Healthy Michigan plan surpasses all expectations by first anniversary

The Healthy Michigan Plan, Michigan’s Medicaid expansion program, celebrates its first anniversary today. What an amazing year it has been for the program – with enrollment currently just over 600,000! The governor’s budget for 2015 estimated enrollment at 400,000 and 450,000 for budget year 2016. The budget released in February 2015 revised those estimates upward to 540,000 for 2015 and 580,000 for 2016. Those forecasts already have been surpassed – and it’s only April.

It is hard to imagine the peace of mind and improved quality of life this program has brought to hundreds of thousands of low-income individuals and their families. As of March 30, nearly five of six individuals enrolled in the program have incomes at or below the federal poverty level, about $11,800 per year for one person or $24,300 for a family of four. They can see a doctor for annual check-ups, obtain the medications they need to manage chronic diseases such as high blood pressure, diabetes, or cancer, or seek treatment when they are ill or injured.
Current enrollment is just over half female at 51%. The largest enrollment by age category is 164,000 enrollees between the ages of 25 and 34, the age group that was most likely to be uninsured prior to implementation of the Affordable Care Act. What peace of mind for the parents of these enrollees knowing that their young adults have healthcare coverage and won’t start their careers or adulthood in financial ruin from medical debt.

Those enrolled in the program are taking advantage of the opportunity to take control of their health and are receiving the services available to them. According to the Department of Community Health, more than 380,000 primary care and preventive care visits occurred in the first 10 months of the program. Enrollees are clearly engaged in improving their health and managing their chronic diseases with nearly half choosing to follow-up on their chronic diseases by themselves or in combination with other healthy behaviors, such as weight loss.

Under the program, enrollees also can receive incentives for tackling health issues or maintaining healthy behaviors. In addition, those with chronic conditions such as high blood pressure, diabetes, or depression, will be better able to manage their conditions with no copays that create obstacles to care.

While the enrollment system and implementation have not been without bumps in the road, the fact that more than 600,000 Michigan residents have gained high- quality healthcare coverage is simply amazing!

The Department of Community Health deserves a great deal of credit for the success of this program to date, but the governor and lawmakers deserve the credit for approving the legislation that created the program. Happy anniversary!

– Jan Hudson

Report: Promoting Early Literacy in Michigan

Full report | Fact Sheet

For the past several years, policymakers at the state and federal level have focused on improving student achievement as measured by standardized testing, and third grade is considered a pivotal age for mastery of reading skills. After the third grade, children will need reading skills to learn other subjects such as math and science, and to evaluate written text. Almost half of the material in the fourth grade curriculum requires grade-level reading skills.1 Three of every four students who do not read at grade level in the fourth grade will continue to struggle in high school, and thus be at high risk of not qraduating high school.

Early identification and intervention are key to improving literacy among youngsters: Schools alone cannot solve the problem. Michigan has a variety of programs that provide the foundation to literacy and academic achievement, but policymakers have not appropriated funding to address the level of need nor supported policies to improve economic insecurity, which has a well-documented negative impact on child health and academic achievement.

A critical part of Michigan’s  agenda to improve early literacy must address the role of widespread child poverty and the benefits of early intervention. Efforts must begin long before children reach the third grade or even kindergarten.

School readiness is a key strategy endorsed by the Campaign for Grade-Level Reading, a national collaboration of foundations, non-profits, states and communities focused on promoting strategies to improve third-grade reading.2

In 2012, a majority of the states had passed laws targeting improvement in literacy for early elementary students. Most of these states take a comprehensive approach with early identification, interventions and strategies in place to improve literacy, some beginning at birth.

Alternate methods to document proficiency in the third grade vary by state. Since many states have only recently implemented these procedures, it is too early to assess the results. For example, despite significant gains for Tennessee students, higher-income students benefited more. Furthermore, the impact on children, families, teachers and districts of emergency takeovers by the state and closing of neighborhood schools has not been assessed.

The Michigan Picture

Roughly 40% or 40,000 of the state’s third-graders demonstrated reading skills that were rated below proficiency (Level 2), as defined in the 2013 MEAP; 10,000 of those showed minimal skills, rated as “not proficient” (Level 4).3

The percentage of third-graders at Level 4 in each county ranges from a low of 3% in Dickinson and Charlevoix to 19% in Oscoda. In some of the most populous counties, such as Wayne, Saginaw and Genesee, 9-10% of third-graders performed at the lowest level. The cost of earlier intervention strategies pales in comparison with the cost of high school dropouts in the current economy.

As Michigan looks to align its standards with the Common Core—English and math standards developed by the Council of Chief State Officers and the National Governors Center for Best Practice—the test results would more likely reflect Michigan student performance on the national test where almost seven of every 10 fourth-graders (69%) in the state did not demonstrate grade-level skills. The NAEP 2013 Grade 4 reading test results dropped the state to a ranking of 37th among the 50 states, according to the 2014 national KIDS COUNT report.4

Family income makes a difference in academic achievement.

Similar to the nation, in Michigan the difference in reading proficiency between children from low- and higher-income families is dramatic.5 Roughly 80% of fourth-graders from Michigan’s low-income families did not demonstrate proficiency on the 2013 NAEP compared with just over half (56%) of those in higher-income families. The gap widened between 2009 and 2013 as children from higher-income families exceeded the gains of those from low-income families. In Michigan schools, the higher the concentration of children from low-income families, the larger the percentage of children not demonstrating proficient reading skills.

The number of children in Michigan who live in low-income families has escalated dramatically since the economic downturn and sluggish recovery. Between 2006 and 2013 Michigan experienced a 34% increase in the percentage of students eligible for free or reduced price meals in the School Lunch Program: Almost half of all public K-12 students were eligible in 2013 compared with just over one of every three in 2006. All the growth in eligibility occurred among students qualifying with family incomes below 130% of the poverty level—roughly nine of every 10 students eligible for the program.

