NHeLP EPSDT Letter to California Department of Health Services

Executive Summary

This letter urges California’s Medicaid Agency to take action to instruct Medicaid Managed Care plans that they are required under state and federal law to provide services mandated by EPSDT to enrollees under 21. NHeLP and its partners become aware that several plans were refusing to cover certain services for children under age 21 enrolled in Medi-Cal because they claimed that the schools, and not Medi-Cal, were primarily responsible to provide these children with needed services. We suggested to California that guidance was necessary to both clarify the plans’ responsibility for providing needed services to members,  and to clarify the state’s policy.