EPSDT is designed not only to finance health care for children but also to assure that children receive appropriate, quality services to improve their health. As described in federal program rules: “The EPSDT program consists of two, mutually supportive, operational components: (1) assuring the availability and accessibility or required health care resources; and (2) helping Medicaid recipients and their parents or guardians effectively use them."
Within broad federal guidelines, states have flexibility to design an EPSDT program that fits with their Medicaid, public health, and medical care systems. Informing and support services are specifically described in the federal EPSDT rules.
For INFORMING, states are required to:
For SUPPORT SERVICES, states are required to:
Under federal EPSDT rules, state Medicaid Agencies are required to inform all Medicaid eligible children under age 21 and their families about EPSDT on a timely basis, using effective methods of communication and clear, non-technical language in informing families.
Title V agencies – both the federal Maternal and Child Health Bureau and the state agencies that receive block grant funding – have a strong commitment promoting to family-centered, community-based, culturally competent systems of care. By promoting this approach for EPSDT, Title V agencies can help Medicaid agencies better fulfill their responsibilities to provide outreach and information to families.
Links to More Information
The following links will take you to examples of EPSDT information and promotional materials used across the country.
Title V program leaders often create or fund care coordination. While there is no specific “care coordination” category under Medicaid, some Title V care coordination may qualify for reimbursement as case management.
Medicaid describes case management as “an activity under which responsibilities for locating, coordinating and monitoring necessary and appropriate services for a recipient rests with a specific individual or organization.” [State Medicaid Manual Part 4, Section 4302; Part 5, Section 5310(D)]
Under this general definition, Medicaid has several types of case management.