For more than 40 years, Early and Periodic Screening Diagnostic and Treatment (EPSDT) benefits have provided a critical set of services for Medicaid-enrolled children. With the fiscal pressures on states, the opportunities to enhance EPSDT coverage are significant.
This report examines the continuing role of Medicaid’s EPSDT benefit in a changing health care system. Part I provides an overview of EPSDT, including information about the flexibility provided by the Deficit Reduction Act (DRA), and also details state practices in implementing EPSDT benefits within managed care arrangements. Part II synthesizes the findings of an expert workgroup convened by the Center for Health Care Strategies to identify promising approaches for modernizing EPSDT to better meet the needs of children and families in today’s health care system. Recommendations are organized under three broad themes: 1) making coverage work effectively; 2) measuring performance; and 3) integrating Medicaid-covered health services with services essential to child development that are financed through other non-medical programs.
The report concludes with opportunities and challenges that lie ahead in modernizing EPSDT, both in states that use managed care purchasing arrangements and in states that move toward greater use of DRA flexibility.