Survey of Medicaid Managed Care Contracts: EPSDT Vision and Hearing Services

Executive Summary

An estimated 25 percent of all school children in the United States have some type of vision problem significant enough to affect daily life and school performance. Similarly, despite the proliferation of hospital-based newborn hearing screening programs, a significant number of children with possible hearing loss are not receiving prompt diagnosis and treatment. Children enrolled in Medicaid are entitled to a comprehensive array of preventive and ameliorative care through the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit. As states have increasingly turned to managed care entities (MCEs) to fulfill their Medicaid administration obligations, these companies are charged with affirmative duties to ensure children receive EPSDT benefits. This report surveys the contracts governing states’ relationships with MCEs to document the extent to which the contracts address children’s hearing and vision services and how these services are monitored.