• Printer-friendly States’ Obligations to Assist Families (19 KB)

EPSDT is designed not only to finance health care for children but also to assure that children receive appropriate, quality services to improve their health. As described in federal program rules: “The EPSDT program consists of two, mutually supportive, operational components: (1) assuring the availability and accessibility or required health care resources; and (2) helping Medicaid recipients and their parents or guardians effectively use them."

Within broad federal guidelines, states have flexibility to design an EPSDT program that fits with their Medicaid, public health, and medical care systems. Informing and support services are specifically described in the federal EPSDT rules.

For INFORMING, states are required to:

• Inform all Medicaid eligible children under age 21 and their families about EPSDT on a timely basis (i.e., within 60 days of enrollment).
• Use effective methods of communication and clear, non-technical language in informing families – with a combination of face-to-face, oral, and written information recommended. Targeted information for at-risk groups also is recommended.
  • Example of One county’s Effort to Inform Families
• Inform Medicaid eligible pregnant women about EPSDT, as well as adoptive and foster care parents of eligible children.

• Offer and provide, if requested and necessary, assistance with transportation to medical care.
• Offer and provide, if requested and necessary, assistance with scheduling appointments for EPSDT care and services.
• Provide transportation and scheduling assistance for screening and diagnostic and treatment services.
• Specify in the state plan the state’s responsibility for transportation assistance and describe the methods to use.
• Example of how Nevada uses its website to offer information to families.

• Printer-friendly Informing and Involving Families (19 KB)

Under federal EPSDT rules, state Medicaid Agencies are required to inform all Medicaid eligible children under age 21 and their families about EPSDT on a timely basis, using effective methods of communication and clear, non-technical language in informing families.

Title V agencies – both the federal Maternal and Child Health Bureau and the state agencies that receive block grant funding – have a strong commitment promoting to family-centered, community-based, culturally competent systems of care. By promoting this approach for EPSDT, Title V agencies can help Medicaid agencies better fulfill their responsibilities to provide outreach and information to families.

• Accessing Mental Health Services for Children in Maryland through the Medical Assistance/Medicaid EPSDT Benefit – an easy to use fact sheet for families.
• Parent- to-Parent of Vermont has produced an excellent guide for parents (particularly those whose children have special health needs) called Six Ways to Access Medicaid/EPSDT.
• Oklahoma Health Care Authority (OHCA): Consumer friendly state website includes AAP and immunization schedule, ride assistance telephone line, FAQ, and treatment examples.
• A recent booklet for parents called "EPSDT: Supporting Children with Disabilities." (Focus on Maryland)
• Washington Protection and Advocacy System: User-friendly information, with examples.

• Printer-friendly Case Management in Medicaid and EPSDT (20 KB)

Title V program leaders often create or fund care coordination. While there is no specific “care coordination” category under Medicaid, some Title V care coordination may qualify for reimbursement as case management.

Medicaid describes case management as “an activity under which responsibilities for locating, coordinating and monitoring necessary and appropriate services for a recipient rests with a specific individual or organization.” [State Medicaid Manual Part 4, Section 4302; Part 5, Section 5310(D)]

Under this general definition, Medicaid has several types of case management.

• Administrative case management includes activities that help fulfill the mission of the Medicaid program, specifically that help the program operate efficiently and beneficiaries receive needed health care. For administrative case management, the federal government contributes is at a rate of 50%.
  • Managed Care Purchasing Specifications.
• Case management in the EPSDT process is a type of administrative case management. It generally refers to the outreach, informing, and other administrative roles under EPSDT.
• Targeted case management was created as a type of medical assistance, not an administrative function.
• States have the option to design and provide targeted case management for specific categories of beneficiaries, specific geographic areas, or specific sets of services. For example, several states offer targeted case management for pregnant women and other states deliver targeted case management through home visits to young children. Targeted case management is added as a benefit to the state Medicaid plan, and the federal contribution is at the medical assistance rate (i.e., like other medical care services).
• Coordination of case management among multiple programs is a challenge in every state. This letter offers some advice to Medicaid and Child Welfare directors regarding targeted case management.
• The George Washington University purchasing specifications on Medicaid Managed Care for Children in Substitute Care also provide relevant information.