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Health and Development Policies

Profile benchmarks for improving access to public health insurance

Profile benchmarks for improving access to maternal health and mental health

Profile benchmarks for enhancing children’s preventive care and early intervention services  

Profile benchmarks for enhancing care coordination and program participation

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Profile benchmarks for improving access to public health insurance

State sets the income eligibility limit for public health insurance (Medicaid/CHIP) at or above 200% of the federal poverty level (FPL) | State provides 12-month continuous eligibility for both Medicaid and CHIP

In 2019, 8 percent of US children under age 6 lacked health insurance. Across the states, this percentage ranges from 2% (MA, HI) to 15% (TX).1 Research has shown that strengthening public health insurance access for children produces not only gains in health outcomes and family finances but also government cost savings and greater future financial security for children.2-5

  • Studies of state and federal expansions of Medicaid coverage demonstrate that these programs increase health care use and improve the health of children and educational outcomes of children.2
  • Public health insurance also reduces out-of-pocket medical spending and increases financial stability for families.3
  • Recent analyses indicate that each dollar spent on Medicaid generates at least $12.66 in benefits. Benefits to government include cost savings from reduced emergency visits and hospitalizations, and higher future taxes paid by children.2, 4
  • Providing continuous health insurance coverage can help avoid interruptions in preventive care, reduce costly emergency care due to coverage gaps, and decrease the administrative burden for states (e.g., costs of handling changes in circumstances or processing terminations).5

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State provides lawfully residing immigrant children with Medicaid/CHIP coverage without 5-year waiting period | State provides lawfully residing pregnant immigrant women with Medicaid/CHIP coverage without 5-year waiting period

Lawfully residing immigrants in the United States face many barriers to health care coverage, including restrictive laws and a lower likelihood than US-born citizens of being employed by jobs that provide employer-sponsored health care coverage.6, 7 Additionally, lawfully residing immigrants may be hesitant to use public programs like Medicaid and CHIP due to fears about deportation or family members being denied entry into the US.8

Many states have a 5-year waiting period that requires lawfully residing immigrants to wait 5 years before accessing public services like Medicaid and CHIP. Under the Immigrant Children’s Health Improvement Act (ICHIA), states have the option to waive the 5-year waiting period.9

  • In 2020, 26% of lawfully residing immigrants lacked health insurance coverage.6 These rates are even higher for specific groups of lawfully residing immigrants, such as Latino non-citizens between the ages of 15-49, who in 2019 had an uninsured rate of 52%.10 Coverage rates are higher for lawfully residing children, but still low; in 2020, 17% of lawfully residing immigrant children were uninsured.6
  • Children of immigrant parents who lack health insurance have been found to be more likely to also lack health insurance and a regular source of health care.11
  • Waiving the 5-year waiting period has a significant impact on rates of insurance coverage. Immigrant children living in states without a 5-year waiting period were found to have insurance rates that were 24.5% higher than children in states with the 5-year period.12
  • Removing barriers to health care access such as the 5-year waiting period can help reduce health disparities between immigrant and US-born populations.13

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State provides temporary coverage to children under Medicaid or CHIP until eligibility can be formally determined | State provides temporary coverage to pregnant women under Medicaid until eligibility can be formally determined

Presumptive eligibility is the practice of allowing qualified entities like public schools and hospitals to screen children, pregnant women, and other eligible populations for Medicaid and CHIP coverage and temporarily enroll them in the programs. This allows individuals to begin receiving benefits before their application has been formally processed by Medicaid or CHIP agencies.14 Presumptive eligibility can reduce roadblocks for eligible populations seeking enrollment in Medicaid and CHIP and can reduce delays in health care.15

  • Presumptive eligibility has been a useful tool during the COVID-19 pandemic because individuals can be enrolled in temporary Medicaid or CHIP coverage during a virtual or telephone visit, instead of at an in-person appointment.14
  • Approximately 6 million people across the US are eligible for Medicaid, but not enrolled. Presumptive eligibility can be an effective way of reaching these populations.15
  • Presumptive eligibility for pregnant women can increase the likelihood of obtaining early prenatal care.16

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State does not require redetermination of eligibility for Medicaid/CHIP more than once a year

