• Printer-friendly Title V Rules for EPSDT Linkages (22 KB)

This page provides an overview of the relationship between Title V and Medicaid, including the EPSDT program, with a focus on federal law requirements.

Title V of the Social Security Act was enacted in 1935 as a health services safety net for all women and children. Today, the Title V Maternal and Child Health Services Block Grant continues to pursue the goal of improving the health of all mothers and children. Title V is administered by the Health Resources and Services Administration (HRSA).

Between 1967 and 1989, Congress enacted a number of amendments to Title V, adding requirements to work closely with and assist Medicaid in a number of activities. Currently, the Title V law requires that state MCH programs:

• Assist with coordination of EPSDT. View details
• Establish coordination agreements for with their State Medicaid programs. View details
• Provide a toll-free number for families seeking Title V or Medicaid providers.
• Provide outreach and facilitate enrollment of Medicaid eligible children and pregnant women. View details
• Share data collection responsibilities, particularly related to infant mortality details and Medicaid. View details
• Provide services for children with special health care needs and disabilities not covered by Medicaid. View details

Federal EPSDT rules call for coordination with Title V, but in different ways than the Title V law requires coordination with Medicaid.

Federal EPSDT Requirements include:

• Establishment of written state MCH-Medicaid agreements which provide for maximum utilization of Title V-supported services and aims to improve child health status.
• Reimbursement of Title V providers for services rendered, even if such services are provided free of charge to low-income uninsured families. (Payment mechanisms include reimbursement for costs, capitation payments, or prospective interagency transfers with retrospective adjustments.)

Learn more about the role of Title V agencies in administering EPSDT programs.

• State Strategies
  

• Printer-friendly State Strategies for Using Title V to Strengthen Medicaid’s EPSDT Program (19 KB)

This page provides examples of how the states have used relationships between Title V and Medicaid, including the EPSDT program, to improve child health. Over the years, states have:

• Assisted with administration of EPSDT.
• Provided EPSDT screening through Title V funded child health clinics operated by local health departments.
• Created toll-free hotlines to assist families with information about and enrollment in Medicaid and EPSDT.
• Fund local health departments to provide outreach, coordination, and referral services. Used home visiting programs as a strategy for EPSDT outreach and informing.
• Recruited, trained, and supported public and private EPSDT providers, including through “medical home” initiatives.
• Funded centers of excellence and regional centers for specialty pediatric care, including child development, genetic services, orthopedic care, sickle cell disease treatment, and HIV/AIDS.
• Promoted use of EPSDT financing for school-based health centers in medically under-served communities, as well as other school health initiatives.
• Assisted in development of EPSDT screening tools and periodicity schedules.
• Developed standards of care and policies to support quality improvement in EPSDT, including development of managed care contract provisions.
• Promoted dental screening and preventive oral health services (e.g., fluoride rinsing, dental sealants) in pediatric care settings.
• Evaluated and/or monitored EPSDT program performance.

• Printer-friendly Title V Role in Quality Monitoring (19 KB)

State Title V agencies can play an important role in monitoring EPSDT. The examples below describe some current and past data and monitoring activities undertaken by Title V agencies.

• Collect and publish the data required under Title V legislation
• Assist Medicaid agency in tracking screening ratio, as they aim to reach 80%
• Collect data on service utilization and outcomes of children with special health care needs enrolled in Medicaid

• Collaborate with the Academy of Pediatrics, Academy of Family Physicians, Primary Care Association, and other professional organizations to train about and promote participation in EPSDT
• Develop EPSDT data collection tools for maternity and pediatric providers
• Monitor EPSDT screening rates among local health departments that provide well-child care

• Assist in conducting managed care record review or focus studies
• Monitor the adequacy of screens
  • Data Requirement Page
    

• Printer-friendly Title V - EPSDT Partnerships to Improve EPSDT Administration (19 KB)

State Title V agencies can play an important role in guiding EPSDT. In fact, the EPSDT rules encourage state Medicaid agencies to delegate tasks to Title V agencies to assure access and receipt of the full range of screening, diagnostic, and treatment services.* Such delegation may be local, regional, or statewide. The examples below describe some specific activities undertaken by Title V agencies.

• Develop and implement outreach initiatives
  • RWJ Caring for Kids website
• Assist with eligibility and enrollment
  • MEDICAID Managed Care for Pediatric Services
• Coordinate service delivery for children with special health care needs enrolled in Medicaid

• Recruit and train providers
• Develop clinical guidance for providers based on Bright Futures and EPSDT rule
• Oversee EPSDT screening in local health departments, including data collection to monitor screening rates
• Help assure continuing of care through care coordination projects

• Assist in developing managed care contract provisions
• Monitor the adequacy of managed care plan provider networks

• Develop standards of care and periodicity schedules
• Convene expert panels and medical advisory boards
  Review medical necessity decisions using skilled medical personnel with expertise in maternity and pediatric care