State Strategies for Defining Medical Necessity for Children and Youth with Special Health Care Needs
Medicaid programs nationwide are mandated to use the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit to improve the health of low-income children with special physical, emotional, and developmental health care needs. This benefit supports children and youth with special health care needs (CYSHCN) by ensuring they receive individualized health care when they need it—provided those services are deemed medically necessary for the individual beneficiary.
Determining the medical necessity of services under EPSDT can prove challenging for states. The EPSDT benefit and the challenges surrounding its implementation are nothing new for states. In a recent survey and conference call, state EPSDT coordinators and CHIP directors shared their experiences navigating the definition of medical necessity for CYSHCN. The brief takes a fresh look at the current issues affecting the state EPSDT and CHIP officials who implement medical necessity policy, and looks ahead to new and emerging issues that may affect state EPSDT policy in years to come.
Download the Publication
For individuals living with complex, often chronic conditions, and their families, palliative care can provide relief from symptoms, improve satisfaction and outcomes, and help address critical mental and spiritual needs during difficult times. Now more than ever, there is growing recognition of the importance of palliative care services for individuals with serious illness, such as advance care planning, pain and symptom management, care coordination, and team-based, multi-disciplinary support. These services can help patients and families cope with the symptoms and stressors of disease, better anticipate and avoid crises, and reduce unnecessary and/or unwanted care. While this model is grounded in evidence that demonstrates improved quality of life, better outcomes, and reduced cost for patients, only a fraction of individuals who could benefit from palliative care receive it. 