Continuous coverage for Medicaid and CHIP means that states do not require individuals to redetermine their eligibility for the programs more than once a year in order to remain enrolled.i Continuous coverage is an effective strategy for protecting access to health care for families experiencing housing or employment instability; it also reduces administrative burdens and costs for state Medicaid and CHIP agencies.17

  • Continuous Medicaid and CHIP coverage reduces gaps in health insurance coverage, allowing children to receive consistent health care, including essential well-child visits and developmental screening.17
  • Requiring redetermination of eligibility for Medicaid and CHIP more than once a year can be particularly difficult for families experiencing housing instability, inconsistent wages, or changes in their marital status. More than 10% of Medicaid beneficiaries experience churn, which is disenrollment followed by re-enrollment in Medicaid. Churn can lead to higher administrative costs for state Medicaid agencies as well as a loss of consistent health care.18, 19
  • Children in states with continuous Medicaid eligibility have been found to have better health outcomes; continuous eligibility is associated with a lower chance of parents reporting that their child is in poor or fair (versus good) health.20

Note: i. At the time of publishing, the COVID-19 public health emergency remains active. For the remainder of the federally-determined public health emergency, Medicaid and CHIP eligibility redeterminations and disenrollments are frozen.21 Continuous coverage during the public health emergency has contributed to an increase in the number of people enrolled in Medicaid and CHIP, with a 20% increase in Medicaid and CHIP enrollment between February 2020 and September 2021.22 An anticipated 13% of people currently enrolled in Medicaid are expected to be determined ineligible for Medicaid coverage when the public health emergency ends.23


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Profile benchmarks for improving access to maternal health and mental health

State provides 12 months of postpartum Medicaid coverage for all eligible women

Medicaid covers almost half of all births in the country.24, 25 Providing Medicaid coverage for 12 months after delivery ensures that new mothers have access to health and mental health care, which can benefit both the mother and child.

Research suggests that postpartum Medicaid coverage could address critical health needs in the postpartum period.24, 26, 27

  • Postpartum care can address chronic conditions such as diabetes, as well as new conditions related to pregnancy and childbirth, such as postpartum depression.24 Also, dangerous postpartum conditions such as preeclampsia and blood clots may not emerge until weeks or months after delivery.27
  • About 29% of maternal deaths in the US occur between 43 and 365 days postpartum, many of which can be prevented with adequate, continuous postpartum care.27
  • Offering 12-month postpartum coverage is an important strategy to reduce disparities in health outcomes by race and ethnicity, including decreasing maternal morbidity and mortality.26

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State extends Medicaid coverage for family planning to otherwise ineligible low-income women*

*NCCP notes that family planning resources are utilized by people across the gender spectrum. “Women” is used here in accordance with the language used by Medicaid.

Family planning services such as contraception, health education, and screening for sexually transmitted infections help prevent the spread of STIs, unintended pregnancies, and short birth spacing between pregnancies. Federal law mandates that pregnant women with incomes up to 138% of the federal poverty line are eligible for Medicaid coverage to provide them with family planning services. Over half the states go beyond the minimum requirements and have family planning waivers that extend Medicaid coverage for family planning services to low-income women who otherwise do not qualify for Medicaid.28, 29 Programs vary state-by-state, but common features include extending Medicaid coverage past the 60 days post-partum standard and extending Medicaid coverage for pregnant women with incomes up to 250% of the federal poverty line.29

  • Family planner waivers in New York and Illinois led to a 5% reduction in unintended pregnancies. An even greater reduction was seen among individuals under 21 years old; unintended pregnancies for this group in New York and Illinois were reduced by 7-8%. The family planning waiver in Oregon was associated with a 13% reduction in unintended pregnancies.30
  • Several states that found success with family planning waivers have since codified their family planning expansions into law with state plan amendments, which has led to further increases in the use of contraceptive and family planning services.31 39 states have adopted the Affordable Care Act’s Medicaid coverage, which has allowed a greater number of people to access family planning services who were previously ineligible for Medicaid.32

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State has adopted Medicaid expansion as part of the Affordable Care Act

Medicaid has been expanded to cover adults up to 138% of FPL in 39 states.32 This expansion has critical benefits for mothers and children in families that are most vulnerable to poor health outcomes.33-36