Proficiency rates for students closely track family income as reflected in eligibility for free or reduced price school meals. In Michigan’s 15 largest counties the percentages of third-graders scoring proficient on the MEAP reflected the percentage of low-income students: The lower the percentage of students eligible, the higher the percentage proficient. The relationship held for both traditional and charter schools, also known as public school academies. Michigan also has the largest concentration of children in high-poverty neighborhoods in the country (15%)—thereby compounding the negative impact of family economic insecurity.

The impact of the state’s economic decline on families has been aggravated by state cuts in programs designed to blunt the impact of business cycle downturns on families and children. Either the eligibility standards or the benefit amount for several programs, including unemployment insurance, the state Earned Income Tax Credit, cash assistance (FIP), child care subsidies and food stamps (SNAP), have all been reduced in the last few years, at the same time as job growth lagged and wages stagnated or fell in the sluggish recovery.

Mass incarceration exacts a profound toll on African American children and communities.

While social support programs have waned in Michigan, the number of prisoners in the corrections system remains at record highs. Almost 50,000 children in Michigan have a parent in state prison, excluding jail and federal prison, and almost half of all prisoners lived with their children prior to their arrest.

A recent study found that the absence of a parent due to incarceration can have a worse impact than parental absence due to divorce or death.6 Having a parent in prison or jail was “linked to a greater incidence of attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD), behavioral or conduct problems, learning disabilities, speech or other language problems and developmental delays.”7

The prison population, disproportionately minority males, has resulted in worsening unemployment and decreasing family stability in communities of color. The prison experience itself can compromise physical and mental health and, once saddled with a prison record, ex-offenders struggle to find employment. The cost of parental incarceration also falls on their families and children. African American children are three times more likely to have a parent incarcerated as the national average: In the U.S. one of every nine African American children has an incarcerated parent compared with one of every 28 children of all race/ethniticy in the U.S.8

School readiness begins at birth.

Physical and emotional health from birth forms the bedrock for academic achievement. Babies who weigh less than five and one-half pounds at birth or spend less than 37 weeks in utero are much more likely to experience developmental delay, chronic disease or even death. In 2012, roughly 17,000 Michigan babies were born either too soon or too small or both. These fragile infants can often spend extra weeks or even months in intensive care and then need special services in early childhood and later years.

A healthy pregnancy improves the likelihood of a healthy birth.

The roughly 29% of mothers who do not receive adequate prenatal care, defined as beginning in the critical first three months of pregnancy and continuing regularly throughout the pregnancy, are at higher risk of an unhealthy birth than those who have timely regular care. Increased access to health insurance and medical care through the Healthy Michigan Plan, the state expansion of Medicaid under the Affordable Care Act, will increase the likelihood that more women will be in better physical health overall should they become pregnant. Uninsured women are more likely to delay prenatal care because of cost concerns or lack of a medical home and suffer from untreated chronic health conditions, which can compromise a healthy birth.

Expanded access to health insurance through the Healthy Michigan Plan benefits low-income parents and also other adults likely to be involved in children’s lives, such as caretaker relatives, childless adults and 19- and 20-year-olds.9 Improvements in the well-being of the significant adults in children’s lives will benefit those children, particularly in the early years.

All eight strategies outlined in the state’s Infant Mortality Reduction Plan focus on improving the likelihood of a healthy birth and infancy.10 The strategies include promoting safe sleep practices for infants, expanding home visits to high-risk women and reducing unintended pregnancies. However, in the last two budgets policymakers have allocated only one tenth of the funding required to fully implement the plan.

Parents matter.

The early years are a critical developmental stage when the brain undergoes its most dramatic growth and the capacity that supports future literacy is developed. The quality of the interaction between children and their parents and other caregivers in the early days and months affects the emotional and social well-being of the child as well as his/her cognitive development.11 Providing supports and training on fostering communication and nurturing behavior with infants, especially for parents and caregivers in low-income communities where resources are limited, can make a critical difference for healthy development, physically and emotionally. Children who arrive at kindergarten without social emotional skills are less likely to be able to focus on reading and math.

The resources available in the neighborhood and community to support families with children play a critical role for parents. Parents who are stressed by financial worries, health problems and mental illness can unwittingly trigger a chronic and severe response in their children that compromises development. Researchers have now documented the lifelong consequences of so-called “toxic stress” that causes a chemical response in the developing brain resulting in a negative impact on behavior and the ability to learn.

Early interventions, such as evidenced-based home visiting programs, can improve maternal and infant interactions, provide access to supportive programs and expand overall well-being, high school graduation and employment. Research on early brain development has demonstrated how vital nurturing relationships are to the social-emotional health of young children. Sustained support for parents of young children to foster maternal and infant bonding provides a foundation for positive interaction and eventual academic success.

Michigan has been able to expand its home visiting programs dramatically through its successful applications for federal funds totaling $34 million authorized in the Affordable Care Act. State funding, on the other hand, has actually fallen; the Executive Budget recommendations between Fiscal Years 2006 and 2015 reduced state funding for public health. The governor’s recommendation to invest $5 million in home visiting for Fiscal Year 2016 would be funneled through the School Aid budget to Intermediate School Districts.

While parents want to prepare their children for success in school, they may not have the latest tools or knowledge. In some Michigan districts one-third of births are to mothers who do not have a high school diploma. Minnesota, one of the top 10 states for reading proficiency among fourth-graders, offers a weekly class, Early Childhood Family Education, for children ages 0-4 and their parents in every school district in the state.12 Education professionals model activities and interaction for parents and children, and parents have their own group session on issues with which they are struggling. The program is offered to all parents with a sliding fee based on income. Participants from all income levels have participated over its 40-year history.

