Maternal and
Child Health Services
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Few areas of health care are more important than services
for pregnant women, and children and adolescents, including
those with special health care needs. And, no other
program offers more opportunities to States and localities
in financing these services than Medicaid.
The services Medicaid can assist with are critical
because they literally affect health status and health
costs over a lifetime. Among these services are prenatal,
perinatal and postnatal services, primary and preventive
care, immunizations and well-child check-ups, and treatment
for acute and chronic medical conditions. Medicaid funding
can help address important public health objectives,
including reducing infant mortality and improving birth
outcomes, immunization rates and child health.
Numerous opportunities exist to use Medicaid to increase
access and services for children, adolescents and pregnant
women. Medicaid funding can be obtained through several
strategies, including those listed below. Arranging
Medicaid financing for any given strategy requires discussions
and agreements with the State Medicaid agency. Each
approach will require specific research and may vary
from State to State.
The following are key strategies to appropriately use
Medicaid financing for maternal and child health services.
They are organized in specific areas of opportunity
as outlined below:
A. Medicaid Eligibility
- For infants
- For children and adolescents ages 1-18
- For pregnant women
- For family planning services
- Presumptive eligibility
- Twelve-month continuous eligibility
B. Medicaid Enrollment Strategies
- Outreach, marketing and promotion
- Facilitating enrollment
C. Medicaid Coverage of Medical Services
- Early and Periodic Screening, Diagnostic and Treatment
Program (EPSDT)
- Enhanced prenatal services
- Family planning services
- Services for children with special health care
needs
- School-based services
D. Medicaid Reimbursement for Services
- Fee-for-service reimbursement
- Managed care
E. State Children's Health Insurance Program (SCHIP)
- Eligibility
- Outreach and promotion
- Coverage of medical services
Below is a brief discussion of each of these key areas:
A. Medicaid Eligibility
Medicaid Eligibility for Infants: Federal
law requires Medicaid coverage for children in "poverty-level"
categories. Eligibility requirements vary with the age
of the child. For infants from birth to their first
birthday, all State Medicaid programs must set eligibility
at or above 133% of the Federal Poverty Level (FPL).
(For a family of three for the year 2000, 133% of the
FPL is $18,819.) As of October 1999 all but one State
had expanded eligibility for infants above the 133%
level under Medicaid or the State Children's Health
Insurance Program, including 42 States that set eligibility
for infants at 185% of the FPL or higher.
Medicaid Eligibility for Children Ages One to
18: Federal law requires that States cover children
ages one to six at 133% of the FPL. For children age
six and above, Federal law specifies eligibility at
100% of the FPL for children born after September 30,
1983. This provision will fully phase in eligibility
at 100% of the FPL for children to their 19th birthday
in the Year 2002.
States have the option to phase in older children at
100% of the poverty level more quickly, or to set eligibility
at levels higher than 100%. Many States have done so.
Under Section 1902(r)(2) or Section 1931 of the Social
Security Act, a State can expand eligibility to the
level it might choose. A few States have expanded eligibility
under Medicaid to 275% or 300% of the FPL using this
approach. Other States are using their State Children's
Health Insurance Program as the vehicle to expand coverage
for children to these levels.
Eligibility for Pregnant Women: Medicaid
has special eligibility rules for women who are pregnant.
The objective is to provide a source of payment that
will encourage prenatal care and lead to improved pregnancy
outcomes. Federal law requires Medicaid to cover women
who are pregnant and for 60 days following delivery
in households with income up to 133% of the FPL. States
are allowed to increase eligibility levels to 185% of
the FPL (and above 185% under Section 1902(r)(2).) Three-fourths
of the States have gone above 133% of the FPL, including
ten that have eligibility at or above 200% of the FPL.
Family Planning Waivers: A special waiver
is available to States under Section 1115 that allows
limited Medicaid eligibility specifically for family
planning services only. These waivers are directed at
the issue of unplanned pregnancies and spacing of births.
Usually, these waivers allow Medicaid to continue to
cover family planning services after Medicaid has covered
the birth of a child since pregnancy-related Medicaid
coverage ends 60 days following the delivery. Beyond
this 60-day pregnancy-related eligibility, these waivers
have enabled States to extend family planning eligibility
for 10 months to two years.
Presumptive Eligibility: To encourage
prenatal care without any delay relating to ability
to pay, Medicaid coverage can be established immediately
by a provider under "presumptive eligibility."
