On September 26, 2024, the Centers for Medicare & Medicaid Services (CMS), the federal agency that oversees Medicaid, sent a letter to all state Medicaid directors titled “Best Practices for Adhering to Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Requirements.” EPSDT is children’s Medicaid, which pays for more services than Medicaid for adults. The whole idea of EPSDT is to aggressively intervene so that children can get on and stay on the right developmental track.
The letter is 57 pages long and covers many important topics. This slide show gives an overview of the letter, and we encourage you to review it yourself. Still, we want to share the themes we at Families as Allies have pulled out of it so far (in these points, Medicaid refers to the state Medicaid authority, which in Mississippi is the Mississippi Division of Medicaid).
- Medicaid should inform families about the range of Medicaid services available to children.
- Medicaid should help families understand and access transportation services.
- Medicaid should ensure the right kinds of providers offer high-quality care coordination to children and families, possibly by using nontraditional providers, such as peer supporters and community health workers.
- Managed-care organizations and Medicaid cannot use prior authorization to delay children’s access to the treatment they need. (Prior authorization means the managed care organization has to say it’s OK for a service provider to give a service to a child before the child can receive it.)
- Managed care organizations and Medicaid cannot limit the amount of services children receive in the same way they sometimes limit adult services.
- Medicaid’s job is to ensure that the people who work for Medicaid and the people who treat children on Medicaid understand and follow the rules regarding children’s Medicaid.
- Medicaid’s contracts with managed care organizations should require them to individualize services to what children need, have enough providers and ensure that those providers are helping the children they see.
- Medicaid should maximize the use of telehealth, including paying specialists to help primary care providers learn how to treat children with some behavioral health conditions in their practices.
- Medicaid should use creative strategies to attract and pay qualified professionals.
- Medicaid should make sure it meets the needs of children with special healthcare needs by doing these things:
- Ensuring that there is a wide array of effective community-based services for mental health and substance use disorders, including limiting inpatient care unless necessary;
- Supporting primary care providers to treat children with mild-to-moderate behavioral health needs in their practices rather than referring them to outside mental health providers;
- Ensuring that there is a single point of entry into the system of care, and families know how to find it;
- Ensuring a seamless and coordinated system of care.
- Medicaid should make sure children in foster care and those leaving foster care receive high-quality services.
- Medicaid should improve services for children with special healthcare needs and disabilities and also help them with non-medical services. Medicaid should support their families with system navigation.
If you have questions or feedback about this letter for the Mississippi Division of Medicaid, you can use this General Inquiry Form to contact them by mail (550 High Street, Suite 1000, Jackson, MS 39201) or fax (601-359-6294).
We encourage you to watch the Division of Medicaid and Families as Allies websites for the next scheduled Medicaid Advisory Committee (MAC) and Beneficiary Advisory Council (BAG). These two groups advise the Division of Medicaid on its services and policies. The federal government requires that both groups include Medicaid beneficiaries. You can learn more about the MAC and BAG at Medicaid.gov.