Lead poisoning continues to threaten children in Michigan.

Roughly 3,600 of the state’s toddlers ages 1-2 who were tested in 2013 had lead exposure (5 or more micrograms of lead per deciliter of blood) that would require case management.13 Toddlers are particularly vulnerable to lead poisoning due to their developing nervous system and their hand-to-mouth behavior. Lead dust generated by friction in windows and doors with multiple layers of paint poses a serious risk.

Decades of research have established the negative impact of early lead exposure on cognitive development. One research study found the amount of lead in students’ teeth was linked to lower IQ and academic performance.14 Eleven years later, a follow-up found those students with the highest levels of lead as youngsters were seven times less likely to graduate from high school. Recent MRI studies have shown that higher blood lead levels in early childhood correlates with brain damage, especially in the prefrontal cortex that regulates decision-making and impulse control, among young adults.

While the removal of lead from gasoline and paint has helped protect many children from the impact of lead, the presence of lead-based paint in the state’s older homes in rural and urban areas continues to threaten child health and well-being. In recent years Michigan’s childhood lead poisoning prevention program has limped along with support from federal block grants to continue surveillance, provide education about lead risk to professionals working with young children and their families, support some direct prevention activities and sustain limited case management in the most affected areas. The Department of Community Health has been able to maintain crucial services, but there is a critical need for case management and housing alternatives for families in lead-compromised housing.

In the 2014 budget just over $1 million was allocated to remediate lead in housing, and in 2015 the funding was bumped to $1.75 million. This expansion in funding supports remediation and provides more children with safe housing. With such clear evidence of lead’s detrimental impact on children’s capacity to learn, policymakers should continue to support investments to eradicate the risk to children from such exposure.

Access to quality child care for infants and young children is a challenge.

Low-income women are less likely to have access to paid sick or vacation time or maternity leave so access to reliable child care is critical as they must often return or even find work to support the family. (A pregnancy or a birth can cost them their jobs.)15 The risk of job loss increases with birth complications for the mother or infant.

Michigan’s already low child care subsidy hourly rate does not pay extra for children with special needs, and the standard rates for the age groups have fallen far below the recommended rate standard. For example, in 2012 the state subsidy for a 4-year-old in center care was $433 a month—less than half the market rate that year.16 In July 2014 the subsidy rate was raised for providers with 3-5 stars but, as of August, 82% of the almost 10,000 child care providers/programs had achieved only basic licensing requirements in the quality rating system. Roughly two of five children in subsidized care rely on unlicensed relative or neighbor care.

In fact, participation in Michigan’s child care subsidy program has plummeted despite the high level of need among Michigan’s low-income families. The state has one of the lowest eligibility levels in the country: Only families with income barely over poverty level (120%)—$1,990 a month for a family of three—qualify for the subsidy. In most states families with income above 150% or near double the poverty level remain eligible for a subsidy. Child care for only one preschool child represents a significant expense in a low-income family: The average monthly cost of full-time child care ($532) in Michigan for one preschool child would consume almost half of a full-time minimum wage income.17

Despite this level of need, few families can access the program. The average monthly caseload dropped from 65,000 families to 22,000 between FY 2005 and FY 2014.18 Spending for the program dropped over 70% in the same period. Yet one of every eight parents in Michigan’s low-income families with young children reported that lack of access to child care had meant someone in the family had to quit a job, not take a job or greatly change a job, according to the National Survey of Child Health (2011-12). High turnover in low-wage employment and Michigan’s pay-by-the-hour subsidy policy compromises both quality and stability in child care.

Opportunities to attend high-quality preschool need to continue to expand in Michigan.

While Michigan dramatically expanded its Great Start Readiness program for 4-year-olds in 2013 and 2014, research shows that starting preschool at age 3 yields cumulative effects, particularly in literacy skills.19 In one study children completing the second year of preschool demonstrated more mastery of decoding and letter recognition than those who attended only one year. Similarly, the 2010 Head Start Impact Study found significant differences in outcomes for children who started the program as 3- or 4-year-olds. The findings suggest that the number of years of participation in Head Start matters and that starting Head Start earlier is associated with stronger and lasting outcomes. “The 3-year-old cohort demonstrated more numerous and sustained outcomes in areas such as cognition, social-emotional development, health factors, and supportive parenting practices.”20

A preschool setting for 3-year-olds, especially those at highest risk, also provides an opportunity to build social-emotional competence at a younger age, as well as influencing parents earlier through modeling positive interactions and connecting them with resources to improve their own physical, emotional and financial well-being. Such comprehensive programs provide support to families at a critical point for both parents and children. These relationships are more difficult to alter once family dynamics become entrenched and children reach the K-12 system with its more formal settings, larger classes and institutional demands.

Smaller classes in the early grades are a key strategy to improve reading skills.

While Michigan’s Great Start to Readiness Program for 4-year-olds mandates one adult to every eight children, some kindergarten classes in Michigan number 30 to 40 with one teacher, according to anecdotal evidence. Unfortunately, such large classes seem to occur more in schools and districts with large concentrations of low-income children. National standards recommend one teacher per 18 students in kindergarten.22

Smaller class sizes in the early grades ease the transition into the K-12 system. Studies have found that smaller classes result in teachers spending less time on discipline and more time on instruction. Furthermore, students are more likely to participate and have more positive relationships with their classmates.23 Even more critical, researchers found that disadvantaged students benefit the most from smaller class size.

Early intervention programs for children and their families can make a critical difference.

A growing body of research shows that early relationships are not only critical to social/emotional development but are closely linked to brain development and physical health—the building blocks of school readiness. Early screenings with standardized tools can identify social and emotional problems in young children so services can be provided as early as possible. Easy and fair reimbursement policies for primary care doctors will encourage screenings.

