Medicaid EPSDT Requirements
The Centers for Medicare & Medicaid Services (CMS) released guidance on Medicaid early and periodic screening, diagnostic, and treatment (EPSDT) requirements, as required by the Bipartisan Safer Communities Act. The guidance discusses policies, strategies, and best practices to maximize health care access and utilization by:
- Promoting EPSDT awareness and accessibility
- Expanding and using the child-focused workforce
- Improving care for EPSDT-eligible children with specialized needs
CMS highlights states’ best practices for expanding the EPSDT workforce within federal requirements. These include broadening provider qualifications, using telehealth, encouraging the use of interprofessional consultation, and using payment methodologies that incentivize EPSDT provider participation.
CMS recommends that states take steps to reduce administrative burden, such as streamlining provider enrollment and performing cost-benefit analyses of prior authorizations. CMS acknowledges that, without adequate payment rates, other steps to improve the workforce will be less effective.
Medicaid Expansion Report
The Assistant Secretary for Planning and Evaluation Office of Health Policy released a new issue brief, “Medicaid: The Health and Economic Benefits of Expanding Eligibility.” This brief examines the impact of Medicaid and highlights the importance of Medicaid coverage for low-income children and adults.
Highlights include:
- In March 2024, more than 76 million people, or more than 23 percent of the total population, were enrolled for comprehensive benefits in Medicaid.
- Medicaid has evolved from a program primarily covering parents and dependent children with incomes below the federal poverty level (FPL) to a program that extends eligibility to nearly every child and non-elderly adult in 40 states and the District of Columbia with incomes up to 138 percent or more of the FPL.
- In 2022, more than 31 percent of Latino, 34 percent of Black, and 38 percent of American Indian and Alaska Native individuals in the United States were enrolled in Medicaid.
- Medicaid and the Children’s Health Insurance Program cover about half of all children and more than 40 percent of all births, including a majority of Latino, Black, and American Indian and Alaska Native children and births.
- The Affordable Care Act’s expansion of Medicaid generated important health and economic benefits, including reduced mortality and improved financial well-being, for the adults newly gaining coverage.
Contact Director of Policy Rob Nelb, MPH, at rnelb@essentialhospitals.org or 202.585.0127 with questions.
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