Enacted nearly 40 years ago, Early and Periodic Screening, Diagnosis, and Treatment services (EPSDT) has been broadened in its coverage requirements, but has never been modernized in its operational and service delivery dimensions despite fundamental changes in pediatric practice, the organization and delivery of health care, provider compensation arrangements, and quality performance measurement. Medicaid covers more than 20 million children and is by far the single most important source of health care financing for low-income children.

Although the overall health of American children has improved over the last 40 years, low-income children continue to face higher rates of mortality and morbidity and a greater prevalence of chronic conditions. While the goal of EPSDT is to identify, diagnose, and treat physical, behavioral, and developmental issues early, only one-third of the estimated 12 to 16 percent of children with developmental problems are identified by physicians before entering school.

In collaboration with the George Washington University Center on Health Policy Research, CHCS worked to develop an “operational prototype” for the provision of EPSDT. The operational prototype was a set of policy and procedural recommendations that sought to address key deficiencies in the current system and give child-serving agencies and managed care organizations concrete tools to re-orient EPSDT toward integrated service provision, continuous quality improvement, and measuring/benchmarking key health outcomes.

Key activities included:

  • National analysis of the role that key child-serving agencies play in the dispensation of children’s preventive health services. Advisory group participation in five-month collaborative process to develop the framework for the “operational prototype.”
  • “Operational prototype” specification development.
  • Federal and state policy reforms to support the new model.
  • Pilot of prototype.