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States’
Obligations to Assist Families |
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:
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Inform all Medicaid eligible children under
age 21 and their families about EPSDT on a
timely basis (i.e., within 60 days of enrollment).
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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.
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Inform Medicaid eligible pregnant women about
EPSDT, as well as adoptive and foster care
parents of eligible children.
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For
SUPPORT SERVICES, states are required to: |
- 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.
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Provide transportation and scheduling assistance
for screening and diagnostic and treatment
services.
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Specify in the state plan the state’s
responsibility for transportation assistance
and describe the methods to use.
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Example
of how Nevada uses its website to offer information
to families.
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Informing
and Involving Families Top |
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. |
Links
to More Information |
The
following links will take you to examples of EPSDT
information and promotional materials used across
the country. |
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Case
Management in Medicaid and EPSDT Top |
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%.
- 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.
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