• Pre-implementation (3 months): State QI staff will focus on understanding opportunities for improvement in their state, culminating in the development of an aim statement, identification of QI partners, and creation of a strategic plan for beginning their QI project.

• Implementation (18 months): State QI staff will work with their QI partners to conduct Plan-Do-Study-Act testing, “learning their way” into strong program and policy change.

  To learn more, attend the informational webinar: 

  Webinar: Overview of the Improving Preventive Care in Early Childhood Affinity Group and the Expression of Interest Process 
  
  Webinar date and registration (coming soon).

  State Medicaid or CHIP staff interested in joining the affinity group must complete an Expression of Interest (EOI) form. When completing the EOI, please indicate the Improving Preventive Care in Early Childhood as the affinity group you are interested in. Note: It is not necessary to indicate a specific project focus or identify QI partners at this time, as project development will be supported during the first three months of the affinity group.

  Expression of Interest: to fill out the EOI, click here (coming soon).

  Questions

  Please submit any questions to the QI TA mailbox at  MedicaidCHIPQI@cms.hhs.gov

Improving Infant Well-Child Visits

CMS offers QI TA to help states increase the attendance and quality of well-child visits for Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries ages 0 to 15 months, including:

1. QI TA resources, to help state Medicaid and CHIP staff and their QI partners get started improving the use of infant well-child visits for their beneficiaries. and
2. Improving Infant Well-Child Visit Ages 0 to 15 Months learning collaborative, to share different approaches to improving well-child visit care and state examples.

QI TA Resources 

These resources can help states get started in developing their own infant well-child QI projects:

• Getting Started on Quality Improvement Video. This video provides an overview of how Medicaid and CHIP agencies can start a QI project to improve the attendance and quality of infant well-child visits. The Model for Improvement begins with small tests of change, enabling state teams to “learn their way” toward strong programs and policies.
• Driver Diagram and Change Idea Table. A driver diagram is a visual display of what “drives” or contributes to improvements in infant well-child visits. This example of a driver diagram shows the relationship between the primary drivers (the high-level elements, processes, structures, or norms in the system that must change to use and quality of infant well-child visits) and the secondary drivers (the places, steps in a process, time-bound moments, or norms in which changes are made to spur improvement). The document also includes change idea tables, which contain examples of evidence-based or evidence-informed QI interventions to improve the use of infant well-child care. The change ideas were tailored for Medicaid and CHIP.
• Measurement Strategy. This document provides examples of measures that can be used to monitor infant well-child care QI projects.

Improving Infant Well-Child Visits Ages 0 to 15 months:

Learning Collaborative Resources

In 2021, CMS facilitated a two-year Improving Infant Well-Child Visits learning collaborative to support state Medicaid and CHIP agencies’ efforts to improve the use of infant well-child visits for infants ages 0 to15 months. The learning collaborative included a webinar series and affinity group to support state Medicaid and CHIP agencies’ QI efforts. The webinars, listed and linked to below, described approaches that states can use to improve attendance and quality of infant well-child visits.

California, Missouri, North Carolina, South Carolina, Texas and Virginia participated in the action-oriented affinity group where teams designed and implemented an infant well-child QI project in their state with tailored TA from CMS. Learnings from participating states can be found in the state highlights brief.

 Learning Collaborative Webinar Series

• State Spotlights Webinar on Improving Infant-Well Child Care (Video) (Transcript). This 2024 webinar spotlighted several state QI projects from the affinity group, highlighting their strategies, partnerships, and lessons learned.
• Using Payment, Policy and Partnerships to Improve Infant Well-Child Care (Audio)(Transcript). This August 2021 webinar focused on Medicaid and CHIP payment incentives, managed care contracts, and other strategies that can increase the use and quality of infant well-child visits and advance equity. Speakers from the CMS and Mathematica introduced CMS’ Maternal and Infant Health Initiative and shared the importance of high-quality well-child visits and the opportunities within Medicaid and CHIP to impact infant health. Speakers from Pennsylvania and Texas’ Medicaid and CHIP agencies described their efforts to expand and incentivize participation in infant well-child visits, such as through value-based purchasing, performance improvement projects, CHIP Health Services Initiatives (HSIs), and partnerships with aligned service providers like the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). State presenters offered insights into ways to incentivize efforts to close gaps in care, engage families, and improve performance on quality measures. During the Q&A session, presenters discussed the impact of the COVID-19 pandemic on well-child care, the potential of using telehealth or hybrid visits to increase access, and incentives for managed care plans, and addressing the social determinants of health in value-based payment strategies.
• Improving Quality and Utilization of Infant Well-Child Visits (Audio)(Transcript). This September 2021 webinar focused on the characteristics of a high-performing system of well-child health care. CMS and Mathematica presenters shared the Maternal and Infant Health Initiative’s Theory of Change. Speakers from Washington and Arkansas Medicaid and CHIP agencies discussed how their states have achieved high rates of participation in infant well-child visits and how they use data to monitor performance and disparities and ensure access to services. Washington shared insights on leveraging collaborative performance improvement projects to identify and address barriers to care. Arkansas discussed the state’s per member per month incentives for performance and minimum performance measures for infant well-child visit rates. During the Q&A session, presenters highlighted efforts to improve health equity, engage parents and providers, and leverage performance measures and quality tools to improve attendance at infant well-child visits.
• Models of Care that Drive Improvement in Infant Well-Child Visits (Audio)(Transcript). In this September 2021 webinar, three states—Oregon, Michigan, and North Carolina—shared approaches to designing and implementing models of care associated with improved infant well-child visit participation, including patient-centered medical homes (PCMHs) and home visiting. States offered insights on the importance of strategic alignment of policies, processes, and partnerships. Oregon discussed its home visiting program and quality incentive strategy for its coordinated care organizations. The state incentivizes progress on the HEDIS measures and other measures designed by the state’s Pediatric Improvement Partnership, including a measure of social-emotional health service capacity and access for infants and children. Michigan discussed how the state requires managed care organizations (MCOs) to identify and publish disparities in well-child visit rates and how they encourage plans to reduce disparities. The state also uses an algorithm that automatically assigns members to MCOs based on MCOs’ performance and reimburses for maternal-infant health home visiting. North Carolina shared its Keeping Kids Well program, which aims to increase well-child visit and immunization rates and reduce disparities in those rates. The program offers coaches to practices to support their improvements, established an advisory board of key interested parties, and provides customized vaccination notices for practices to distribute to beneficiaries, in partnership with health systems and pharmaceutical companies. The state also used the Healthy Opportunities payment to incentivize the identification and redress of health-related social needs and provided the Health Equity Payment to providers serving areas with high poverty rates.