Behavioral health conditions among children and adolescents are increasing, in 2022, suicide was the second leading cause of death among people aged 10-14. In 2023, the Centers for Disease Control and Prevention (CDC) reported that among high school students:

• 40% reported persistent feelings of sadness or hopelessness within the past year.
• 20% seriously considered attempting suicide within the past year.

Many children and adolescents are not receiving the treatment they need, access to timely, effective, and appropriate children’s behavioral health services remains a challenge in many states.

Medicaid is a key funding mechanism for meeting the behavioral health needs of children and youth. Early and Periodic Screening, Diagnostic, and Treatment (EPSTD) provides comprehensive care, including behavioral health care, for children under 21, enrolled in Medicaid.

Are you utilizing EPSDT effectively to meet the needs of young people? Public Consulting Group (PCG) presents a simple roadmap for expanding the use of EPSDT across your service array to better serve this population.

• Engage your Medicaid Partner

  Find the children’s behavioral health lead in the Medicaid agency and begin discussions about what services are needed. Partnering with your Medicaid agency is essential to success.

• Assess

  Assess the gaps in service and treatment for children and families. What are the unmet needs in the community and how can EPSDT meet those needs?

• Consider a Medicaid State Plan Amendment

  States may need to either update or submit new State Plan Amendments to the Centers for Medicare and Medicaid Services (CMS) to incorporate new services or modify existing services under EPSDT. This ensures that the state plan aligns with federal requirements and supports expanded services.

• Enhance Provider Networks

  Recruit and train providers to understand EPSDT requirements and best practices. Utilizing telehealth services can support provider shortages in underserved areas. Consider how additional provider types can become Medicaid providers.

• Increase Awareness and Outreach 

  Increase awareness and outreach by launching educational campaigns to inform both providers and families about the availability of EPSDT services. Enhance community partnerships with local agencies to increase awareness about available EPSDT services.

• Improve Care Coordination

  Establish or enhance care coordination programs to assist families with navigating the healthcare system and accessing services. Creating a single point of entry for EPSDT services reduces complexity for families.

• Expand Service Coverage

  Expand services to provide a comprehensive range of behavioral health services from early intervention through crisis management. Integration of EPSDT services into school-based services will allow for EPSDT services to reach more children.

• Update Funding Array

  Complete an assessment of your federal funding array to identify opportunities to leverage EPSDT in places where you may have been using local or state funds.

• Implement Claiming Processes

  Establish Medicaid billing rates for newly covered EPSDT services and create mechanisms for providers to bill for services that can be claimed to Medicaid. Utilize a third-party administrator to reduce complexity for providers.

• Monitor and Evaluate

  Conduct reviews to support compliance with EPSDT requirements and identify areas for improvement. Establish feedback mechanisms from providers, service beneficiaries and other stakeholders to allow for continuous quality improvement

Learn More

For more information on how EPSDT can be used to serve children and youth with behavioral health needs please see recent CMS and Administration for Children and Families (ACF) guidance.

To learn more about how PCG can help expand the use of EPSDT across your agency, contact us today!

kbright@pcgus.com