Emotional health should be viewed as essential as physical health and be part of all programs for young children and their families. Providing proven services that support social and emotional well-being to families, caregivers and preschool providers can ensure the mental health needs of young children in all settings are identified and addressed.

Babies need loving relationships with adults in order to develop social-emotional skills.

Social-emotional skills fostered by stable loving relationships beginning in infancy with caregivers provide a foundation for a child’s ability to make friends, follow directions, control emotions, solve problems and focus on tasks.24 Michigan has been a leader in promoting infant mental health. Currently, more than 1,550 children and their families receive Infant Mental Health Home Visiting services annually (funded through the Community Mental Health system/Medicaid). IMH Home Visiting programs offer weekly home visiting by IMH-Endorsed®, Master-level therapists to Medicaid-eligible families who are at high risk for abuse, neglect or poor parenting. The program serves pregnant women and families with babies from birth through 47 months, including families with children in foster care. The emphasis is on the reduction of risk and enhancement of strengths to better assure that children are ready to learn. Thousands more receive IMH-informed services through programs such as some Early Head Start and Early On programs.25

For Medicaid-eligible children, primary healthcare providers are directed to administer a psychosocial/behavioral assessment and developmental screening at each scheduled well-child visit. Practitioners are advised to use a validated and standardized screening instrument, as recommended by the American Academy of Pediatrics.

Michigan’s early intervention services are limited.

The first three years of a child’s life provide a critical period of opportunity to address and minimize delays in development. Early interventions can decrease future needs for special education and other more intensive services. Such interventions address individual cognitive, physical and social-emotional development, as well as language and speech to strengthen the foundation of learning skills. Developmental screenings are an important mechanism for identifying children with delays. Unfortunately only one of every four parents of young children ages 10 months to 5 years in Michigan reported their child had received a developmental screening during a healthcare visit in the past year.26

Michigan’s Early On program is funded with federal dollars through IDEA Part C.27 The Michigan Department of Education distributes roughly $8 million through formula grants based on child population to the state’s 57 Intermediate School Districts to identify and provide services to eligible children and their families.

In 2013, less than 3% of children ages 0-2 were identified with a disability or developmental delay and received some kind of early intervention service, which could have consisted of a single visit during the year. A 2006 estimate, based on a variety of risk factors, suggested that almost 8% of the state’s infants and toddlers might benefit from early intervention.

Unfortunately federal funding does not cover the services necessary to meet the needs of the children and their families who participate in the program, according to a recent state audit.28 Each state sets its own standard for services eligible through Part C, and Michigan has one of the lowest eligibility thresholds in the nation, despite instituting more restrictions effective July 2010 and not investing any state dollars into the program.29 The audit revealed that many Intermediate School Districts limited services to Part C-only eligible children and did not ensure qualified professionals were providing the services.30 Furthermore, significant differences occur in access and quality of services across districts, which raises issues with equal access, and the state department was not monitoring ISD compliance with federal regulations.

A majority (60%) of Early On-eligible children do not meet the more stringent standards to qualify for services through state-funded Michigan Mandatory Special Education. Children and their families eligible for Special Education services received comprehensive services provided by qualified personnel, according to the audit. Michigan is the only state in the nation that has two different programs with different eligibility standards for services to this age group. To add to the confusion, Early On services are coordinated through the Office of Great Start, while special education services are coordinated through the Office of Special Education.

The lack of services for Part C-eligible children is not a new problem. Comments summarized from public meetings in nine locations throughout the state 14 years ago as part of a report to the U.S. Department of Education noted that available Part C services were “being maxed out with the dollars that are available now.”31 The report cited a need for:

  • training for all stakeholders, including parents, teachers, administrators, and especially general practice physicians;
  • consistent information about available services;
  • system-wide accountability and oversight; and
  • more effective support system for parents of children with disabilities.

These same themes were echoed in the recent audit report. In response to the audit, MDE’s Office of Special Education and Office of Great Start designed a special project that included on-site child file reviews in five ISDs. The results of that investigation are to be shared with MDE’s deputy superintendents.

The steep rise in the numbers of children ages 3-5 eligible for Special Education compared with the youngest children suggests that children might have been in need of services at a younger age but were not identified. The number escalates fivefold between the two age groups—ages 0-2 and 3-5. However, identification is especially difficult during the earliest years as lags in development become more evident as children age, and sometimes families are reluctant to admit their children need special education or have a problem.

Children struggle to learn to read for a variety of reasons, including hereditary conditions such as dyslexia. Dyslexia, which affects 5-17% of school-age children, often causes difficulty in decoding words, slows reading speed and interferes with comprehension of written text.32 It has no known cause and does not reflect a lack of intelligence or motivation. It does not qualify as a disability or a Special Education category, but standard reading instruction techniques do not work for children affected by dyslexia.

Children whose dyslexia is not addressed can face academic problems as standardized testing with timed sequences become more and more prevalent as a way of assessing student achievement. Furthermore, schools generally do not address the special needs of children with dyslexia, and techniques for teaching reading to children with dyslexia are not part of the curriculum at most universities.

Attendance Matters

Another strategy to improve literacy among third-graders is to address chronic absenteeism early—even at preschool. The youngest and oldest students in the K-12 system have the highest levels of chronic absenteeism. For children to learn they must be present—physically and emotionally—in the classroom on a regular basis. Researchers have documented that children who are chronically absent, defined as missing 10% of school days for any reason during the school year, have lower levels of achievement and increased likelihood of dropping out of school.33 Early intervention is critical as children who are often absent tend to be so over multiple years so they fall further and further behind regular attendees.

Until recently few schools reviewed individual attendance. Generally schools would track average daily attendance, but a school can have 90% average daily attendance with 40% of its students chronically absent because different children are absent on different days.34 In some Michigan districts school administrators are focused on addressing the causes of unexcused absences.

