Lessons from CA: Ensuring Medi-Cal Plans Provide Services to Children

Executive Summary

In this month’s Lessons from California, we highlight how NHeLP worked to ensure that California’s Medi-Cal managed care plans provide medically necessary services to children, even when those children might be able to receive some of these services from another entity. As a result of NHeLP’s advocacy, California released new guidance that explains the obligation of Medi-Cal managed care plans to comply with the federal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) requirement, which mandates that states provide a wide array of services to Medicaid recipients under age 21, and prohibits states from delaying or denying services based on the theoretical or partial availability of these services from other entities.