A provider can then provide services and Medicaid will
pay for pregnancy-related services provided that day.
Application forms can be completed that day or later.
Similarly, a State can allow presumptive eligibility
for children. This allows the provider to make a preliminary
determination of Medicaid eligibility based on information
immediately available. The provider can then provide
services and these services are eligible for Medicaid
payment without regard to the outcome of the formal
eligibility determination process.
Twelve-month Continuous Enrollment: A
State has the option to enroll children for 12-month
periods of time, instead on a month-to-month basis with
requirements for monthly reporting of income and resources.
Adopting this policy addresses the problem of discontinuity
of care caused by interruptions in Medicaid eligibility.
Without a policy for continuous eligibility, a child's
enrollment is often characterized by a pattern of being
on-and-off-Medicaid due to small changes in household
income. With continuous enrollment, Medicaid eligibility
is determined for an annual period, and coverage continues
without regard to changes that occur from month to month.
This policy provides more secure coverage and simplifies
the process for both beneficiaries and the State agency.
B. Medicaid Enrollment Strategies
Medicaid can only pay for health care services for
persons who are actually enrolled in Medicaid. Many
eligible persons are not enrolled because they do not
know about the program or do not know they may be eligible.
Sometimes persons do not attempt to enroll because they
do not want to deal with a process they perceive as
a hassle or the stigma they associate with the program.
The Personal Responsibility and Work Opportunity Reconciliation
Act of 1996 (PRWORA), PL 104-193, ended the automatic
eligibility link between Medicaid and welfare. Eligibility
for Medicaid is now distinct from eligibility for welfare,
and the eligibility determination process may also be
separate. It is now quite likely that a person on Medicaid
will not be on welfare. (In fact, Medicaid enrollees
not on welfare outnumber those on welfare.) Another
change in Medicaid involved a new definition for determining
Supplemental Security Income (SSI) eligibility for children
with disabilities. Implementing the new rules created
confusion for a time in many States. As a result, some
eligible children and adults lost Medicaid coverage
even though they remained eligible. States are now adopting
strategies to find and enroll these eligibles.[2]
Strategies that increase the likelihood of enrollment
are those that provide easily understood information,
mainstream the program and streamline the process.
Outreach, marketing and promotion to encourage
enrollment of eligible adults and children:
Successful strategies include outreach, marketing and
promotion through the use of radio and TV public service
announcements, simplified forms and procedures, and
assisting persons in applying for Medicaid. These efforts
are particularly important to find and enroll eligible
uninsured children and pregnant women and can be carried
out in conjunction with, or by, State Title V Maternal
and Child Health offices.
Facilitating enrollment of eligible children
and pregnant women: The key to enrollment seems
to be a proactive strategy to locate persons who may
be without any health coverage and possibly eligible
for Medicaid or SCHIP, providing them good information
and making the enrollment process as easy as possible.
These approaches are important both for enrolling pregnant
women and for the parents to enroll their children.
As mentioned above, these activities are generally most
successful when carried out in conjunction with State
Title V Offices. This joint work is supported
not only by the U.S. Department of Health and Human
Services, but by Congress through its mandates in the
Title V law. In addition to this Medicaid and Title
V collaboration, research has shown the following strategies
to be effective for outreach, information dissemination,
and simplifying the application and enrollment process:[3]
1. Providing information and outreach: Good
information about Medicaid eligibility and coverage
is often hard to find for parents and pregnant women.
A well-developed comprehensive strategy can locate
persons who might be eligible, can provide information
and application forms to persons at a time they need
and want them, and as necessary can assist throughout
the application and enrollment process.
2. Allowing enrollment by mail or phone: This
significantly reduces the hassle for the applicant,
because it allows an application to be completed and
submitted without the need to take time off from work,
to negotiate a public transportation system, or to
spend time in a noisy waiting room.
3. Using "outstationed eligibility workers":
These workers are stationed in hospitals and clinics
to assist with the Medicaid application. Eligibility
workers can be located in hospitals and Federally
Qualified Health Centers (FQHCs), and the costs associated
with these workers will qualify for the Medicaid administrative
costs (Generally, the Federal match is 50% for administrative
costs). In some States, the hospital or health center
is required to cover the non-Federal share of the
costs. Providers have found these eligibility workers
are able to provide authoritative information, and
speed the eligibility process by initiating the application
and determining eligibility on-site.
4. Extending office hours: Extended hours
for people to apply for enrollment supports agency
efforts to encourage self-sufficiency and independence.
