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Sharp decline in child health care amid coronavirus prompts call to action by Medicaid chief

Boston Medical Center RN Kelley Toli (left) and child life specialist Karlie Bittrich saw to 2-month-old Alfredo Guillaume in a pediatrics tent outside of Boston Medical Center in April.Erin Clark/Globe Staff

A sharp decline in the number of low-income children receiving vital care during the pandemic, including vaccinations and mental health care, prompted a call to action Wednesday by the nation’s top health insurance administrator, who is seeking creative solutions, starting in Boston.

“A lot of pediatricians are sounding the alarm," Seema Verma, administrator of the Centers for Medicare & Medicaid Services, said in an interview with the Globe. “We’re trying to sound that alarm at the federal level to get a better focus on this issue.”

New CMS data show millions of children, many living in poverty, missed vaccinations and other care in the depths of the coronavirus pandemic from March through May, as parents feared going out or bringing their children to doctors’ offices.


During that stretch, there were 22 percent fewer vaccinations nationwide among children under age 2 who rely on Medicaid insurance. There were 44 percent fewer child screenings that track growth, assess health, and provide early detection of autism and developmental delays. Also, there were 69 percent fewer dental services.

In Massachusetts, Verma said, that translates into about 30,000 fewer vaccinations for children under 2, nearly 90,000 fewer screenings, and 200,000 fewer dental services.

Since May, preliminary numbers suggest that telehealth for children has increased dramatically, but not enough to offset the decline in care for vulnerable children, Verma said. Also, some services, such as vaccinations, can’t be provided through telehealth.

While national data show that vaccination rates are increasing, the number of vaccines administered so far has yet to make up for the large decline, she said. That increases the risk of vaccine-preventable illnesses, such as measles, mumps, and whooping cough.

Verma is holding virtual roundtable discussions with health leaders across the country to brainstorm ways to convince parents it’s safe to bring their children back to the doctor. She spoke Wednesday with leaders at Boston Children’s Hospital, where administrators had success easing parents' fears by holding well-child visits and administering vaccines in a separate building, across the street from the primary care clinic.


The hospital is often considered a leader in children’s health care, and CMS viewed it as a natural choice to hear from local leaders about their on-the-ground experiences related to forgone care.

Among those in discussions with Verma was Dr. Shari Nethersole, executive director of BCH’s Community Health. Nethersole leads the hospital’s work to improve child health, particularly in underserved communities, where disparities are common and coronavirus has hit hard.

“I am still worried about children’s dental care. I don’t see that coming back," Nethersole said in a separate interview. She recently treated a youngster with severe dental decay.

“Parents tend to put dental care lower on the priority list than vaccinations," she said. “That will be the hardest to recover.”

Nethersole said much of the hospital’s other child health services have rebounded, to about 90 percent of where they were before the pandemic.

But now they face a new challenge: getting flu shots to thousands of children. Typically, the hospital invites 50 children and their families at a time in the evenings for the vaccine. But they can’t do that this year because of the need to socially distance. So they are searching for bigger spaces or different opportunities.

“We are having conversations with the Boston Public Health Commission for options to get more children in for flu shots before the end of the year," Nethersole said. “We’re really encouraging families to know that it’s safe to bring their children to the doctor. If they hold off they will be sicker when they come in, particularly as we get into the fall and winter."


The latest reports from nearly three dozen community health centers across the state are encouraging, indicating visits have started to rebound. The Massachusetts League of Community Health Centers said pediatric visits are down only 28 percent for the year, compared to this time last year. About 30 percent of those visits were through telehealth.

In stressing the importance of regular child screenings, Verma spoke from experience. She has two children, and when her son was 4 he was found to have a cataract in one eye during a routine screening — very unusual for someone that young.

Had it not been detected, her son’s brain would have compensated and essentially used the other eye, she said. The neural pathways that develop from his eye to his brain just would not have developed in that one eye.

“He would have lost vision in that eye,” Verma said. “And so if it wasn’t for the screening that detected the cataract, he wouldn’t have had that brain development. So I’m a big, strong believer in screening services.”

Verma hopes her discussions with health leaders will help more children get the services they desperately need.

“Maybe there’s a pediatrician’s office that’s staying open late so they can catch up on immunizations. Maybe there’s a weekend clinic that’s open,” she said. “I think schools also need to think about how they’re going to be doing screening services. It’s not OK to forgo, or to not do, these services.”


Kay Lazar can be reached at Follow her @GlobeKayLazar.