  • Research has found that when parents have Medicaid coverage, children are more likely to have both Medicaid coverage and to receive preventive health care.33, 34
  • States with Medicaid expansion reduce health insurance coverage disparities for children of color. In non-expansion states, over one-third of Hispanic infants were born to mothers without health insurance, while this percentage declined by about a half in expansion states.35 Analyses of the 2019 American Community Survey by the Kaiser Family Foundation also found lower child uninsured rates in expansion states compared to non-expansion states. About 6% of Black children lacked health insurance in non-expansion states, but the uninsured rate dropped to 3% in expansion states. The uninsured rate for Native Hawaiian/Other Pacific Islander children was 5% in expansion states, but the rate was 21% for this group of children in non-expansion states.36

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State Medicaid pays for maternal depression screening during pediatric/family medicine visits under the child’s Medicaid

Rates of maternal depression among low-income women with young children are high, ranging from 25% to 50%.37 Maternal depression in early childhood interferes with sensitive, responsive parenting and is associated with less optimal parent-child relationships, early development, and positive mental health outcomes.38, 39 Early detection and effective treatments can help alleviate depression and its negative impacts on children’s development.38, 40 Recognizing the harmful effects of maternal depression on children, many states’ Medicaid agencies recommend conducting four maternal depression screens during well-child visit in the first year based on suggestions from the American Academy of Pediatrics’ Bright Futures Medicaid EPSDT periodicity schedule.

Research has documented the benefits of maternal depression screening.37, 41, 42

  • Maternal depression screenings can improve rates of detection, referral, and treatment of postpartum depression in new mothers.41 For example, a recent study on addressing maternal depression through Home Visiting has found that screening interventions in Home Visiting programs (e.g., specifying policies and protocols for depression screening and home visitor response to screening results; tracking systems for screening, referral, and follow-up) increase screening rates and referrals to evidence-based treatments, helping reduce depressive symptoms among mothers with positive depression screens.37
  • A systematic review of studies on depression screening and treatment suggests that screening pregnant women and new mothers for depression may decrease depressive symptoms in women living with depression as well as reducing the occurrence of depression, especially in the presence of additional treatment supports (e.g., care management, treatment protocols, availability of trained clinicians).42

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Profile benchmarks for enhancing children’s preventive care and early intervention services  

State’s EPSDT screening periodicity schedule meets recommendations of the American Academy of Pediatrics

EPSDT (Early and Periodic Screening, Diagnostic, and Treatment) is a critically important child health benefit under the Medicaid program that provides preventive well-child visits, screening, assessment, and necessary services for identified conditions. Under EPSDT, necessary treatment for any identified condition must be provided and paid for by Medicaid whether or not the treatment is covered in the state’s Medicaid plan. The purpose of EPSDT is to identify and treat any health or developmental conditions as early as possible, before they result in serious harm or disability.43

An EPSDT “periodicity schedule” shows the frequency and timing of EPSDT screenings for children in different age groups. Most states’ Medicaid programs require health care providers to use the periodicity schedule established by Bright Futures, the health promotion initiative of the American Academy of Pediatrics (AAP). The periodicity schedule helps ensure that children are being monitored at frequent enough intervals so that conditions can be identified and treated early. Evidence supporting EPSDT points to the role of screening, early detection, and treatment of health and developmental problems in promoting access to interventions and school readiness.43

  • Children who had the AAP recommended EPSDT screens in the first two years were found more likely to be ready for school based on an assessment conducted in kindergarten.44
  • The use of regular, age-appropriate developmental screening with standardized tools results in more children being referred for evaluation of possible developmental delays and for early intervention services.45
  • EPSDT can be particularly helpful for children in foster care whose social-emotional, developmental, and health problems may have otherwise been overlooked during unstable living situation, and for children with ongoing health conditions who need more than routine care.43, 46

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State includes at-risk children in the definition of eligibility for IDEA Part C

Part C of the federal Individual with Disabilities Education Act (IDEA) establishes requirements for providing Early Intervention (EI) services to infants and toddlers with disabilities. States also have the option to offer EI services to children with conditions or risk factors that place them at significant risk of developing a disability or delay. While state definitions vary, an infant or toddler may be considered “at risk” due to a variety of biological and/or environmental factors, including low birth weight, nutritional deficiencies, abuse or neglect, and prenatal drug exposure.47