Early morning, evening and weekend hours allow access
to those who otherwise might have to take time away
from a job or school.
5. Improving treatment of applicants at enrollment
centers: Applicants are more encouraged to follow
through on their application for Medicaid when they
perceive they are treated with respect and dignity.
Improving the way applicants feel about how they are
treated increases the likelihood that they will follow
through and successfully complete the application
process.
6. Allowing enrollment at clinics or doctors'
offices: A logical place for enrollment for Medicaid
coverage is at the moment the uninsured child or pregnant
woman seeks a service from a health care provider.
When coupled with presumptive eligibility, Medicaid
can cover services provided that day.
7. Allowing enrollment at schools or day care
centers: In many school districts, large numbers
of children are uninsured and eligible for Medicaid.
Schools can provide information about Medicaid and
how to apply, and can facilitate the enrollment process.
Medicaid enrollment may financially benefit the school
when the school is a provider of health care services
that Medicaid covers.
8. Using a toll-free information and enrollment
telephone line: A toll-free telephone service
is an effective means of communicating information
and answering questions about Medicaid and State Children's
Health Insurance Program (SCHIP). All States have
a 24-hour, Title V telephone hotline that is required
to provide information on enrolling in Medicaid and
SCHIP. Some States have found it is useful to have
extended hours, including weekends. Many Medicaid
and SCHIP programs, or their enrollment brokers, also
have toll-free hotlines and have found it useful to
have extended hours, including weekends. This allows
interested persons to access information or even initiate
an application over the phone or during a time that
does not interfere with work or school.
9. Simplifying the enrollment form: The traditional
Medicaid application form is long and complex. States
have found they can simplify and shorten the application
form, and still obtain the information necessary to
determine eligibility.
10. Minimizing the documentation needed to apply:
It is sometimes difficult and time-consuming to locate
all the documents that prove identity, income and
resources. A review of what is really necessary can
minimize the requirements and improve the chances
an eligible person will follow through and complete
the application process.
11. Simplifying eligibility policies: Key
policy options that simplify eligibility criteria
include the following:
a) Dropping the assets test for children and
pregnant women: Eligibility can be based only
on household income, without regard to the value
of other resources. This policy simplifies the eligibility
determination process for both the State agency
and for the applicant.
b) Dropping requests for social security numbers
from members of the household who are not applying
for coverage: Some states have a policy of requesting
the social security numbers of all members of the
applicant's household even though all members of
the household are not applying for coverage. A State
can decide to request the social security numbers
of only the members in the household who are applying
for coverage.
c) Adopting presumptive eligibility: Presumptive
eligibility allows immediate enrollment and coverage.
Presumptive eligibility allows a provider who is
certified to do so to make an immediate, preliminary
determination that Medicaid eligibility requirements
are met. A State can decide that proof of income
or resources is not required for the presumptive
determination of eligibility. The child or pregnant
woman can be enrolled, and the provider can provide
treatment immediately with assurance that services
are eligible for Medicaid payment, even if the applicant
is later determined to be ineligible. The official
application forms can be completed and submitted
later.
d) Allowing the application to be mailed:
The application can be accepted by mail without
the applicant appearing in person.
e) Providing continuous 12-month enrollment:
A State can decide to enroll a child for a 12-month
period, without regard to any changes in household
income that may occur during this time. Without
this policy, a State must deal monthly with any
changes in income, and even small changes may result
in loss of eligibility and disenrollment from Medicaid.
Continuous enrollment prevents the churning of periodic
dis-enrollment and re-enrollment that often occurs
when the enrollee (or the enrollee's parent) is
required to report income each month. With continuous
enrollment, patients are more likely to have continuity
of care, and providers are more likely to accept
Medicaid patients because there is greater certainty
of coverage and payment.
f) Adopting common application forms and policies
for both Medicaid and the State Children's Health
Insurance Program (SCHIP): A State can facilitate
coordination between Medicaid and SCHIP by using
common forms and adopting common policies on issues,
such as treatment of income and resources, use of
twelve-month continuous enrollment, documentation
requirements, and coverage of benefits. By Federal
law, a child eligible for Medicaid cannot be enrolled
in SCHIP. It is useful to make the transition from
one program to the other as seamless as possible
because a change in the number of persons in the
household or even a small change in income can make
a child eligible for one program and ineligible
for the other.
g) Making the program like mainstream health
insurance: As States find ways to encourage
eligible persons to enroll in Medicaid and SCHIP,
they have found a key part of the strategy is to
model the programs after mainstream health insurance
coverage. This strategy is often reflected in the
name and the program, the terminology applied to
program procedures, the manner in which applicants
and beneficiaries are treated, and the ease with
which persons are able to enroll and re-enroll.
