CMS Releases New Guidance for Medicaid & CHIP Early & Periodic Screening, Diagnostic, & Treatment (EPSDT) Requirements

The Centers for Medicare & Medicaid Services (CMS) has released comprehensive guidance to support states in ensuring the 38 million children with Medicaid and the Children’s Health Insurance Program (CHIP) coverage – nearly half of the children in this country – receive the full range of health care services they need.

Under Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements, eligible children and youth are entitled to a comprehensive array of prevention, diagnostic, and treatment services — including well-child visits, mental health services, dental, vision, and hearing services. These requirements are designed to ensure that children receive medically necessary health care services early, so that health problems are averted, or diagnosed and treated as early as possible. Because of the EPSDT requirements, Medicaid provides some of the most comprehensive health coverage in the country for children and youth.

The guidance clearly explains the statutory and regulatory EPSDT requirements, and suggests best practices across key areas, including:

• Increasing access to services through transportation and care coordination.
• Expanding the children-focused workforce.
• Improving care for children with specialized needs (including children in the child welfare system and children with disabilities).
• Expanding awareness among families of their children’s rights under the EPSDT requirements.

The EPSDT guidance also includes information to help address the needs of children with behavioral health conditions. Youth in the United States are experiencing a mental health crisis, research shows. The EPSDT guidance includes a series of strategies and best practices that states can use to meet children’s and youth’s behavioral health needs. For example, it suggests that states create a children’s behavioral health benefit package and support the management of children and youth with mild to moderate behavioral health needs in primary care settings. States must provide coverage for an array of medically necessary mental health and SUD services along the care continuum – including in children’s own homes, schools and communities -- in order to meet their EPSDT obligation.