A Helping Hand: Support for Families in Using the EPSDT Benefit

The Medicaid benefit for children and adolescents (also known as the Early and Periodic Screening, Diagnostic, and Treatment benefit or EPSDT), Medicaid’s comprehensive and preventive child health component, is the backbone of public health insurance for children and youth. It provides over 44 million children with access to a range of preventive, screening, and treatment services. State Medicaid agencies are continuously developing and implementing new strategies under the EPSDT benefit to improve the care delivered to children. Sharing the tools, resources, and strategies developed by each state will enable policymakers to benefit from the work of their peers.
Over the past year NASHP, in partnership with the Centers for Medicare & Medicaid Services and NORC at the University of Chicago, has populated a new “Resources to Improve Medicaid for Children and Adolescents” Map. This map disseminates resources produced by state Medicaid agencies that will be useful to other states pursuing similar goals of improving service delivery under the Medicaid benefit for children and adolescents. State-specific map pages for all 50 states and the District of Columbia explore resources on a number of topics, including state definitions of medical necessity; practices for delivering behavioral health, oral health, and care coordination services to children; and initiatives to improve access or collecting data relevant to the EPSDT benefit.
The map also collects information on supports states are providing to pediatric providers, as well as to Medicaid-enrolled children and their families. These families, in particular, may need assistance in navigating the health care system and effectively using the EPSDT benefit. Medicaid agencies assist families in a number of ways, including by offering the following:
Resources for Families and Children Virtually every state Medicaid agency hosts a website aimed at informing families about the EPSDT benefit and explaining how to access services. Information is often made easily accessible through Frequently Asked Questions, brochures, and even videos. Mailings, reminder phone calls, and newsletters are popular strategies for alerting families when a child is due for a well-child visit. States that rely on managed care organizations (MCOs) to administer the EPSDT benefit employ contract language to encourage MCOs to perform outreach to families and provide information through web-based resources and member handbooks.
Some states, like Texas, have web pages targeted at adolescents, a group particularly hard to reach for well-care visits. Alabama has developed simplified materials and a patient education protocol for working with illiterate or only marginally literate Medicaid beneficiaries that it teaches to providers.
Plan and Provider Selection Tools States have developed tools families can use to easily find Medicaid providers and evaluate the quality of health plans and services. California provides a “Provider Information Network” tool to help beneficiaries search for Medicaid-participating doctors, hospitals, dentists, and clinics by location. Florida’s Agency for Health Care Administration offers a “Florida Health Plan Finder” that provides comparative information on managed care plan quality, hospital and ambulatory surgery center performance, and drug prices at Florida pharmacies. States also provide quarterly updates to the Insure Kids New dentist locator directory to assist parents to find a Medicaid-participating dentist in their community.
Dedicated Personnel to Support Families Medicaid agencies are providing personnel and material resources to guide families through the health care system. Iowa uses Medicaid-funded coordinators based in local Title V agencies to provide outreach and care coordination to families, while Ohio requires Medicaid managed care plans to employ “EPSDT/Maternal Child Health Managers” responsible for helping families access benefits. Maryland’s Medicaid program funds local health departments in the state to provide a variety of assistance to children eligible for the EPDST benefit, including outreach, appointment scheduling, and case management services. In Mississippi, Family Support Specialists—unlicensed peers who have experience as the parent of a child with serious emotional disturbance—help families take advantage of resources available under a Medicaid home and community-based services waiver for children with behavioral health needs.
Self-Management Strategies Some states offer families or Medicaid-enrolled youths opportunities and supports to manage their own care regimen. Colorado, in partnership with New Mexico, is using a CHIPRA Quality Demonstration Grant to support a School-Based Health Center (SBHC) Improvement Project. Through this project, the state is providing SBHCs with training on enabling adolescents to direct their own care as they mature. Idaho offers Family-Directed Services that allows families of Medicaid-enrolled children with developmental disabilities the flexibility to choose and design the services the child receives
Together these resources and outreach efforts help Medicaid-enrolled children and families to access the benefits they need. Learn more about these and other state approaches to delivering the EPSDT benefit by visiting NASHP’s “Resources to Improve Medicaid for Children and Adolescents” Map!