  • Infants and toddlers of color and those in lower-income families receive fewer well-child visits.48 These visits provide an opportunity for developmental screening and possible referral to Part C Early Intervention when a delay is suspected.
  • State EI programs also vary in their use of screening tools and practices, and as a consequence, may miss developmental problems, especially in the social-emotional domain. For example, a recent survey found that only nine states require the use of a specialized social-emotional screening tool for children referred from Child Welfare.49
  • Expanding the definition of eligibility for IDEA Part C to include a broader range of circumstances and conditions that place a child at significant risk of a delay or disability could result in earlier or more frequent referrals to Part C for screening and an evaluation, leading to the provision of developmental supports for infants and toddlers that could prevent a delay or treat one at an early stage.48

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Profile benchmarks for enhancing care coordination and program participation

State has an online dual-benefit form to apply for Medicaid and SNAP

Streamlined enrollment processes for Medicaid and SNAP allow more families to access these programs. Some states provide an online dual-benefit form to apply for both Medicaid and SNAP, reducing the logistical challenges of applying for both programs. Households that receive SNAP benefits generally have at least one member that qualifies for Medicaid, and combining the application process can ensure easier access to services for participants and fewer administrative hurdles for the agencies processing applications.50 

  • Administrative burdens, such as complicated enrollment forms, reduce participation in public assistance programs among eligible populations who could benefit from the services.51
  • A coordinated enrollment program for Medicaid and SNAP, as well as other public benefits, could reduce churn, the cycles of eligible individuals being disenrolled and re-enrolled in public assistance programs.52, 53
  • Reducing churn allows families to experience the benefits of continuous enrollment (e.g., adequate food, consistent health coverage, and ability to meet basic family needs) while also lowering costs for Medicaid and SNAP administrators.54

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State has at least one Help Me Grow affiliate site that has fully implemented a centralized access point

Help Me Grow (HMG) is a national model being adopted by states and communities that helps families and children’s health care providers monitor young children’s development and get help accessing resources to promote healthy development and family well-being. Full implementation of the model includes a centralized access point that is usually operated as a call center where a specialist helps families identify needs and access services that will meet their needs.55

  • Centralized access points are effective at providing support to families with young children; in 2021, 90% of the families who engaged with an HMG centralized access point stated that it met their needs.56
  • Evaluations of state HMG sites have shown that these initiatives increase family protective factors and reduce risks for early childhood developmental delays.57, 58

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1. NCCP analysis of 2015-2019 American Community Survey data

2. Currie, J., & Chorniy, A. (2021). Medicaid and Child Health Insurance Program improve child health and reduce poverty but face threats. Academic Pediatrics, 21(8), S146-S153.

3. Wherry, L. R., Kenney, G. M., & Sommers, B. D. (2016). The role of public health insurance in reducing child poverty. Academic Pediatrics, 16(3), S98-S104.

4. Hendren, N., & Sprung-Keyer, B. (2019). A unified welfare analysis of government policies (NBER Working Paper No. 26144). National Bureau of Economic Research.

5. Brooks, T., & Gardner, A. (2021). Continuous coverage in Medicaid and CHIP. Georgetown University Center for Children and Families.

6. Kaiser Family Foundation. (2022). Health coverage of immigrants.

7. Broder, T., Lessard, G., & Moussavian, A. (2022). Overview of immigrant eligibility for federal programs. National Immigration Law Center.

8. Pillai, D. & Artiga, S. (2022). 2022 changes to the public charge inadmissibility rule and the implications for health care. Kaiser Family Foundation.

9. Kaiser Family Foundation. (2022). Medicaid/CHIP coverage of lawfully-residing immigrant children and pregnant women.

10. Fuentes, L., Desai, S., & Dawson, R. (2022). New analyses on US immigrant health care access underscore the need to eliminate discriminatory policies. Guttmacher Institute.

11. Aragones, A., Zamore, C., Moya, E. M., Cordero, J. I., Gany, F., & Bruno, D. M. (2021). The impact of restrictive policies on Mexican immigrant parents and their children’s access to health care. Health Equity, 5(1), 612-618.