According to an analysis of 2011-12 attendance data in districts throughout the state, more than one-quarter of students in at least 10 Michigan school districts missed two full weeks of school with unexcused absences.35 Similar to other states, which have varying definitions of chronic absenteeism, the analysis found rates highest in urban and rural areas where child poverty tends to be more prevalent.

By focusing on children in the early grades, barriers to regular attendance can be addressed early. An analysis of absenteeism among students grades 1-3 in 20 school districts within the Kent Intermediate School District, found that chronically absent children were twice as likely to fall below grade-level reading skills by grade three as regular attendees. Almost one-quarter of children who missed 10% or more of school (18 days) in grades 1-3 scored below the proficiency standard in Grade three reading compared with 12% of students with less than 10% absenteeism.36 The study, which was done in collaboration with the Kent County Services Network, is designed to help leadership formulate a plan to address absenteeism.

Children in early elementary grades are chronically absent for multiple reasons including, but not limited to, illness, transportation, parental physical or mental health and concerns about bullying or safety.

Poverty Matters

Children in low-income families who have the most to gain by regular school attendance also have the greatest barriers, such as illness, transportation, hunger, toothaches, lead poisoning, asthma, housing mobility and homelessness. They also may be more susceptible to bullying or harassment as they change schools more frequently due to instability in parental employment or housing and live in neighborhoods where safe routes to school are an issue. With the decline of neighborhood-based schools, particularly in urban areas of the state, safe-routes-to-school initiatives become more critical as charter schools and schools of choice are not required to provide transportation for their students.

Children in low-income families also are at particularly high risk of lead poisoning due to nutritional deficits, particularly iron and calcium, and the higher likelihood of living in older rental housing units. Between 2005 and 2012 child poverty escalated by roughly one-third in the state, placing more children at risk. In 2013 roughly one of every three children, ages 0-8, lived in families that qualified for the Supplemental Nutrition Assistance Program (food stamps) with income just slightly above the poverty level.

Policymakers usually treat standardized test results, chronic absenteeism and dropout rates as “school” problems that are not related to the strength of other systems such as health, human services, transportation and housing. To its credit, Michigan has supported more than 100 school-based or school-linked health centers, although mostly in middle and high schools.

In addition, under the Pathways to Potential program, the Department of Human Services places workers, called “coaches,” in schools. This outreach began in 2012 as part of a truancy prevention effort in response to high crime rates in four urban areas: Detroit, Saginaw, Flint and Pontiac. As of fall 2014, 160 schools throughout the state host the program. While DHS workers help connect families to services to facilitate school attendance, lack of cooperation by families on cash assistance or continued truancy by their children can result in the termination of the benefits that cover basic needs for the whole family. This approach further deprives all of the children in the family.

Due to such policy changes, many more families now face increased risk of homelessness and hunger. Policies that have imposed lifetime limits on cash assistance for low-wage workers with children fail to recognize the instability of employment in the low-wage sector. Parents who cycle in and out of low-wage part-time jobs to support their families in a period of sustained relatively high unemployment rarely qualify for unemployment benefits so the cash assistance program is the only option. Large numbers of families who subsist on incomes below poverty level do not qualify for the program because of the low eligibility level: Only families with incomes below roughly half the poverty level ($814 monthly) qualify for assistance. The maximum cash assistance grant ($492 a month for a family of three) does not cover the average Fair Market Rent for a family in any Michigan county.

While policymakers have restricted access to programs that address economic insecurity, more initiatives have targeted child health. One of the most successful efforts in the state to address the health needs of low-income children has been the systematic expansion of the Healthy Kids Dental program, a public-private partnership between the Department of Community Health and Delta Dental of Michigan. Now in 80 of the 83 counties, the program features higher payment rates and simplified administration to increase access to dental care for Medicaid-eligible children. The last three counties without HKD are among the most populous and most diverse so it is critical to expand the program to provide equitable access to care. With tooth decay the number one chronic disease among children, HKD is an important investment for the state. Children afflicted by tooth decay and toothaches are more likely to miss school and struggle to concentrate even when present. Poor oral health in childhood also compromises permanent teeth and affects overall health into adulthood.

Recommendations to Improve Literacy Among Early Elementary Children in Michigan

The most rapid and critical development occurs in the first three years of life. Programs that foster maternal and infant mental and physical health in those early years are key strategies to improve physical, cognitive and social-emotional development. Healthy development in the early years provides the foundation for literacy in the early grades.

1. Strengthen and expand existing systems for young children and their families.

  • Infant Mortality Reduction ($2 million/$11 million needed): Roughly 17,000 infants are born too small or too soon each year putting them at risk for developmental delay, chronic disease and even death. Funding the priorities in the Infant Mortality Reduction Plan would increase healthy births. In FY 2015 roughly $2 million was allocated.
  • Childhood lead poisoning prevention ($1.25 million/$11 million needed): Even trace amounts of this substance can stunt cognitive development and affect behavior with lifelong impact. Roughly 4,000 young children ages 0-2 who were tested in 2013 had lead in their systems.
  • Early On ($0/$100 million needed): Early intervention for children with developmental delay or disability can make a critical difference to these children, their families and their communities. Full funding for the program to meet current levels of need would cost an estimated $100 million; currently the state relies only on federal funding of roughly $8 million to provide program services. Addressing conditions that could interfere with school readiness improves opportunities for early literacy.
  • Child care subsidy ($136 million/$500 million needed): Michigan has one of the lowest eligibility levels and reimbursement rates in the country. A good job is the best route out of poverty, but parents who cannot access affordable and reliable child care have difficulties finding and keeping a job. Lack of stability in child care also compromises quality.
  • Preschool for 3-year-olds (flexibility with existing funds): Michigan has made great strides in expanding access to preschool for 4-year olds, but public preschool programs for 3-year-olds in the state are very limited. Research studies document that children who have attended two years of preschool have higher scores for literacy skills than those attending only one year. Allowing ISDs to use GSRP funds to expand access for 3-year-olds and evaluate the outcomes would better tailor funding to community needs and could result in even greater gains in social-emotional development and literacy skills.
  • Healthy Kids Dental ($22 million needed): Medicaid-eligible children in only three counties in Michigan do not have access to Healthy Kids Dental. These also are the counties with the largest populations of children of color. Toothaches and decay interfere with regular attendance and learning. The $22.5 million investment by the state would bring nearly $44 million in federal funds.

