Federal officials have released new guidance they say will help ensure children enrolled in Medicaid or the Children’s Health Insurance Program (CHIP) have better access to comprehensive health care services.
The AAP has been a leader in advocating for officials to address long-standing barriers children and families in these programs face.
“This new guidance – made possible by persistent pediatrician and AAP advocacy – represents historic progress toward ensuring children can receive the comprehensive care and services they need to be healthy,” said AAP CEO/Executive Vice President Mark Del Monte, J.D. “We applaud the Centers for Medicare & Medicaid Services for taking this important and much-needed step forward and call on states to implement the guidance, so it best meets the needs of children.”
Nearly half of U.S. children are covered by Medicaid or CHIP. Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) requirements guarantee children enrolled in Medicaid timely access to all medically necessary services, including preventive, dental, mental health and special services. However, many state programs have fallen short on providing this care.
The AAP advocated for legislation requiring the Centers for Medicare & Medicaid Services (CMS) to identify gaps in EPSDT requirements, provide technical assistance to states, issue guidance and send a report to Congress.
The CMS released guidance to states last week that clarifies states’ obligations and describes best practices they can use to meet them.
CMS’ letter to state health officials focuses on three areas:
- promoting EPSDT awareness and accessibility so eligible families understand their rights,
- growing the number of pediatricians and other pediatric practitioners participating in the Medicaid program, and
- improving care for children with specialized needs with a focus on children with mental health conditions, children in foster care and children with disabilities or other complex health needs.
Supporting mental health is a key part of the letter. CMS said states must provide a full continuum of mental and behavioral health services for children with and without a diagnosis. It laid out the components of a high-functioning system that largely follow the recommendations the AAP and its partners provided to the agency.
CMS recommends mental health systems have a single point of entry, support children with mild to moderate needs in primary care settings and cover a range of specialty care provided in the community. In addition, inpatient mental health treatment should be relied on only when medically necessary.
The letter also discusses how best to expand the child-focused workforce. CMS recommends paying adequately to incentivize provider participation, broadening provider qualifications, using telehealth, using interprofessional consultations to access specialty providers, and reducing administrative burdens such as prior authorization.
Officials said they are committed to improving care for children in Medicaid and CHIP.
“We need to make sure our children have what they need to stay well. Medicaid makes that possible,” U.S. Department of Health and Human Services Secretary Xavier Becerra, J.D., said in a press release. “This guidance to our states today will help millions of kids get the services that are crucial to their health and development, no matter where they live.”
