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Policy Update EPSDT (Nov) PDF Print E-mail


Medicaid Well-Child Visits and Mental Health Checkups


EPSDT
The annual well-child checkup covered by Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit requires that an adolescent mental health assessment be offered during the visit.  However, evidence suggests that few states are including this portion of the visit, and rates of mental health screening for adolescent Medicaid enrollees appear to be well below the 39 percent of eligible patients who receive a well-child visit every year. A white paper from the TeenScreen National Center for Mental Health Checkups Adolescent Mental Health Checkups in Medicaid offers policy options at the Federal level to improve state practice.

Many obstacles contribute to a gap in screening practices. When adolescents do see their doctors, many receive incomplete or no mental health screening. Some states do not stipulate that wellness visits for adolescents occur annually, and not all states reimburse primary care providers for screening.  A prior survey of state Medicaid programs found that 23 states did not address mental health in their screening tools in any form, and just five states recommended the use of a standardized screening tool.

The report addresses these issues and outlines important recommendations at the federal level for the Center for Medicare and Medicaid Services (CMS) to improve rates of mental health screening. With more than one-third of U.S. children covered by the Medicaid program, positive changes toward wider implementation of screening have the potential to improve mental health outcomes for millions of adolescents. 

Massachusetts: Leading the Way in Adolescent Mental Health Checkups

Massachusetts has some of the most comprehensive requirements for the inclusion of mental health screenings in Medicaid well-child visits. Initial data gathered since the state’s wide-spread implementation of screening in the beginning of 2008 shows significant improvement in the rate of mental health checkups at well-child visits.

Massachusetts: Progress in Mental Health Screening Since Rosie D. EPSDT Decision


2008 Data Show Increased Rate for Screening at Well-Child Visits; Rate Climbs from 16 to 47 Percent

Massachusetts has some of the most comprehensive requirements for the inclusion of mental health screenings in Medicaid’s Early and Periodic Screening, Diagnostic and Treatment (EPSDT) well-child visits.  These requirements were a result of a 2006 decision in the Rosie D. lawsuit, in which the plaintiffs sued the state of Massachusetts for failure to provide timely diagnosis and treatment of mental health problems as required by federal Medicaid statutes.

In 2006, the Court found that Massachusetts had violated the Medicaid EPSDT provisions, and the state was required to implement a remedial plan, which the state began implementing in July of 2007.  This is the first instance of a court-ordered implementation of screening with mandated data collection and reporting to ensure enforcement.  The plan requires that mental health screenings be offered at all well-child visits going forward from the Dec. 31, 2007 start date.  

The state specified a list of eight evidence-based, standardized screening tools to be used in primary care settings and stipulated that this list of tools be appropriate for pediatric patients of all ages – infants to 21 years of age.

Screening data for 2008 showed a significant improvement in the rate of mental health screening at Medicaid well-child visits. The first year of implementation saw progressive increases in the overall screening rate each quarter, climbing from just 16 percent in the first quarter of 2008 to more than 47 percent in the final quarter of the year.  As provider education and member notices about the availability of developmental and mental health screenings at the well-child visit continue, this rate should continue to climb.  Private insurers across the state are also beginning to offer screening to their patients following the lead of the Medicaid system.

Massachusetts’ Remedial Plan for Mental Screening and Services includes five main components:
  1. All Medicaid recipients are to be notified of the availability of mental health screening and other services.
  2. Mental health screening using a standardized tool is to be offered at all Medicaid well-child visits.
  3. Children screening positive are referred for a mental health assessment.
  4. Children diagnosed with a serious emotional disturbance are to be offered Intensive Care Coordination and Treatment.
  5. Community Service Agencies will coordinate home-based care.