Leveraging Medicaid to reimagine care and healing

In Hawaiʻi, one in three high school students report persistent feelings of sadness or hopelessness, rising to nearly half of all girls. Suicide was the leading cause of death for youth ages 10-19 between 2018 and 2022. Of the young people who died by suicide with a documented mental health need, none were receiving services at the time of death. Native Hawaiian and Pacific Islander (NHPI) youth are disproportionately impacted: their suicide mortality rate is roughly eight times the statewide youth average. Youth from Compact of Free Association communities (Marshallese, Micronesian, Palauan) face additional barriers of language access, migration trauma, stigma, and eligibility gaps.

Led in partnership with local anchor Kamakanaaloha, LLC, former Hawai’i Medicaid Director Judy Mohr Peterson, and Danny Goya, our goal is to align public, private, and philanthropic partners around a shared vision for youth mental health, well-being and resilience. Grounded in cultural- and community-centered approaches, the work seeks to unlock public financing while strengthening the capacity of community organizations already leading healing in communities. Hawaiʻi has already begun this work, and those lessons will shape ongoing priorities across the state.

In Iowa, one in four young people ages 3-17 screen positive for depression, anxiety, or ADHD. Between 2016 and 2021, the share of Iowa sixth graders reporting persistent feelings of sadness or hopelessness nearly doubled, from 14% to 27%. Yet half of Iowa youth experiencing a major depressive episode receive no treatment at all. Youth in rural communities and those involved with child welfare or the justice system face steeper barriers: long waits, provider shortages, and care fragmented across systems. The gap is widening even as investment falls: state Medicaid spending on children’s behavioral health dropped from $49 million in 2018 to $34 million in 2023, even as enrollment held steady and the need grew.

Grounded in early, community-based care, the work seeks to unlock public financing while strengthening the capacity of community organizations across Iowa. Significant effort is underway through the REACH settlement and the state’s transition to Certified Community Behavioral Health Clinics, opening new doors for community-based organizations to become Medicaid providers. Working alongside state and local partners, When We Lead is building on Iowa's priorities and progress to advance transformation for the state's kids and families.

Across the Commonwealth, children and families are facing growing mental health challenges—but far too often, the systems meant to support them respond too late or not at all. Strong Minds, Bright Futures, the local anchor partner for When We Lead Pennsylvania, is a growing statewide coalition of over 110 partners across 60 counties committed to building a stronger future for Pennsylvania's children. Launched in response to deep concerns raised by families, educators, health professionals, and youth, Strong Minds is transforming how Pennsylvania supports children's mental health across schools, communities, and care systems. Guided by five essential reforms and grounded in community-driven research and youth leadership, Strong Minds leads multi-sector advocacy and implementation toward an equitable, prevention-focused system of care, leveraging Medicaid as the primary financing lever.