CMS Issues New Guidance on Children’s Medicaid Access

The Centers for Medicare & Medicaid Services (CMS) recently issued broad new guidance to assist states in making sure children in Medicaid and CHIP receive their required Early and Periodic Screening, Diagnostic, and Treatment. As of May 2024, an estimated 38 million children are enrolled in Medicaid and CHIP, many of whom are eligible for EPSDT services covering a wide range of physical and behavioral health service needs.

Three areas that it focuses on in terms of improving the access of children to EPSDT services are:

• Promotion of the availability and accessibility of EPSDT benefit.
• Expansion of the workforce for child-specific care.
• Enhancement of care for children with special needs, especially mental health and behavioral health services.

Towards this end, CMS encourages states to engage families more effectively with their benefits and to support better coordination of care for children. The rule further asks Medicaid-managed care plans to provide all services needed by eligible children, including transportation to health care appointments.

Workforce concerns are addressed by strategies that recommend expansion of qualifications among providers, increase interprofessional consultation, and enhance the use of telehealth. CMS encourages states to pursue financial incentives for physicians to deliver high-quality care to children.

The third issue suggests expanding services offered to children with behavioral health needs. These include such provisions as access through one point of entry to care and comprehensive covered community-based services.

Overlooks will include dedicated attention to foster children as well as those with disabilities, with CMS reminding states that its coders are expected to cover all medically necessary care.

CMS explained that this guideline marks the first of the most comprehensive updates made on EPSDT in the last decade and places a great emphasis on its role in addressing issues about mental health and promoting health equity among poor children.