The child health portion of Medicaid is the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program for children. It was created to fulfill pediatric care standards and meet the needs of low-income children in aspects of physical, emotional, and developmental needs. The program has been in effect since 1967 in order to find issues, and mitigate problems in children that cannot afford proper health care.
Federal statutes, guidelines, regulations, and laws all cover many aspects of what Medicaid is required to cover for children. These benefits are different than they are for adults. 1 in 3 children five years old and under are eligible for Medicaid services and therefore is very important to make sure that these children receive the proper physical, and mental health as well as developmental services via EPSDT .
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There are five essential elements of the EPSDT programs. Problems associated with health and development should be identified early, as soon as birth if evident. Health checks should be done periodically and at age-appropriate intervals in order to detect and intervene before problems get out of hand. Screenings and tests should be performed for physical, mental, developmental, hearing, dental, and vision issues. Diagnostic tests should be performed when a risk is found. Problems that are found need to be treated .
EPSDT was designed to make sure that all services necessary for a healthy life are available to children whose families cannot afford their own health coverage. EPSDT even helps parents make appointments and assists with transportation to and from these appointments. The program ensures that required health care is available and accessible as well as helping patients and their parents appropriately use the services .
The Social Security Act includes Title V, which was enacted in 1935. This legislation verifies that all women and children have access to health services. The act works in conjunction with EPSDT. Together they require that each state has a written MCH-Medicaid agreement which includes services supported by Title V and of course, aims to improve the status of childhood health. Providers of Title V services must be paid, even if services were free to low-income, uninsured families .
The Deficit Reduction Act of 2005 allowed states the ability to modify how Medicaid services are delivered to children which permits them to create the best services available for their own demographic . The New York State program is called the Child Teen Health Program (CTHP) .
Beyond the standards set forward by EPSDT, New York State has developed individual programs that support the particular needs of the population. The State Newborn Screening Program requires that babies are tested at birth for particular issues. The screening includes testing for certain inherited metabolic conditions, hemoglobinopathies such as sickle cell disease, congenital hypothyroidism and HIV .
The State Newborn Hearing Screening Program requires that all hospital develop a hearing screening protocol for all newborns. Most hospitals do have in-house screening services while others have relationships with outside screeners and a follow up plan in place for those who need additional services after testing .
The state’s Immunization Program includes a recommended schedule for childhood immunization. The plan includes 17 different vaccines for both children and adults including those protecting against mumps, polio, shingles, measles, and more. The law requires that children either be vaccinated against meningococcal meningitis or the parents must sign a waiver indicating their understanding of the risks of doing so .
Another additional feature of New York State’s CTHP is the Lead Poisoning Prevention Program. A blood test at 1 to 2 years old will determine if the child has been exposed to excess lead. The risk assessment tool is also available to health care providers to assist in determining if further testing should be required .
While CTHP in New York State does include education for the patient and its guardians regarding health, there is no sexual education. Sexual behavior and education is an important topic for adolescence. A lack of knowledge can be associated with sexually transmitted infections and pregnancy. As lower income people are also the most likely to be less educated, it is important to add these services to New York State’s EPSDT program. Research indicates that teens who receive sexual education are 50% less likely to become pregnant than those who are taught via abstinence only programs. Of 48 programs studied, two-thirds had positive effects on its students. 40% of the studies helped to delay sexual initiation, reduce the quantity of partners, or increased the use of condoms or another contraceptive. 30% of the programs reduced how often the participants were having sex, some even regained abstinence. 60% of the programs reduced the amount of unprotected sex. Overall sexual education creates a positive outcome for the adolescents participating the in the program and should be included in New York State’s CTHP .
The EPSDT and Title 5 work in conjunction with each state’s Medicaid program to make sure children and teens have access to the health services they need even if they cannot afford them. The programs aim to identify problems early, include periodic checkups, screen for ailments, diagnose, and treat the problems. New York State continues this sentiment with a specific program for its citizens.
- Advocates for Youth. (2009, September). Comprehensive Sex Education: Research and Results . Retrieved from Advocates for Youth: http://www.advocatesforyouth.org/publications/1487
- The New York State Department of Health Office of Medicaid Management. (2005). EPSDT/CTHP Provider Manaul for Child Health Plus A (Medicaid). Albany: The New York State Department of Health Office of Medicaid Management.
- U.S. Department of Health and Human Services. (2014). Health Resources and Services Administration Maternal and Child Health. Retrieved from U.S. Department of Health and Human Services: http://mchb.hrsa.gov/epsdt/epsdttitlev.html