12. Saloner, B., Koyawala, N., & Kenney, G. (2014). Coverage for low-income immigrant children increased 24.5 percent in states that expanded CHIPRA eligibility. Health Affairs, 33(5).

13. Bhasin, A. (2021). A systematic failure – Immigrant moms and babies are being denied health care. National Partnership for Women and Families.

14. Schubel, J. & Wagner, J. (2021). State Medicaid changes can improve access to coverage and care during and after COVID-19 crisis. Center on Budget and Policy Priorities.

15. Degife, E., Forman, H., & Rosenbaum, S. (2021). Expanding presumptive eligibility as a key part of Medicaid reform. JAMA Health Forum, 2(2).

16. Shah, J.S., Lee Revere, F., & Toy, E.C. (2018). Improving rates of early entry prenatal care in an underserved population. Maternal and Child Health Journal, 22.

17. Wagner, J. & Solomon, J. (2021). Continuous eligibility keeps people insured and reduces costs. Center on Budget and Policy Priorities.

18. Mann, C. (2022). Stable and continuous coverage provisions in Medicaid gain momentum through Build Back Better Act. The Commonwealth Fund.

19. Koetting, M. (2016). Medicaid contradictions: Adding, subtracting, and redeterminations in Illinois. Journal of Health Politics, Policy and Law, 41(2).

20. Brantley, E. & Ku, L. (2021). Continuous eligibility for Medicaid associated with improved child health outcomes. Medical Care Research and Review, 79(3), 404-413.

21. Lee, C. (2022). States are planning for the end of the continuous enrollment requirement in Medicaid after the COVID-19 public health emergency expires, but many have not made key decisions. Kaiser Family Foundation.

22. Lakhmani, E. (2022). When the public health emergency ends: What will it mean for dually eligible individuals? Health Affairs.

23. Brooks, T., Gardner, A., Osorio, A., Tolbert, J., Corallo, B., Ammula, M., & Moreno, S. (2022). Medicaid and CHIP eligibility, enrollment, and cost sharing policies as of January 2022: Findings from a 50-state survey. Kaiser Family Foundation.

24. Center for Medicare & Medicaid Services. (2021). Prenatal and postpartum care: Postpartum care.

25. Kaiser Family Foundation. (2022). Medicaid postpartum coverage extension tracker.

26. American Public Health Association. (2021). Expanding Medicaid coverage for birthing people to one year postpartum (Policy No. LB21-02).

27. The American College of Obstetricians and Gynecologists. (2022). Talking points: Extending Medicaid coverage for pregnant women beyond 60 days postpartum.

28. Kaiser Family Foundation. (2021). States that have expanded eligibility for coverage of family planning services under Medicaid.

29. Babbs, G., McCloskey, L., & Gordon, S. (2021). Expanding postpartum Medicaid benefits to combat maternal mortality and morbidity. Health Affairs.

30. Adams, E. K., Galactionova, K., & Kenney, G. (2015). Medicaid family planning waivers in 3 states. Inquiry, 52.

31. Redd, S. & Hall, K.S. (2019). Medicaid family planning expansions: The effect of state plan amendments on postpartum contraceptive use. Journal of Women’s Health, 28(4).

32. Kaiser Family Foundation. (2022). Status of state Medicaid expansion decisions: Interactive map.

33. Venkataramani, M., Pollack, C. E., & Roberts, E. T. (2017). Spillover effects of adult Medicaid expansions on children’s use of preventive services. Pediatrics, 140(6).

34. Schubel, J. (2021). Expanding Medicaid for parents improves coverage and health for both parents and children. Center on Budget and Policy Priorities.

35. Sanders, S. R., Cope, M. R., Park, P. N., Jeffery, W., & Jackson, J. E. (2020). Infants without health insurance: racial/ethnic and rural/urban disparities in infant households’ insurance coverage. PLoS One, 15(1), e0222387.

36. Artiga, S., Hill, L., Orgera, K., & Damico, A. (2021). Health Coverage by Race and Ethnicity, 2010-2019. Kaiser Family Foundation.

37. Tandon, D., Mackrain, M., Beeber, L., Topping-Tailby, N., Raska, M., & Arbour, M. (2020). Addressing maternal depression in home visiting: Findings from the home visiting collaborative improvement and innovation network. PloS One, 15(4), e0230211.