 2. Address the connection between poverty and academic achievement.

  • Restore the State Earned Income Tax Credit($252 million needed): This credit rewards work and lifts families above poverty. Currently at 6% from a high of 20% of the federal credit, the additional income can make a crucial difference to child well-being.
  • Reform the criminal justice system and enact policies that reduce disproportionate incarceration of African American males. The impact of the justice system on communities of color is particularly staggering. Mass incarceration is a key driver of poverty. A criminal record can result in lifelong barriers to employment and education.

 

This research was funded by the Annie E. Casey Foundation. We thank them for their support but acknowledge that the findings and conclusions presented in this report are those of the author alone, and do not necessarily reflect the opinions of the Foundation.

 

Endnotes

  1. EARLY WARNING! Why Reading by the End of Third Grade Matters. A KIDS COUNT Special Report from the Annie E. Casey Foundation citing research from The Children’s Reading Foundation.
  2. The Campaign for Grade-Level Reading. http://gradelevelreading.net
  3. Standards are in flux as the MEAP, which was due to be phased out in the 2014-15 school year, was reinstated at the behest of the Legislature in spring of 2014 after a three-year phase-in to a test based on the Common Core Standards.
  4. National Assessment of Educational Progress (NAEP) or the National Report Card provides state-level data on student achievement on various subjects and grade levels based on tests administered every two years to a sample of state students.
  5. Low-income is defined as family income less than 185 percent of the federal poverty level—the eligibility level for free or reduced price in the School Lunch Program ($43,000 for a two-parent family of four). Income data were not available until 2009 in NAEP data.
  6. Krisin Turney. Stress Proliferation Across Generations? Examining the Relationship Between Parental Incarceration and Childhood Health. Presented August 16, 2014, San Francisco, American Sociological Association’s 109th Annual Meeting.
  7. Ibid.
  8. Amanda Alexander. Addressing the Needs of Children of Incarcerated Parents. Presentation. August 2014.
  9. Income eligibility for the Healthy Michigan Plan is set at less than 133 percent of the federal poverty level (up to $15,521 for an individual or $31,721 for a family of four).
  10. Michigan Infant Mortality Reduction plan is available online at http://www.michigan.gov/documents/mdch/MichiganIMReductionPlan_393783_7.pdf.
  11. Jack Shankoff. Center on the Developing Child. Harvard University.
  12. Ron French. Smartest kids: Teaching starts early, with special focus on the poor, in Minnesota. Bridge Magazine. September 14, 2014.
  13. These levels are adjusted periodically by the Centers for Disease Control and Prevention.
  14. Harold Needham et al. The Long-Term Effects of Exposure to Low Doses of Lead in Childhood — An 11-Year Follow-up Report. The New England Journal of Medicine. January 11, 1990. http://www.nejm.org/doi/full/10.1056/NEJM199001113220203#t=articleTop
  15. Liz Ben-Ishai. Access to Paid Leave: An Overlooked Aspect of Economic & Social Inequality. CLASP. April 14, 2014.
  16. Pat Sorenson. Failure to Invest in High-Quality Child Care Hurts Children and State’s Economy. Michigan League for Public Policy. Lansing, MI. September 2014.
  17. Kids Count in Michigan. Michigan Profile 2013. http://www.mlpp.org/kids-count/michigan-2/mi-data-book-2013
  18. Pat Sorenson. Failure to Invest in High-Quality Child Care Hurts Children and State’s Economy. Michigan League for Public Policy. Lansing, MI. September 2014.
  19. Lori E. Skibbea, Carol McDonald Connorb, Frederick J. Morrisonc, Abigail M. Jewkesd. Schooling effects on preschoolers’ self-regulation, early literacy, and language growth. Early Childhood Research Quarterly 26 (2011). pp 42-49.
  20. Child Trends. Research-based Responses to Key Questions about the 2010 Head Start Impact Study. Child Trends Early Childhood Highlights. Volume 2. Issue 1. January 28, 2011.
  21. Hirokazu Yoshikawa et al. Investing in Our Future: The Evidence Base on Preschool Education. http://fcd-us.org/resources/evidence-base-preschool
  22. Sheila Smith, Mercedes Ekono, Taylor Robbins. State Policies through a Two-Generation Lens: Strengthening the Collective Impact of Policies that Affect the Life Course of Young Children and their Parents. National Center for Children in Poverty, Mailman School of Public Health, Columbia University. September 2014.
  23. Gail Braverman. Class size and student achievement: what school leaders must know! Michigan Association of School Boards Journal. Spring 2002 Journal Special Report.
  24. Social and Emotional Health of Children Birth to Age 8 Fact Sheet. www.michigan.gov/socialemotionalhealth
  25. Summary provided by Deborah Weatherston, PhD., IMH-E®Executive Director, MI-AIMH.
  26. National Survey of Child Health 2011/2012 NSCH National Chartbook Profile for Michigan vs. Nationwide.
  27. This program is funded as Part C of the Individuals with Disabilities Education Improvement Act of 2004 to establish an interagency program for coordinating efforts with and across community and governmental agencies to address the needs of children younger than 3 years old who have developmental needs.
  28. Michigan Office of the Auditor General. Performance Audit of Early On – Michigan Department of Education. November 2013. http://www.audgen.michigan.gov/finalpdfs/13_14/r313200012.pdf
  29. Ibid.
  30. Ibid.
  31. Public Sector Consultants, Inc. Fall 2000 Meeting Responses Summary. Part of the U.S. Department of Education’s Continuous Improvement Monitoring Process. Appendix D. January 2001.
  32. Michigan Dyslexia Institute, Inc. https://www.dyslexia.net/WhatIsDyslexia.html
  33. Robert Balfanz and Vaughan Byrnes. Chronic Absenteeism: Summarizing What We Know From Nationally Available Data. Baltimore: Johns Hopkins University Center for Social Organization of Schools. 2012. This source provided all the data cited in this discussion.
  34. Ibid.
  35. Chris Andrews. Michigan’s 91,000 truant students: skipping school, skipping opportunity. Bridge Magazine. October 9, 2013.
  36. Community Research Institute. FINAL REPORT Chronic Early Absenteeism: Prevalence and MEAP Performance in Kent ISD, Kent County, Michigan. Grand Valley University, Grand Rapids, Michigan. 2011. (Attendance data from 2006-09).