For example, some States have renamed their Medicaid
and SCHIP programs so the word Medicaid is not used.
Information is available in hundreds of locations,
and enrollment can be accomplished in dozens of
ways. Public service announcements and paid advertising
portray a mainstream image and emphasize the importance
of enrolling in health coverage. The program terminology
is changed so that people are "beneficiaries"
instead of clients or recipients, they are "approved
for coverage" instead of determined eligible;
or they are "re-enrolled" or "re-newed"
instead of redetermined.
C. Medicaid Coverage of Medical Services
In general, Medicaid coverage is comprehensive. Certain
services available under Medicaid are of particular
importance for children and pregnant women. State Medicaid
offices can work with Title V offices to help assure
that health care providers are available in areas where
there is a shortage of providers who are willing to
accept Medicaid patients and reimbursement.
Early and Periodic Screening, Diagnostic and
Treatment Program (EPSDT): EPSDT is a specific
program under Medicaid that provides well-child and
comprehensive pediatric care for children and adolescents
up to age 20. EPSDT requires comprehensive coverage
of physical and mental health, growth and developmental
assessments, including lab and other diagnostic tests,
immunizations, health education and anticipatory guidance.
Screening exams are covered on a clinically-sound periodicity
schedule specific for each age group or as needed at
any age. EPSDT also requires coverage of any medically
necessary service reimbursable under Medicaid for the
treatment of a condition identified under a periodic
or an "as needed" health exam, even if the
service is not otherwise a covered benefit in that State.
Under EPSDT, States specifically must cover hearing,
vision and dental services for children and adolescents,
even if Medicaid does not cover those services for adults.
Also covered are transportation and scheduling assistance
related to EPSDT screening, diagnosis or treatment.
Immunizations: All childhood vaccinations are
covered under EPSDT and Medicaid. Providers obtain the
vaccines under the Vaccines for Children (VFC) program.
Lead Screening: Under EPSDT, specific testing
for lead is a covered service, as are certain remedial
services necessary to remedy a problem with lead in
a child's home.[4]
Dental: EPSDT requires coverage for children
and adolescents of any necessary dental service reimbursable
under Medicaid for the treatment of a condition identified
under a periodic or "as needed" exam, even
if the service is not otherwise a covered benefit in
that State.
Services for children with special health care
needs: Medicaid can play an important role in
paying for portions of the required medical coverage
for children with special health care needs; many of
whom are enrolled in the Title V Program. Cooperation
between State Medicaid and Title V Programs can enhance
the coordination and case management of sources, result
in better care, and provide a financial resource for
specialty and primary care.
It is important to ensure that children served by Title
V programs are enrolled in Medicaid when they are eligible
to do so. Medicaid is a key source of funding for most
medically necessary services for children with special
health care needs for conditions identified through
an EPSDT screening. Medicaid is especially important
for the coverage of services, such as durable medical
equipment, medical supplies and prescription drugs.
Also important are home- and community-based services
that Medicaid programs can pay for in States with specific
"waiver" programs for the developmentally
disabled.
School-based health services: Providing
health services in schools can be an effective way to
ensure that children receive needed preventive and primary
care services. Medicaid is able to pay for covered services
furnished to children enrolled in Medicaid. Medicaid
policy may need to address the relationship of school-based
services to managed care when the children with Medicaid
coverage are enrolled in a health plan.
Health services related to special education as provided
under the Individuals with Disabilities Education Act
(IDEA) are reimbursable if they are a covered service
under Medicaid. Early intervention programs and school
districts may enroll as Medicaid providers, and receive
payment for covered services for eligible children.
Services usually covered include therapies, case management,
transportation, screening and evaluation, health education
and other services that may fall under EPSDT.
Medicaid funding is also available for administrative
expenditures that support the administration of Medicaid.
