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New federal guidance aims to strengthen health care for children covered by Medicaid, CHIP

August 18, 2022

Federal officials announced several key actions today to strengthen health care services, including behavioral health, for children enrolled in Medicaid or the Children’s Health Insurance Program (CHIP). Much of the guidance aligns with AAP principles on quality care.

The announcements come as mental health conditions are on the rise among children and youths, especially in the wake of the pandemic, and as severe shortages persist in treatment services.

Guidance to states

Two guidance documents and a third proposed rule aim to expand mental health care and access to high-quality, comprehensive health care, according to the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health and Human Services.

In the first guidance, CMS reminds states they have a mandate to cover behavioral health services for children in Medicaid, urging states to “leverage every resource to strengthen mental health care for children,” according to a news release.

A second document calls on states to expand school-based health care for children, including mental health care.

The third proposed rule would, for the first time, require states to report certain quality measures to strengthen Medicaid and CHIP to ensure enrollees have access to the highest quality of care.

Behavioral health services

The CMS reinforced Early and Periodic Screening, Diagnostic and Treatment (EPSDT) statutory mandates for mental and behavioral health services for children in Medicaid and CHIP. The guidance details strategies to improve prevention, early identification and treatment; expand provider capacity; and increase the integration of behavioral health and primary care for children.

Importantly, the guidance details strategies for payment of pediatricians and other primary care practitioners for behavioral health services, even in advance of a formal behavioral health diagnosis.

School-based health services

CMS is advising states to work with schools to deliver onsite health care services to children enrolled in Medicaid, with a checklist of nine essential policy areas related to benefits and payment.

Medicaid-covered services that may be provided through schools include immunizations, health screenings, oral health care, substance use disorder treatment and mental health care.

Mandatory Medicaid, CHIP reporting

A CMS proposed rule includes a Core Set of Children’s Health Care Quality Measures for Medicaid and CHIP. Mandatory reporting requirements would standardize quality measures across Medicaid and CHIP for children across the country. The measures would provide a basis for evaluation, including how well the programs “meet their mission of providing affordable, high-quality, person-centered health care coverage to low-income people…”

The core set can help CMS and stakeholders evaluate Medicaid and CHIP across the 54 programs run by states and territories, including in communities where health disparities persist.

Expanding access

“Children’s use of health services — from primary and preventive care to childhood vaccinations, dental care, and mental health services — has dropped alarmingly during the COVID-19 public health emergency,” CMS Administrator Chiquita Brooks-LaSure said in a news release. “We need to reverse that trend now and expand access to care for eligible children and families. States and schools are key to helping children of all backgrounds learn, grow, and thrive.”

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