Early and Periodic Screening, Diagnostic & Treatment (EPSDT)

Young female dentist examining kids teeth in dentist's office

Problem

Administration of EPSDT, a health benefit for low-income children in the U.S, varies widely by state.

EPSDT is a Medicaid health benefit for low-income children in the United States. Virtually all health care that is financed for low-income children is via EPSDT authority. Like the entire Medicaid program, EPSDT is regulated and overseen by the U.S. Centers for Medicare & Medicaid Services (CMS) and administered by the 50 states, Washington D.C., and territories (hereafter “states”), resulting in a wide range of EPSDT coverage, contractual designs, and data systems that impact screening, referral, and treatment rates.

The client aims to understand state availability, delivery, and provision of EPSDT services and develop strategies to increase and energize state compliance with federal EPSDT requirements.

Solution

NORC is supporting states’ delivery of EPSDT benefit services.

The purpose of this work is to assess and improve state availability and delivery of EPSDT benefit services.

Project analysis will be used to provide a broad range of stakeholders (Congress, states, federal partners, and others) with information on the current national landscape of Medicaid EPSDT services. In addition, they will be used to create more detailed case studies on key EPSDT areas of concern, showcase EPSDT behavioral health best practice examples, provide technical assistance to states, and develop a state EPSDT profile dashboard.

NORC is partnering with the Center for Health Care Strategies, RTI International, and the National Health Law Program on this project.

Result

The strategies developed will increase and energize state compliance with federal EPSDT requirements.

The fundamental goal of this work is to develop strategies to increase and energize state compliance with federal EPSDT requirements, which will ultimately improve the delivery of critical services to the nation’s most vulnerable children.

In 2023, NORC is working on summarizing findings from the environmental scan with CMS, developing plans for state-specific case studies, initiating technical assistance to states, and gathering findings for the Report to Congress.