Reimbursable activities might include: Medicaid outreach;
information and referral; coordination and monitoring
of health services; or eligibility intake.[5]
Note: The Office of the Inspector General and
CMS found in recent audits that some States claimed
Federal funds for services in schools that were not
covered or for children not enrolled in Medicaid. These
claims related both to medical services and administrative
activities. Extra care is needed to be sure Medicaid
funding is claimed only for services that are covered,
and for children who are eligible and enrolled. For
more information on appropriate reimbursement for school-based
health services under Medicaid, CMS provided guidance
in the May 21, 1999 State Medicaid Directors letter.[6]
Enhanced prenatal services: Medicaid
is able to cover services that identify high-risk pregnancies
and improve the likelihood of good pregnancy outcomes.
These services may not be medical services. Typical
services covered include: a) risk assessment; b) case
management; c) health education; d) nutritional counseling;
e) psychosocial counseling; f) home visits; and g) transportation.
A key issue is how these services are covered under
Medicaid managed care programs. (See managed care section
below.) These services may be part of the managed care
contract, or they may be carved out of managed care
and paid separately by Medicaid.
Family planning services: All Medicaid
programs are required to cover family planning services
and supplies. Because family planning services qualify
for a 90% federal matching rate, Medicaid programs require
specific procedure codes to ensure that these services
are properly identified for the special Federal matching
rate.
D. Medicaid Reimbursement for Services
Fee-for-service reimbursement for medical providers:
A provider's participation in Medicaid is voluntary.
Providers who do decide to participate in Medicaid must
agree to accept Medicaid payment as payment in full.
As a result, payment rates are a key factor in the number
of medical providers who are willing to accept Medicaid
patients. In many States, low payment rates discourage
provider participation in Medicaid. Each Medicaid program
is able to set its rates at the level it chooses, within
the amount of money appropriated by the legislature.
Services for children, adolescents and pregnant women
are of high priority, and often merit special attention
in Medicaid rate setting.
Services provided by public providers, including local
health departments and community mental health clinics
can qualify for reimbursement from Medicaid that is
related to the actual cost of providing each service.
Federal law requires States to pay Federally Qualified
Health Centers (FQHCs) at least 95% of reasonable costs
in Fiscal Years (FY) 2001 and 2002, 90% in FY 2003 and
85% in FY 2004, but allows Federal Medicaid matching
funds on payments up to 100% of costs.
Disproportionate Share Hospital (DSH) payments:
Federal law allows States to make special payments to
hospitals that serve a disproportionate share of patients
who are uninsured or on Medicaid. These payments have
become a significant source of funding for children's
hospitals, and other public and teaching hospitals that
often are the major provider of care for children and
women who are pregnant. The State has the ability to
define the criteria for qualifying for these funds,
and to define the total amount. DSH payments are now
about ten percent of the total of all Medicaid payments.
Managed care: Medicaid managed care may
be provided through health plans or through a primary
care case management (PCCM) system. Health plans are
paid a capitated amount per person per month, and are
responsible to pay providers for all services included
in the capitated payment. This is another area in which
State Medicaid and Title V cooperation can enhance the
health care received by perinatal women and children.
A provider (such as a health department) will need to
be enrolled with a health plan to be eligible to receive
payment for services to Medicaid beneficiaries in the
health plan. It is the health plan that decides whether
to contract with any provider, including a health department,
and the amount of payment it will make to providers
in its network. However, a Medicaid agency has discretion
to require in its contract with participating health
plans that certain providers must be included in the
network and how they are to be paid.
A Medicaid program has the option to decide which services
are included in the capitation payment; and therefore,
must be billed to the plan instead of to Medicaid. If
certain services are "carved out" of the capitation
payment, they may be billed directly to Medicaid, without
seeking authorization from the health plan. Services
sometimes carved out include EPSDT screenings for children,
services provided by schools or prenatal care for pregnant
women.
Under a PCCM program, a Medicaid beneficiary selects
or is assigned a primary care provider, who is responsible
for primary care and referrals to specialists. Medicaid
authorization may be required from the primary care
provider in order for services to be paid by Medicaid.
However, a Medicaid program can decide whether prior
authorization is needed for selected services.
E. State Children's Health Insurance Program (SCHIP)
Since enactment of Title XXI in 1997, States have focused
on implementing their SCHIP programs and enrolling eligible
children and adolescents. In the year from December
1998 to December 1999, enrollment in SCHIP programs
more than doubled, from about 0.8 million to 1.8 million.
An estimated 2.6 million children and adolescents are
eligible for SCHIP nationally.[7]
Many States have found that SCHIP outreach and enrollment
has a Medicaid case-finding effect, with one or more
children enrolled in Medicaid for every child enrolled
in SCHIP. Children who are eligible for Medicaid (whether
they are enrolled or not) are by law not eligible to
enroll in SCHIP.
