Meeting the Moment: Understanding EPSDT and Improving Implementation in California to Address Growing Mental Health Needs

Executive Summary

Children and youth across the country are facing an escalating mental health crisis. The events of 2020 have added new and complex stressors, exacerbating mental health challenges while also creating new barriers to accessing care. Unmet mental health needs have grave consequences for individuals, their families, and entire communities. Now more than ever, it is crucial that we have robust, well-functioning systems in place to identify and respond to children’s needs early, effectively, and equitably.

Our “Meeting the Moment” paper is essential reading for anyone interested and engaged in supporting and protecting the health and welfare of children in California. This paper purposefully packs in a lot. It includes more than 150 source citations and fully and faithfully tracks the winding and inconsistent interpretation of the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) entitlement in California with a particular focus on the support for the social, emotional, and behavioral health of children in Medi-Cal.


One important component of this effort is ensuring that vulnerable children and youth receive the full array of services that they need and are legally entitled to under federal law. Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) benefit provides Medicaid-eligible children with a broad entitlement to mental health care. This includes a right to regular screening to identify needs and to receive services necessary to “correct or ameliorate” a child’s condition. When Congress enacted EPSDT more than a half-century ago, it recognized the unique needs of children and the importance of promoting children’s healthy development through this early identification and treatment of needs. States are tasked with carrying out this vision.

California operates the country’s largest Medicaid program, Medi-Cal. Medi-Cal provides a critical safety net to millions of children and families. But historically, California has struggled to fully implement the federal EPSDT entitlement to mental health care. A number of factors—including a complex, fragmented delivery system and the State’s misconstrued application of EPSDT requirements—have hampered progress. As a result, many children and youth are still not receiving the mental health screenings and services that they are owed.

While recognizing the need for a broader re-imagining of how we think about and deliver mental health care, we offer several recommendations for how California can move closer towards meeting the promise of EPSDT in the short term. These include recommendations aimed at ensuring that needs are identified and addressed as early as possible, consistent with the intent of EPSDT.

  • Require Medi-Cal Managed Care Plans to offer Adverse Childhood Experiences (ACEs) / trauma screenings to all enrolled children and youth, and to develop and implement treatment plans to address the needs identified through these screenings.
  • Conduct, and require Managed Care Plans to conduct, more robust outreach to inform families of children’s rights to EPSDT-covered screenings and services, and how to access them.
  • Implement clear, consistent processes for how children’s mental health needs are identified and addressed, and for improved data sharing, referral tracking, and robust case management across plans.
  • Clearly divide the scope of mental health services covered by plans to avoid overlaps that lead to coverage disputes and delays in care.
  • Implement a “no wrong door” approach to ensure children and youth receive all of the services they need, without delay, regardless of where they enter the system.
  • Eliminate requirements that children and youth must have a specific diagnosis, or any diagnosis, prior to accessing mental health services and supports that a provider deems medically necessary.

ABOUT NATIONAL HEALTH LAW PROGRAM

The National Health Law Program, founded in 1969, protects and advances health rights of low-income and underserved individuals and families. We advocate, educate and litigate at the federal and state levels to advance health and civil rights in the U.S. Learn more at www.healthlaw.org

ABOUT CALIFORNIA CHILDREN’S TRUST

The California Children’s Trust (The Trust) is a statewide initiative to reinvent our state’s approach to children’s social, emotional, and developmental health. We work to transform the administration, delivery, and financing of child-serving systems to ensure that they are equity driven and accountable for improved outcomes. The Trust regularly presents its Framework for Solutions and policy recommendations in statewide and national forums. Learn more at cachildrenstrust.org.

ABOUT NATIONAL CENTER FOR YOUTH LAW

The National Center for Youth Law (NCYL) advances justice through research, community collaboration, impact litigation, and policy advocacy that fundamentally transforms our nation’s approach to education, health, immigration, foster care, and youth justice. Our mission is to amplify youth power, dismantle racism and other structural inequities, and build just policies, practices, and culture in support of young people. Learn more at www.youthlaw.org.

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