The Biden administration wants more health care providers to talk to parents about keeping children safe around firearms, as data shows children are increasingly dying by suicide, accidents and homicides involving guns.

Centers for Medicare and Medicaid Services he gave states green light to allow Medicaid providers to counsel parents and caregivers of children about firearm safety and injury prevention.

Public health advocates hope the conversations will become as routine as doctors talking to parents about car seats, water safety, substance use and other safety issues affecting children.

“For the first time, it allows CMS to consider using Medicaid funds to fund these types of screening questions,” said Chethan Sathya, a pediatric trauma surgeon and firearms injury prevention researcher at Northwell Health, the largest healthcare provider in New York.

At Northwell, every patient who walks in the door is asked if they have access to a firearm and if it is locked, unloaded and stored separately from ammunition.

Northwell offers those with firearms, but very few medical providers do.

Incorporating firearms counseling into Medicaid could change that.

“The hope is that this normalizes this question as part of routine medical care,” Sathya said. “When you start funding things, that’s a huge incentive for hospitals and providers to integrate this into regular routine medical care, and it provides a revenue stream for that.”

The CMS move comes after the White House announced last month, the agency will soon allow states “to choose to use Medicaid to pay a health care provider for counseling parents and caregivers about firearm safety and injury prevention.”

A CMS spokesman said Friday that while Medicaid first began allowing coverage of services related to violence prevention in 2021, the latest announcement clarifies that coverage also includes “anticipatory guidance,” or health education and counseling for to help parents and carers understand and improve health. and the development of their children.

“Accordingly, states may reimburse for a health care provider counseling parents on firearm safety and injury prevention,” the spokesperson said.

The agency said it is available to provide technical assistance to states that want to strengthen their violence prevention strategies.

However, what these strategies look like will depend on individual states and whether they adopt such coverage through their Medicaid programs.

Public health experts say it should. They argue that if a doctor asks if there are guns in the home and how they are stored, it can start important conversations that can save lives.

“If you start talking about firearms, depending on where you are, eyes glaze over or people get upset,” said Lois Lee, a physician and associate professor of pediatrics and emergency medicine at Harvard Medical School. “But if you’re talking about keeping kids safe, keeping them from killing themselves, that’s a message we should all be sharing.”

Suicide is the second leading cause of death for children ages 10 to 14 in the U.S. and the third leading cause of death among people ages 15 to 24, according to the Centers for Disease Control and Prevention.

The leading method of suicide in 2020 for 10-24 year olds was firearms – and the vast majority used firearms HELD by a member of the household.

While people usually focus on why people die by suicide, the methods are also an important factor. That’s because firearms are the most lethal method of suicide, and research shows that people who survive suicide attempts are unlikely to make future attempts. But most people don’t survive gun suicides.

Still, it’s unusual for doctors to discuss firearm safety with parents, Sathya said.

Public health crisis

The change from the Biden administration comes after a multi-year effort by experts to get society to recognize gun violence as a public health problem.

Earlier this year, Surgeon General declared gun violence a public health crisis. And last year, the Biden administration established the White House Office on Gun Violence Prevention.

Still, some hoped the Biden administration would go further. The change does not extend to Medicare, which covers adults over age 65 and some people with disabilities, nor does it extend to adults on Medicaid, according to the White House announcement last month.

“The people with the highest suicide rates are middle-aged men and older men,” said Catherine Barber, senior researcher at the Center for Harm Research at the Harvard School of Public Health.

The ad also didn’t mention the possibility of Medicaid paying for firearms storage and safeties, noted Christopher Cogle, a professor in the University of Florida Department of Medicine.

Cogle and his colleagues asked CMS for such a code in December, in line with other types of equipment, called durable medical equipment, that insurance pays for to keep people healthy.

“What this DME code would do is allow doctors and nurses to have these storage and safety devices on site and be able to turn them in right away while the family is there talking about safety,” he said, comparing with the crutches or walkers that patients are sometimes discharged with. “This is when clinically it’s best to act on things. As soon as you discharge a patient from the clinic, the chances of them following through really go down.”

It’s not enough for providers to ask about guns in the home, experts say. It’s important to do this in a nonjudgmental way and help people develop safety plans if they’re expressing suicidal thoughts, going through major changes, or struggling with mental health or substance use disorders, she said. Barber of the Harm Research Center at the Harvard School of Public Health.

Doctors should also consult with gun owners and gun-conscious groups in their communities so that keeping people safe is accepted by the community, Barber said.

If you or someone you know is in crisis, please call, text or talk to the Suicide and Crisis Lifeline on 988 or contact the Crisis Text Line by texting TALK to 741741.

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