Biden wants Medicaid doctors to talk to parents about firearms

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

The Centers for Medicare and Medicaid Services has given states the 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 become as routine as physicians talking to parents about car seats, water safety, substance use and other safety issues impacting kids.

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

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

Northwell offers those with firearms gun locks, but very few health care providers do this.

Incorporating firearm counseling into Medicaid could change things.

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

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

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

“As a result, 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 who want to strengthen their violence prevention strategies.

Still, how those strategies look will depend on individual states and whether they adopt such coverage through their Medicaid programs.

Public health experts say they should. They argue that having a doctor ask whether there are guns in the home and how they are stored 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 mad,” said Lois Lee, a physician and associate professor of pediatrics and emergency medicine at Harvard Medical School. “But if you talk about keeping kids safe, preventing them from killing themselves, that is a message all of us should share.”

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

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

While people typically 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 people who survive suicide attempts are unlikely to make future attempts. But most people don’t survive suicides by firearm.

Still, it’s uncommon for doctors to talk to parents about firearm safety, Sathya said.

Public health crisis

The change from the Biden administration follows a multi-year push by experts to get society to recognize gun violence as a public health issue.

Earlier this year, the surgeon general declared firearm violence a public health crisis. And last year, the Biden administration established the White House Office of Gun Violence Prevention.

Still, some hoped the Biden administration would go further. The change doesn’t extend to Medicare, which covers adults 65 and older and some people with disabilities, nor does it extend to adults in Medicaid, according to the announcement from the White House last month.

“People with the highest rates of suicide are middle-age men and older men,” said Catherine Barber, senior researcher at the Harvard School of Public Health’s Injury Research Center.

The announcement also did not mention allowing Medicaid payment for firearm storage and safety devices, noted Christopher Cogle, a professor in the Department of Medicine at the University of Florida.

Cogle and his colleagues petitioned 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 enable doctors and nurses to have these storage and safety devices on premise and be able to hand it out immediately while the family is there and talking about safety,” he said, comparing it to crutches or walkers that patients are sometimes discharged with. “That’s the time that clinically it’s best to act on things. As soon as you discharge a patient from the clinic, the chances of them following through on things really plummets.”

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

Physicians should also consult with gun owners and groups that care about guns in their communities so keeping people safe is embraced by the community, Barber said.

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