Medicaid’s Gold Standard Coverage for Children and Youth: Past, Present, and Future

Executive Summary

This article originally appeared in the “Loyola University Chicago School of Law: Annals of Health Law and Life Sciences.”

Since 1967, federal law has entitled low-income children and youth under age twenty-one to coverage of Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services through Medicaid. Designed specifically for these low-income children, EPSDT not only offers comprehensive screening services and a broad scope of treatment benefits but also incorporates care coordination services designed to ensure that children and families know about EPSDT and how to use it. Properly implemented, EPSDT is the gold standard coverage for children.

This article offers a comprehensive overview of the EPSDT benefit. After providing information about the various population groups entitled to EPSDT and a brief overview of the Medicaid program, we explain the driving forces behind EPSDT. Congress intended EPSDT to be implemented aggressively and has amended the law on multiple occasions to make that clear. Next, we discuss what EPSDT looks like today and how EPSDT performance can be measured by policy makers, health care providers, press, advocates, and other members of the public using publicly available data. Finally, we assess the future implementation of EPSDT. As we explain, in order to achieve its promise, EPSDT will need to embody twenty-first century standards of care. That is to say, ensuring up-to-date preventive screening services will not be enough. States will need to focus their attention on the nature and extent of diagnostic and treatment services.

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