Supreme Court: Another chance to affirm ACA as the law of the land — the whole land

There is a lot at stake for about 300,000 Michiganians as the U.S. Supreme Court begins consideration of the King v. Burwell case today.

This case will  determine whether the Affordable Care Act permits the federal government to provide premium tax credits to qualifying individuals anywhere in the U.S. or only in states that established their own Health Insurance Marketplaces.

An adverse ruling in this case could eliminate these tax credits established in the law to make coverage more affordable. It is hard to imagine that Congress would have intended to pick winners and losers for healthcare coverage in such an arbitrary and surreptitious manner. (more…)

Many kids stuck in poverty without solutions

Contact: Judy Putnam or Jane Zehnder-Merrell, 517.487.5436

Kids Count in Mich. ranks 82 counties on child well-being

LANSING, Mich. – Too many kids in Michigan remain mired in poverty at a time when policymakers have reduced help for struggling families, according to the Kids Count in Michigan Data Book 2015 released today.

Three measures of economic conditions worsened over the trend period with nearly one in every four children living in an impoverished household, a 35 percent increase in child poverty over six years. The trend period measured from 2006 to 2012 or 2013, depending on the availability of data.

“The unraveling of family’s economic security cries out to be addressed by state leaders but what’s happened is just the opposite of what is needed,’’ said Jane Zehnder-Merrell, Kids Count in Michigan Project director at the Michigan League for Public Policy.

The state Earned Income Tax Credit was cut 70 percent in 2011. It goes to working families earning the least. (Voting ‘yes’ on the May 5 road funding proposal will restore it to 20 percent.) Other barriers are hard caps on lifetime limits for cash assistance, fewer weeks of unemployment, an asset test that limits federally funded food assistance, and child care subsidies that haven’t kept up with inflation.

“These are the tools we have to make sure a family in a crisis doesn’t spiral downward and is able to survive. The shredding of these programs is bad policy when it comes to the well-being of Michigan’s children,’’ Zehnder-Merrell said. “It’s hoped that the merger of the state departments of Community Health and Human Services will offer improved services for children and families, though budget pressures could bring more cuts.’’

In addition, Michigan in recent years eliminated financial aid grants for adults attending public colleges and universities and slashed adult education to a fraction of where it was a decade ago.

The toxic effect of poverty on children cannot be overstated. Research shows that children growing up in poor homes are more likely to drop out of school and less likely to have stable employment as adults. Boosting income in those families through such strategies as tax credits pays off with children in those families earning more and working more hours when they grow up.

More than a half-million Michigan kids lived in poverty, defined as $23,600 or less a year for a two-parent family of four. Child poverty is particularly high in communities of color where a lack of jobs and transportation has deepened economic woes. Detroit, a majority African-American city, has the highest level of concentrated poverty of the 50 largest U.S. cities, a recent report from the Annie E. Casey Foundation found.

The Kids Count report also highlights the racial inequity in access to oral health that needs to be addressed in the 2016 budget. The Healthy Kids Dental program, which provides additional payments to dentists for children on Medicaid, is in 80 counties. The three remaining counties left out of the program, Wayne, Oakland and Kent, have large populations of children of color.

That means that only 28 percent of white children eligible for Medicaid are in counties without Healthy Kids Dental compared with 63 percent of African-American children eligible for Medicaid.

“Gov. Snyder has called for the Healthy Kids Dental to be available in all communities. That needs to happen this year. Using public dollars in a way that mainly benefits white children and leaves out African American children is simply unacceptable,’’ said Gilda Z. Jacobs, president and CEO of the Michigan League for Public Policy.

Of the 15 trends in child well-being examined in the report, eight improved, five worsened, one stayed about the same and one could not be tracked over time. The report also ranks 82 of the 83 counties for overall child well-being with Livingston and Ottawa counties tied for the best rating of No. 1.

Statewide, all four education trends improved while fewer children remained in foster homes or relative care. Yet nearly 200,000 children live in families investigated for abuse or neglect, a 41 percent jump in the rate between 2006 and 2013, while nearly 34,000 were confirmed as victims of abuse or neglect.

A partner in the release of the Kids Count report, Matt Gillard, president and CEO of Michigan’sChildren, said p revention and early intervention are the keys to ensuring safety at home.

“It’s so very important that we focus on interventions that work – the earlier the better. This includes increasing evidence-based services for the most challenged families in local communities to prevent child abuse or neglect, and targeting services to vulnerable families with infants,’’ Gillard said. “A two-generation approach that helps parents get the resources and tools that they need, while at the same time supporting children, is critical.”

The Michigan Coalition for Children and Families, representing 20 child and family advocacy groups across the state, will use the report to focus on improvements to benefit children.