A State can implement SCHIP as a Medicaid expansion,
or as a separate program based in the private health
insurance market, or it can implement both. In its design
and public appearance, a Medicaid expansion SCHIP program
is often indistinguishable from Medicaid (although the
SCHIP program qualifies for a higher rate of Federal
matching funds than Medicaid). A separate SCHIP program
may be based on private health insurance coverage, and
unlike Medicaid, have a nominal premium, copayments
for services for children and adolescents, and limits
on benefits.
SCHIP Eligibility: SCHIP has provided an excellent
opportunity to expand access to needed health care
for children. Enrolling children and adolescents in
SCHIP provides significant coverage that can bridge
the gap between Medicaid and private employer-sponsored
health insurance.
States can also choose to cover the adults associated
with SCHIP-covered children. A number of States now
provide "family coverage" by covering adults
under Medicaid, as an extension of their coverage
for children enrolled in SCHIP or Medicaid. CMS has
announced on July 31, 2000 that it will now consider
waivers to include coverage of parents of children
or adolescents enrolled in SCHIP.
SCHIP Outreach and Promotion: Expenditures
to market SCHIP, and to find and enroll children are
eligible for Federal SCHIP matching funds. States
have often found that their marketing efforts for
SCHIP have served to encourage eligible children to
apply for health coverage. Many children are found
to be eligible for Medicaid, as well as SCHIP.
Conclusion
This document provides an overview of the potential
for State and local health programs to use Medicaid
as a source of financing, with a focus on maternal and
child health services. Medicaid has become a significant
source of funding for almost every health-related service
in the U.S. for low-income persons. However, Medicaid
has an especially important role in financing medical
care for women, children and adolescents. Medicaid funding
of these services has increased significantly over the
past decade. New opportunities for Medicaid to support
such services will continue to emerge. A periodic review
is useful to identify new ways for a State to take advantage
of Medicaid as a source of funding to help finance these
services.
Other Opportunities to Use Medicaid
In addition to maternal and child health services,
Medicaid is also a potential source of financing for
a number of other State or local health programs. Specific
areas where Medicaid can be a source of funding include
oral health services, rural health services, services
for persons living with HIV/AIDS, and mental health
and substance abuse services.
Contact for More Information
If you have questions or wish to obtain additional
information on implementation strategies, contact HRSA
at:
Alexander Ross
U.S. Department of Health and Human Services
Health Resources and Services Administration
Health Systems and Financing Group
5600 Fishers Lane, Room 10-29
Rockville, Maryland 20857
Phone: 301-443-1512
Fax: 301-443-5641
E-mail: aross@hrsa.gov
For copies of this document, contact:
HRSA Information Center
P.O. Box 2910
Merrifield, VA 22116
Phone: 1-888-Ask-HRSA
Fax: 703-821-2098
TTY: 877-4TY-HRSA
Se Habla Espanol
OR
Visit the HRSA web site at: www.hrsa.gov/medicaidprimer
For more information about maximizing partnerships
with Medicaid, visit the Website of the Association
of Maternal and Child Health Programs at www.amchp.org
(not a Government Web Site)
This document was prepared by Health
Management Associates under a contract with HRSA.
Footnotes:
[2] CMS issued a directive
to State Medicaid Directors dated April 7, 2000 to ensure
that Medicaid eligibility is determined for those who
leave welfare. See CMS Website at www.cms.gov
[3] Medicaid Survey on
Barriers to Medicaid Enrollment, Kaiser Commission
on Medicaid and the Uninsured, 1999.
[4] CMS guidance to State
Medicaid Directors on August 22, 1999 indicated "any
follow-up services, including diagnostic or treatment
services determined to be medically necessary that are
within the scope of the Federal Medicaid statute, should
also be provided. This would include both case management
services and the one-time investigation to determine
the source of lead for children diagnosed with elevated
blood levels."
[5] Detailed requirements
are found in CMS, "Medicaid and School Health:
A Technical Assistance Guide." August 1997.
[6] CMS issued a letter to
State Medicaid Directors dated May 21, 1999, which provided
guidance on reimbursement for school-based health services
under Medicaid. See CMS Website at www.cms.gov/medicaid
[7] "CHIP Program Enrollment:
December 1998 to December 1999," Kaiser Commission
on Medicaid and the Uninsured. July 2000. Publication
2195.
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