Using a Life Course Health Development Framework to Redesign Medicaid.

Since the Affordable Care Act, Medicaid programs serve millions more enrollees across the life course, yet beneficiaries continue to experience high rates of preventable morbidity and mortality rooted in earlier life experiences. By incorporating evidence from life course science into Medicaid, using the Life Course Health Development (LCHD) framework, states can more effectively achieve lifelong health improvement. We describe 5 elements of an LCHD-informed strategy states can use to align Medicaid redesign initiatives toward a common goal of improving life course health outcomes: targeting prevention to sensitive periods; prioritizing intervention on social exposures; maximizing longitudinal continuity in coverage and service delivery; building technological systems with capability to measure performance and outcomes over time; and selecting financial models that support LCHD-informed care. With this framework, states can strategically direct investment to improve health for vulnerable Americans, and assure their investment will pay off over time.