“This report offers communities and state level officials a treasure trove of information so they can know what’s working and what needs to be improved,’’ said Michele Strasz, chair of MCCF and the director of the Capital Area College Access Network.

More contact information: Matt Gillard, matt@michiganschildren.org, 517.488.9129 (c); Michele Strasz, programdirector@capitalareacan.org, 517.712.2014 (c).

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Kids Count in Michigan project is part of a broad national effort to improve conditions for children and their families. Funding for the project is provided by the Annie E. Casey Foundation, the Detroit-based Skillman Foundation, Steelcase Foundation, Blue Cross Blue Shield of Michigan Foundation, United Way for Southeastern Michigan, Battle Creek Community Foundation, Kalamazoo Community Foundation and John E. Fetzer Fund of the Kalamazoo Community Foundation.

‘Yes’ on road funding is right direction

From the League’s First Tuesday newsletter
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It’s a pivotal time for Michigan public policy. Decisions made in the next few months will determine the path Michigan takes into the future.

In three short months, voters on May 5 will decide Proposal 1, the road funding package. There’s no doubt that this is Michigan’s single best chance to raise sorely needed money to pay for road repairs and put new dollars into school classrooms all while protecting families earning the least. (more…)

Another milestone for the Healthy Michigan Plan

The Healthy Michigan Plan reached another milestone this week with enrollment topping 481,000. That number exceeds the original enrollment projection of 477,000 for the entire program. It was expected to take two years to achieve full enrollment.

What an accomplishment in nine months!

The best part is that enrollees are actually receiving healthcare services. According to the Department of Community Health, more than 315,000 primary care and preventive care visits have occurred since the program was implemented. Enrollees are clearly engaged in improving their health and taking advantage of the services now available to them to do so. (more…)

400,000 reasons to give thanks

From the First Tuesday newsletter
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As we head into the month of November, there are more than 400,000 reasons to give thanks.

That’s how many previously uninsured or underinsured people in Michigan are now able to access healthcare thanks to the Healthy Michigan Plan.

The plan passed the Michigan Legislature last year with bipartisan support as part of Medicaid expansion under the Affordable Care Act. About half the states have taken this step to improve the health of their citizens.

The League was part of a strong, diverse coalition that supported the expansion. Those efforts are now bearing an amazing amount of fruit.

In just six months, enrollment exceeded the first-year expectations.

Just how phenomenal this is in Michigan is evident in the League’s latest interactive map. On the map below, hover your mouse over a county. You will find an estimate of the uninsured and how many people signed up for the Healthy Michigan Plan in just the first six months. In all, more than 400,000 have enrolled.

In some counties, there are more enrolled than previously thought were uninsured! While some of these may have had limited insurance and were really underinsured, it’s a good benchmark to gauge the level of tremendous need.

Genesee County is particularly notable with a large number of its residents joining the plan.

The Affordable Care Act is indeed the gift that keeps on giving. Besides offering comprehensive healthcare coverage to thousands of low-income adults, many of them holding full-time jobs, the Affordable Care Act has offered many positive benefits, according to the U.S. Department of Health and Human Services:

  • Nearly 273,000 in Michigan have signed up for insurance through the Marketplace. Enrollment begins again Nov. 15.
  • There are 94,000 young adults in Michigan benefiting from the provision that allows parents to keep their children on their plans until they turn 26 years old.
  • A requirement that health insurance companies spend 80 cents or more of premiums on healthcare or improvements to healthcare, or give the money back, resulted in $13.2 million in rebates to more than 184,000 in Michigan in 2013. The average refund was $118 per family. Since implementation in 2011, rebates to Michigan consumers have exceeded $45 million.
  • Most insurers can no longer deny coverage for a pre-existing condition, benefiting 4.4 million nonelderly in Michigan with some type of health condition.

With so many more in Michigan accessing preventive care, it means that good health is a goal within reach for those enrolling in the Healthy Michigan Plan.

The success of this program to date is indeed a reason to celebrate.

– Gilda Z. Jacobs

Census numbers tell of stagnancy and slow recovery

Today is the big day that comes each year: the release of American Community Survey figures on income and poverty.

Ready for some numbers?

Michigan’s household median income in 2013 ($48,273) was a bit higher than in 2012, but is nearly $1,000 lower than in 2009. The income bracket that grew the largest from 2009 to 2013 was the share of Michigan households who make under $10,000 a year. The only other income bracket with a significant share increase was households making more than $200,000 a year. These numbers taken together suggest that the slow economic recovery in Michigan is primarily benefiting those at higher incomes. (more…)

Back to school: Are children ready to learn?

For children to succeed in school, they must go to school “ready to learn” –  rested, fed and healthy. But how many children will start the school year with a toothache or other dental problem?

According to the Department of Community Health’s 2011 -2012 Count Your Smiles survey, the number is likely pretty high. (more…)

Healthy Michigan plan enrollment tops 275,000

Enrollment in the Healthy Michigan Plan as of June 2 totals 276,622. This is truly remarkable considering the program was implemented just over two months ago on April 1. Genesee County, at 98.5%, has enrolled the highest percentage of those potentially eligible. What a great achievement.

The Healthy Michigan Plan is Michigan’s unique Medicaid expansion plan. It provides comprehensive healthcare coverage to Michigan’s low-income uninsured residents. To be eligible for the program, an individual must be between the ages of 19 and 64, not currently eligible for Medicaid or Medicare, a citizen or lawfully admitted to the U.S., and have income less than 133% of the federal poverty level (up to $15,521 for an individual or $31,721 for a family of four).

Application for the program can be made by phone (1-855-789-5610), online at www.michigan.gov/mibridges, or in person at a local Department of Human Services office. Applications made through the on-line system can have eligibility determined in a matter of minutes and sometimes even seconds. (more…)

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