38. Earls, M. F., Yogman, M. W., Mattson, G., Rafferty, J., Baum, R., Gambon, T., … & American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health. (2019). Incorporating recognition and management of perinatal depression into pediatric practice. Pediatrics, 143(1), e20183259.

39. Bernard, K., Nissim, G., Vaccaro, S., Harris, J. L., & Lindhiem, O. (2018). Association between maternal depression and maternal sensitivity from birth to 12 months: A meta-analysis. Attachment & Human Development, 20(6), 578-599.

40. van der Zee-van den Berg, A. I., Boere-Boonekamp, M. M., IJzerman, M. J., Haasnoot-Smallegange, R. M., & Reijneveld, S. A. (2017). Screening for postpartum depression in well-baby care settings: A systematic review. Maternal and Child Health Journal, 21(1), 9–20.

41. Bauman, B. L., Ko, J. Y., Cox, S., D’Angelo, MPH, D. V., Warner, L., Folger, S., Tevendale, H. D., Coy, K. C., Harrison, L., & Barfield, W. D. (2020). Vital signs: Postpartum depressive symptoms and provider discussions about perinatal depression — United States, 2018.  MMWR Morbidity and Mortality Weekly Report, 69(19), 575–581.

42. O’Connor, E., Rossom, R. C., Henninger, M., Groom, H. C., & Burda, B. U. (2016). Primary care screening for and treatment of depression in pregnant and postpartum women: Evidence report and systematic review for the US preventive services task force. JAMA, 315(4):388–406.

43. Mahan, D. (2018). Medicaid’s children’s benefit—EPSDT—supports the unique needs and healthy development of children. Families USA.

44. Pittard III, W. B., Hulsey, T. C., Laditka, J. N., & Laditka, S. B. (2012). School readiness among children insured by Medicaid, South Carolina. Preventing Chronic Disease, 9.

45. Schickedanz, Adam & Halfon, Neal. (2020). Evolving roles for health care in supporting healthy child development. Future of Children, 30(2).

46. Ferdinand, J.M. (2020). An analysis of the Early and Periodic Screening, Diagnostic, and Treatment benefit: Implications for the healthcare of children in foster care. Policy Perspectives, 27(2).

47. Early Childhood Technical Assistance Center. (2022). Part C eligibility. The FPG Child Development Institute of the University of North Carolina at Chapel Hill.

48. Heating, K. & Heinemeier, S. (2022). State of babies yearbook 2022. ZERO TO THREE.

49. Ferguson, D., Smith, S., Granja, M., Lasala, O., & Cooper, H. (2022). Child Welfare and Early Intervention: Policies and practices to promote collaboration and help infants and toddlers thrive. National Center for Children in Poverty, Bank Street Graduate School of Education.

50. King, M. D. & Giefer, K. G. (2021). Most children receiving SNAP get at least one other social safety net benefit. United States Census Bureau.

51. Fox, A., Feng, W., & Reynolds, M. (2022). The effect of administrative burden on state safety-net participation: Evidence from food assistance, cash assistance, and Medicaid. Public Administration Review, 2022. 

52. Wagner, J. (2020). Using SNAP data for Medicaid renewals can keep eligible beneficiaries enrolled. Center on Budget and Policy Priorities.

53. Ambegaokar, S., Neuberger, Z., & Rosenbaum, D. (2017). Opportunities to streamline enrollment across public benefit programs. Center on Budget and Policy Priorities & Social Interest Solutions.

54. Wagner, J. & Huguelet, A. (2016). Opportunities for states to coordinate Medicaid and SNAP renewals. Center on Budget and Policy Priorities.  

55. National Center for Children in Poverty. (2019). Alabama – PRiSM.

56. Help Me Grow National Center. (2021). Building impact report headlines.

57. Hill, K.D. & Hill, B.J. (2018). Help Me Grow Utah and the impact on family protective factors development. Journal of Children’s Services, 13(2).

58. Spain, A. K., Anderson, M., & McCrae, J. S. (2020). Getting connected: Referrals for family support in early childhood. Chapin Hall at the University of Chicago.

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